Optimal radiography of the acutely injured shoulder

Over ten months, 172 radiographic examinations were performed on acutely injured shoulders, using three views: a) true AP in external rotation b) orthogonal views: 1) supine axial 2) erect 60 degree anterior oblique of all the examinations, 43 were abnormal with a variety of fractures and dislocations. We found the AP view almost twice as effective in detecting any abnormality. Realizing the need for orthogonal views in all shoulder trauma, the axial and anterior oblique were directly compared. Our data indicate that each orthogonal view is of equal value in assessing anterior dislocations and all other injuries. However, the axial projection is a much more difficult study to achieve technically in the acutely injured patient. Thus an examination of the injured shoulder should include two views: an AP in external rotation and a 60 degree anterior oblique. If an axial view can be obtained, it should be added.