eMedicine Specialties > Orthopedic Surgery > Shoulder

Shoulder Dislocations: Workup

Author: Scott Welsh, MD, Staff Physician, Department of Orthopedic Surgery, Borgess/Bronson Hospitals, Michigan State University
Coauthor(s): Mark Veenstra, MD, Consulting Staff, K Valley Orthopedics, Southwestern Michigan Sports Medicine Clinic
Contributor Information and Disclosures

Updated: Nov 3, 2009

Workup

Imaging Studies

  • Radiography: Conventional radiography should be performed in all patients with suspected shoulder dislocations to confirm the diagnosis and also to exclude associated fractures prior to any attempted reduction.11 Routine radiographs should include at least an anteroposterior (AP) view and an axillary view.12
    • The AP view can be obtained in neutral, internal, or external rotation. In internal rotation, one can easily see a Hill-Sachs lesion of the posterolateral humeral head.
    • The axillary view nicely shows glenohumeral subluxation or dislocation, as well as anterior or posterior glenoid rim fractures.13 A standard axillary view may be difficult in the acute injury setting because it requires 90° of abduction. However, many modifications exist to avoid excessive movement of the painful extremity. For example, the transverse axillary lateral requires the patient to abduct the arm only 10-30°.
    • Other views that may be useful include the scapular Y view, which is helpful for diagnosing dislocations and scapular fractures. This view, however, should not replace the axillary view because it does not show subtle subluxations of the glenohumeral joint or fractures of the glenoid rim.
      • The true AP or Grashey view is helpful in assessing subtle joint incongruity, superior or inferior subluxation, degenerative changes, or glenoid hypoplasia.
      • The Garth or West Point view is useful in detecting bony Bankart fractures of the anteroinferior glenoid rim as well as Hill-Sachs defects. This view is advantageous in the acute setting because it does not necessitate the patient moving the arm.
      • The Stryker notch view can also be useful in detecting Hill-Sachs lesions. However, this view is of limited usefulness in detecting subluxations or glenoid fractures.
  • Computed tomography (CT) arthrography, magnetic resonance imaging (MRI), and/or magnetic resonance arthrography may be helpful in assessing some shoulder dislocations.14
    • CT arthrography was commonly used in the past to evaluate patients with glenohumeral instability either after the initial dislocation or with recurrent instability. However, today, it is used only when an MRI is contraindicated or if glenoid version abnormalities are suspected.
    • MRI and magnetic resonance arthrography have been shown to be more sensitive than other methods in detecting labral and ligamentous pathology, rotator cuff and cartilage tears, capsular abnormalities, and biceps injuries. MR arthrography is more sensitive than MRI alone and is the study of choice after a shoulder dislocation, particularly in cases of recurrent instability, and it is superior to MRI for diagnosing the pathologic lesions mentioned above.

More on Shoulder Dislocations

Overview: Shoulder Dislocations
Workup: Shoulder Dislocations
Treatment: Shoulder Dislocations
Follow-up: Shoulder Dislocations
References
Further Reading
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References

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Keywords

shoulder dislocations, shoulder instability, shoulder dislocation, anterior shoulder dislocation, posterior shoulder dislocation, inferior shoulder dislocation,  subglenoid shoulder dislocation, subclavicular shoulder dislocation, intrathoracic shoulder dislocation, retroperitoneal shoulder dislocation, luxatio erecta, multidirectional shoulder instability, traumatic shoulder dislocation, atraumatic shoulder dislocation, atraumatic shoulder

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Contributor Information and Disclosures

Author

Scott Welsh, MD, Staff Physician, Department of Orthopedic Surgery, Borgess/Bronson Hospitals, Michigan State University
Scott Welsh, MD is a member of the following medical societies: Michigan State Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Mark Veenstra, MD, Consulting Staff, K Valley Orthopedics, Southwestern Michigan Sports Medicine Clinic
Disclosure: Nothing to disclose.

Medical Editor

Cato T Laurencin, MD, PhD, Van Dusen Chair Professor of Academic Medicine, Distinguished Professor of Orthopaedic Surgery, and Chemical, Materials, and Biomolecular Engineering, University of Connecticut
Cato T Laurencin, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Pekka A Mooar, MD, Professor, Department of Orthopedic Surgery, Temple University School of Medicine
Pekka A Mooar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD, Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association
Disclosure: Nothing to disclose.

 
 
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