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Need an AP shoulder Xray interpreted for abnormalities after an accident

DOCTOR OF THE MONTH - May 2014
May 2014
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Radiologist
Practicing since : 2002
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Question
I need an AP shoulder Xray interpreted for abnormalities. It was taken after a motorcycle accident. I have 2 more Xrays available to view but the system won't let me upload them.
Posted Thu, 15 Aug 2013 in X-ray, Lab tests and Scans
 
 
Answered by Dr. Vivek Chail 53 minutes later
Hi XXXX,
Thanks for writing in.

Its most unfortunate that you met with a motorcycle accident and injured yourself.

The X XXXXXXX right shoulder shows a transverse (horizontal) fracture involving the right scapula bone (shoulder blade) which is also extending into the inferior part of the glenoid cavity. There is displacement between fracture fragments. The head of humerus bone is intact. The right clavicle also looks intact.

Also there is pseudo subluxation of head of humerus. This is due to bleeding into the joint cavity.

There is also a very suspicious fracture of right third rib laterally (image sent is not very clear on magnification).

Hope your query is answered.
Wishing you good health.

Regards
Dr Vivek
Above answer was peer-reviewed by
 
Follow-up: Need an AP shoulder Xray interpreted for abnormalities after an accident 3 hours later
What would be the suggested course of action from here? Would surgery be recommended or is there indeed any surgery that could correct the conditions cited or is it just a case of taking Non-Steroidal Anti Inflammatory drugs and resting and allowing the body to recover by itself?
Follow-up: Need an AP shoulder Xray interpreted for abnormalities after an accident 9 hours later
I have also uploaded two additional x-ray views named shoulderxray4.jpg and shoulderxray5.jpg for your reference.
 
 
Answered by Dr. Vivek Chail 37 minutes later
Hi XXXX,
Thanks for writing in with updates.

I just got your new X rays on time as I was writing this reply, thanks for it. I understand the X rays were taken on 24-07-2013 and are less than 3 days old. I was waiting for the lateral view (which you have sent subsequently), it gives me information regarding the fracture displacement in antero posterior plane, which is little in your situation.

It is important to know the age of the injury. I would have done a CT scan of your shoulder with 3D reconstruction to know the collection in joint cavity and displacement of fracture fragments in three dimensional planes, though it is not compulsory if your doctor has examined you clinically. Any nerve and blood vessel involvement must be checked. These are most important after injury and I am sure your doctor has examined your right shoulder and arm before deciding your treatment course.

There are no signs associated with anterior dislocation of shoulder in X rays uploaded by you. The humeral head and glenoid surfaces appear aligned which is a normal finding.

I reconfirm the pseudosubluxation of humeral head. There is a cresentric fat layer in the joint space with inferiorly humeral head. This might be due to blood and fluid within the joint cavity.
Treatment is symptomatic with NSAIDS in the initial days after injury. Shoulder immobilization in a sling and bandage is provided for comfort during that time. Early progressive Range of Motion (ROM) exercises and use of the shoulder out of the sling (within clearly defined limits) are initiated as pain subsides. Your injury looks like one of the 90% ones where surgery might not be required. However your doctor may recommend X rays every two weeks to check the healing process.
Most scapular fractures heal completely by 6 weeks, and all external support is discontinued at this time. Progressive use of the upper extremity is encouraged. Continue Range of Motion exercises until full shoulder mobility is recovered. As motion improves, add progressive strengthening exercises. Full functional recovery takes several months. Ultimately, the prognosis for these fractures is excellent.

Hope your queries are answered.
Should there be any further queries, please feel free to ask.

Wishing you good health and quick recovery.

Regards
Dr Vivek
Above answer was peer-reviewed by
 
Follow-up: Need an AP shoulder Xray interpreted for abnormalities after an accident 1 hour later
Dear     Dr. XXXXXXX Chail,

Thank you for your thoughtful and very informative answer to my follow up questions.

The motorcycle accident which caused these injuries occurred on July 20th. Shoulder relocation occurred on July 21st, approximately 18 hours after the accident. The X-rays and Ultrasound images were taken on July 24th, four days after the accident.

I do not have CT scan available but am posting 59 ultrasound images done on both the damaged shoulder and the normal one for comparison. Since there are so many images I have made them into 15 jpegs of 4 images each. I hope that the detail is enough that you will be able to interpret them without being hampered by lack of detail. I can also follow up with individual larger files of any of the images at your request, if that would help.
I have now uploaded the 16 files containing 59 ultrasound images. From my side I can only see that the first 10 were successfully uploaded. If there is a 10 image limit and you are unable to view items ultrasound11 to ultrasound16 I can possibly delete images ultrasound to ultrasound10 after you have viewed them and try uploading images 11 to 16 again. If you can see all 16 jpgs then please ignore this message.
 
 
Answered by Dr. Vivek Chail 29 minutes later
Hi XXXX,
Thanks for sending in your first 10 images.

There must be an upper limit to uploading images and reports. I have viewed images ultrasound 1 to 10 and would request you to delete older images and upload 11 to 16.

Also I would be glad if you could upload the report details of ultrasound if available for technical details.

Regards
Dr Vivek
Above answer was peer-reviewed by
 
Follow-up: Need an AP shoulder Xray interpreted for abnormalities after an accident 30 minutes later
Dear Dr. XXXXXXX Chail,

I have now deleted the first 10 images and uploaded images 11 thru 16, as well as the sheet which was the only other item in the file I received. I hope that you find these helpful and look forward to your reply.
 
 
Answered by Dr. Vivek Chail 8 hours later
Hi XXXX,
Thanks for sending in your remaining images.

Ultrasound is a real time evaluation and chances remain that static images may be less informative than the actual scan due to various technical parameters. I have gone through your ultrasound scan shoulder images and would like to make the following observations regarding right shoulder joint:
1.     The long head of biceps tendon appears normal.
2.     The subscapularis tendon shows some edema on XXXXXXX and external rotation.
3.     Infraspinatus tendon shows edema.
4.     Teres minor and spinogelnoid notch are normal to the extent visualised but the glenoid labrum image is hazy which might be due to injury.
5.     Supraspinatus shows suspicious partial tear at rim.
6.     Acromioclavicular joint detail is not well appreciated in images.
7.     Mild edema noted in region of subarachnoid subdeltoid bursa.
In general there is mild soft tissue injury around right shoulder joint.

Hope your queries are answered.
Should there be any further queries, please feel free to ask.

Wishing you good health and quick recovery.

Regards
Dr Vivek
Above answer was peer-reviewed by
 
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