Onur YEŞİL, Tuba Cimilli ÖZTÜRK, Şebnem Eren ÇEVİK, Özlem GÜNEYSEL

Posterior Omuz Çıkığında Hangisi Önceliklidir: X-Ray ya da Bilgisayarlı Tomografi?

The glenohumeral joint is the most commonly dislocated joint in the human body. Anterior dislocatin is the most common type and posterior dislocations account for <1% of shoulder dislocations. A 28-year-old man was brought to the emergency department by ambulance after a high-velocity motor vehicle accident. At the time of admission he was suffering left shoulder pain. On local physical examination, there was severe pain on the proximal humerus. The left arm was in internal rotation in the adducted position. Radiographs of his left shoulder were performed and no significant pathology was identified in the left shoulder anteroposterior X-ray. Axillary radiography could not be performed because of painful arm movements. Therefore we performed a computed tomography scan, instead of X-ray. The success rate of diagnosing the posterior shoulder dislocations with X-ray is very low. We believe that X-ray, as a primary imaging method, will cause delay in the diagnosis for this group of patients. In the case of suspicion of posterior shoulder dislocations, computed tomography should be the first choice of investigation rather than X-ray.

Anahtar Kelimeler:

Posterior shoulder dislocation, closed reduction, computed tomography, X-Ray

Which Comes First in Posterior Shoulder Dislocation; X-Ray or Computed Tomography?

The glenohumeral joint is the most commonly dislocated joint in the human body. Anterior dislocatin is the most common type and posterior dislocations account for <1% of shoulder dislocations. A 28-yearold man was brought to the emergency department by ambulance after a high-velocity motor vehicle accident. At the time of admission he was suffering left shoulder pain. On local physical examination, there was severe pain on the proximal humerus. The left arm was in internal rotation in the adducted position. Radiographs of his left shoulder were performed and no significant pathology was identified in the left shoulder anteroposterior X-ray. Axillary radiography could not be performed because of painful arm movements. Therefore we performed a computed tomography scan, instead of X-ray. The success rate of diagnosing the posterior shoulder dislocations with X-ray is very low. We believe that X-ray, as a primary imaging method, will cause delay in the diagnosis for this group of patients. In the case of suspicion of posterior shoulder dislocations, computed tomography should be the first choice of investigation rather than X-ray

Keywords:

Posterior shoulder dislocation, closed reduction, computed tomography, X-Ray,

PDF

___

Sileo MJ, Joseph S, Nelson CO, Botts JD, Penna J. Management of acute glenohumeral dislocations. Am J Orthop (Belle Mead NJ). 2009; 38: 282-90.
Garrigues GE, Nagda SH, Yu J. Open luxatio erecta: a case report and literature review. J Orthop Trauma. 2011; 25: 34-7. [CrossRef]
Rudzinski JP, Pittman LM, Uehara DT. Shoulder and Humerus In- juries. In Judith E, Tintinally MD, MS, Editor. Emergency Medi- cine. 7th ed. New York: McGraw-Hill; 2010. p.1834-8.
Tan AH. Missed posterior fracture-dislocation of the humeral head following an electrocution injury to the arm. Singapore Med J. 2005; 46: 189-92.
Harrison LM. Posterior dislocation of the shoulder. J Bone Joint Surg Am. 1952; 34: 584-90.
Cicak N. Posterior dislocation of the shoulder. J Bone Joint Surg Br. 2004; 86: 324-32. [CrossRef]
Tey IK, Tan AH. Posterior fracture-dislocation of the humeral head treated without the use of metallic implants. Singapore Med J. 2007; 48: 114-8.
Poyanli O, Gokcen B, Unay K, Akan K, Esenkaya I. Bilateral pos- terior shoulder dislocation with defect secondary to hypoglycemic coma. J Orthop Sci. 2011; 16: 125-8. [CrossRef]
Haygood TM, Sayyouh MMH. Musculoskeletal Imaging. Michael YM, Chen MD, Thomas L Pope, MD, David J. Ott, MD, Editors. Basic Radiology. 2nd ed. North Carolina: 2011. Chapter 6. http:// www.accessmedicine.com Access date 03.06.2011.
Bozkurt M, Can F, Dogan M, Solak S, Basbozkurt M. Treatment of missed posterior dislocation of the shoulder by delayed open reduction and glenoid reconstruction with corticocancellous iliac bone autograft. Arch Orthop Trauma Surg. 2004; 124: 425-8. [CrossRef]
Yuen CK, Chung TS, Mok KL, Kan PG, Wong YT. Dynamic ultra- sonographic sign for posterior shoulder dislocation. Emerg Radiol. 2011; 18: 47-51. [CrossRef]