The apical oblique view of the shoulder: its usefulness in acute trauma

A retrospective analysis of the radiographs of the shoulder in 511 patients examined for acute trauma was performed to evaluate the usefulness of the apical oblique view (45 degrees posterior oblique with 45 degrees caudal angulation of the central ray). Each study included anteroposterior, transthoracic lateral, and scapular "Y" (60 degrees anterior oblique) views as well as the apical oblique projection. Radiographic evidence of injury detected on each view was recorded. The apical oblique view detected 153 (81%) of the 190 injuries. Twenty abnormalities were seen only in this view. These included 11 glenoid rim fractures, seven Hill-Sachs lesions, one posterior subluxation, and one case of soft-tissue calcification. Additional clinically useful information, such as fracture extension into the joint space and displacement of clavicular fracture fragments, was also uniquely provided in this view. The anteroposterior view was more effective than the apical oblique view in detecting acute shoulder injuries, showing 168 (88%) injuries. However, the two views were often complementary, and in this series, if only the anteroposterior and apical oblique views had been obtained, 188 of 190 injuries would have been seen. The results show that the apical oblique view is useful for the detection of shoulder injuries.