Regional trauma

Shoulder and upper arm

Dr.Aftab Qadir

Outline

Shoulder dislocation

Fractures

Rotator cuff injury

Trauma-series x-rays

Glenoid AP view

Trans scapular lateral view

Axillary view

1.Shoulder dislocation

anterior > 95%

posterior 2-4%

inferior (luxatio erecta) < 1%

Plain Films

X-rays are sufficient in most cases

associated fractures/injuries

Hill-Sachs lesion

bony Bankart lesion

proximal humeral fractures

clavicular fracture

acromioclavicular joint disruption

acromial fracture

Hill-Sachs lesions

Bankart lesion

Posterior Shoulder Dislocation

Radiological signs on AP view:

Internal rotation of the humerus

Light bulb sign

The ‘rim sign’ – Widening of the glenohumeral

space

Inferior shoulder dislocation

Radiographic features

The humeral head is displaced directly below the

glenoid fossa.

arm often in marked abduction (luxatio erecta).

2.Acromioclavicular injury

Features include :

soft tissue swelling

widening of the AC joint

increased coracoclavicular distance

superior displacement of the distal clavicle

4.Clavicular fracture

vast majority occur in the midshaft

fall onto an outstretched arm

common in very young and very old patients.

5.Scapula fractures

uncommon injuries, representing ~3% of all

shoulder fractures.

high energy trauma

Requires trauma series views

associated with other injuries

6.Humerus

fractured by excessive torsion or by a direct

blow.

The humeral neck is frequently fractured in

elderly patients following a fall into the shoulder.

7.Supracondylar fracture

90% are seen in children younger than 10 years

commonly seen in boys

due to accidental trauma

Lateral and AP radiographs are usually sufficient

indirect signs indirect signs

9.Medial epicondyle fracture

represent almost all epicondyle fractures

most common avulsion injury of the elbow

typically seen in children and adolescents

10.Galeazzi fracture-dislocation

fracture of the distal radius with dislocation of

distal radioulnar joint

children, peak incidence of 9-12 years of age

Plain films , orthogonal views

11.Monteggia fracture-dislocation

fracture of the ulna shaft and dislocation of the

radial head

image both the elbow and the wrist, and good

quality AP and lateral views are required.

12.Rotator cuff tear

common causes of shoulder pain

Prevalence of tear increases with age

Acromiohumeral interval indicative of rotator cuff

tear or tendinopathy.

ultrasound may have up to 90% sensitivity and

specificity

Hyperintense signal area within the tendon on

T2W, fat-suppressed and GRE sequences

Few Cases

Thank You