Shoulder X-ray Interpretation in 4 Steps

Shoulder X-rays Interpretation steps include:

• Step 1: assess Bones
• Step 2: assess Joints
• Step 3: assess Soft tissue
• Step 4: assess Ribs and Lungs

Step 1: assess Bones

• Trace the edges of the bones looking for cracks while assessing the bones in Shoulder X-rays interpretation
• Start with Humerus then clavicle, glenoid, coracoid, spine, acromion, scapula, subscapular fossa
• If you see the fracture then start with the fracture then look elsewhere
• Look at the general appearance of the bone looking for decrease or increase in density (osteopenia vs osteosclerosis) or abnormal trabeculation (Paget’s disease)
• Decrease in bone density in greater tuberosity of humerus is normal

Step 2: assess Joints

• Assess:
  • Glenohumeral joint
  • Acromioclavicular joint
  • Sternoclavicular joint
• Look for the shape of the joint, congruity of the bone ends and look for narrowing or asymmetry
• Glenohumeral joint: overlap between humeral head and glenoid with articular surfaces almost replicating each other
• Acromioclavicular joint
  • The inferior edge of the clavicle bone and inferior edge of the acromion should be leveled (on the same line) on clavicle AP view with 20 degree cephalic tilt
  • It is okay if the superior edges don’t match up
  • The joint space should be uniform and joint distance less than 8 mm (normal 5-8 mm)
  • Normal Coracoclavicular distance is between 11- 13mm and there should be no greater than 5mm difference between right and left
• Sternoclavicular joint also checked if you can see it

Step 3: assess Soft tissue

• Soft tissue refers to all soft tissues except lungs
• Look for changes in density, abnormal bulges or any obvious secondary signs of trauma
• Higher density soft tissues are muscles while lower density soft tissues are fat

Step 4: assess Ribs and Lungs

• Check the ribs looking for fractures
• Check lung field make sure they reach the rib cage (no pneumothorax )

Lateral Shoulder X-Rays

• Same 4 steps applies to the lateral shoulder X-Rays
• Coracoid process always pointing anteriorly
• Humerus is sitting in the middle of the glenoid
• Lung fields going to the edges of rib cage

Axial Shoulder X-Rays

• Not easy to obtain on trauma patients (painful)
• Same 4 steps applies to the axial shoulder X-Rays
• Anatomy: acromion, humerus, coracoid, clavicle
• coracoid always pointing anterior
• Make sure the Humeral head is sitting in the glenoid

Imaging Series

• Shoulder series
  • AP
  • Lateral
  • +/- Axial
• Clavicle series
  • AP
  • Axial
• SC joint series
  • AP
  • Axial
• AC joint series: not many AC series (unless it is a confirmed injury) are done so you going to use clavicle X ray or AP shoulder to assess AC 
  • AP
  • +/- Axial

SC Joint X-Rays

• SC joint require AP and Axial to be evaluated
• Also requires knowing the symptomatic side
• Draw a line between your midclavicular  plane for both views, so you can appreciate the displacement
• Axial very helpful in looking for displacement

Examples

Course Menu

This article is apart from the Shoulder and Arm Trauma Free Course, which contain 10 lectures listed down below: