Shoulder- SI vs Lateral Scapula |

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Jul 21 2008, 8:13 PM EDT	M.J.Fuller	13 words added, 11 words deleted
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Introduction

Some institutions have adopted the lateral scapula view as a routine projection for shoulder trauma radiography. Other institutions strictly forbid the lateral scapula view for shoulder trauma radiography. This page examines two cases which are arguably instructive in this debate.

Case 1. Shoulder Fracture Dislocation

$shoulder fracture dislocation$ This patient presented to the Emergency Department following a fall. The initial AP shoulder image demonstrates an abnormal looking humeral head and neck. The exact nature of the bony deformity is unclear.

$shoulder fracture dislocation$ A lateral scapula image suggests that the humeral head is enlocated. However, the appearance is unusual, particularly the position of the articular surface (arrowed).

$shoulder fracture dislocation$ The Infero-superior projection (IS) image reveals that the humeral head is dislocated and impacted on the glenoid resulting in Hills-Sachs impaction fracture.

The patient had an ORIF the following day.

Case 2. Shoulder Fracture Dislocation

$shoulder fracture-dislocation$ This patient also presented to the Emergency Department following a fall. The initial AP shoulder image reveals a fracture involving the humeral head and neck. One unusual feature of this image is that the articular surface of the humeral head appears to be directed inferiorly (arrow)

$shoulder fracture dislocation$ The Infero-superiorinfero-superior projection (IS) image reveals that the humeral head is dislocated and impacted on the glenoid resulting in Hills-Sachs impaction fracture.

A closed reduction of the shoulder dislocation was attempted under anaesthetic but was unsuccessful. The patient subsequently underwent an ORIF.

Discussion

It might appear by the choice of cases that I have taken a clear position in favour of the IS view over the lateral scapula projection. However, this story (not unlike a good Agatha Christie)Christie novel) has a twist. Both of these cases were drawn from a hospital that does not require the IS/SI view as a routine view in trauma radiography of the shoulder. The routine views adopted by this institution are AP shoulder and lateral scapula. In both cases, the radiographer identified the case as a fracture-dislocation from the AP and lateral scapula images and performed the SI view to prove the suspicion.

You could safely argue that the institutions that have adopted the IS/SI view as routine in shoulder trauma radiography have taken a safer position. It could also be argued that the institutions that require routine AP shoulder and lateral scapula views, and that have a comprehensive continuing education program, will allow the radiographers to exercise judgement in these types of cases and perform supplementary views as required.

(please contribute your opinion/experiences using the start a new thread link at the bottom of this page)

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$shoulder fracture dislocation$	This patient presented to the Emergency Department following a fall. The initial AP shoulder image demonstrates an abnormal looking humeral head and neck. The exact nature of the bony deformity is unclear.
$shoulder fracture dislocation$	A lateral scapula image suggests that the humeral head is enlocated. However, the appearance is unusual, particularly the position of the articular surface (arrowed).
$shoulder fracture dislocation$	The Infero-superior projection (IS) image reveals that the humeral head is dislocated and impacted on the glenoid resulting in Hills-Sachs impaction fracture. The patient had an ORIF the following day.

$shoulder fracture-dislocation$	This patient also presented to the Emergency Department following a fall. The initial AP shoulder image reveals a fracture involving the humeral head and neck. One unusual feature of this image is that the articular surface of the humeral head appears to be directed inferiorly (arrow)
$shoulder fracture dislocation$	The Infero-superiorinfero-superior projection (IS) image reveals that the humeral head is dislocated and impacted on the glenoid resulting in Hills-Sachs impaction fracture. A closed reduction of the shoulder dislocation was attempted under anaesthetic but was unsuccessful. The patient subsequently underwent an ORIF.