Ultrasonographic evaluation of birth injury to the shoulder

Injuries of the proximal humerus in infants are often missed or misinterpreted because the humeral epiphysis is frequently nonossified. Ultrasonography enables direct visualization of the proximal humeral epiphysis, metaphysis, joint space, and relationship of the epiphysis with the glenoid cavity. We describe an infant with unexplained agitation and ventilatory difficulty related to a fracture of the proximal right humerus that was not appreciable on plain film radiographs. Sonographic imaging of the shoulder, with use of the opposite side for comparison, clearly demonstrated a Salter I proximal humeral fracture with marked metaphyseal displacement and preservation of the normal epiphyseal-glenoid relationship.