Posterior shoulder dislocations are notoriously difficult to spot, often described as clinically and radiographically occult. In fact, missing them is so common it could be called, colloquially, the standard of care. It doesn’t have to be, however.
Manickam “Nicks” Kumaravel, team doctor for the Houston Texans, highlighted posterior dislocations as a commonly missed diagnosis in chest and shoulder trauma during his talk at the ARRS Annual Meeting.
Lights, Up! On a standard AP view, look for the classic “light bulb” appearance of the humeral head. If a post-fall image simply doesn’t look right, voilà, that’s your cue to dig deeper. You cannot rely on a single projection…
- Scapular Y view is the critical orthogonal projection.
- It clearly demonstrates the posterior displacement that AP views can hide.
RadFYI: To avoid a miss, maintain a high index of suspicion and always verify with orthogonal views.
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