Posterior shoulder dislocations are notoriously difficult to spot, often described as clinically and radiographically occult. In fact, misses are so common, they could be called, colloquially, the standard of care. Not that they have to be, however.
Manickam “Nicks” Kumaravel, team doctor for the NFL’s Houston Texans, highlighted why posterior dislocations remain so frequently missed in chest and shoulder trauma during his ARRS Annual Meeting lecture.
Glow On! 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.
N.B. You cannot rely on a single projection…
- Scapular Y view is the critical orthogonal projection.
- It clearly demonstrates the posterior displacement that AP can hide.
RadFYI: To avoid a miss, maintain a high index of suspicion, always verifying with orthogonal views.
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