Best Practice Case Studies-Case 124 Asset 4 High Yield X-Ray: Shoulder, Clavicle, and Elbow

Video Transcription

Video Summary

The lecture introduced a high-yield review of shoulder, clavicle, and elbow X-rays for sports medicine fellows, emphasizing a systematic ABCDE approach to radiograph interpretation and when to escalate to CT or MRI. Dr. Robert Boutin reviewed common injury patterns, pitfalls, and missed diagnoses.<br /><br />For the shoulder, he covered standard views and key alignment checks, especially the glenohumeral and AC joints. Important findings included AC separations/dislocations, including the easily missed grade 4 posterior displacement, anterior glenohumeral dislocations with Hill-Sachs and Bankart lesions, and posterior dislocations with reverse Hill-Sachs and reverse Bankart injuries. He also discussed luxatio erecta, calcific tendinitis, and subtle greater tuberosity fractures that may be overlooked on plain films.<br /><br />For the clavicle, he highlighted fractures, displacement, and the importance of not missing sternoclavicular joint injuries or medial clavicle fractures, which may require CT to assess and can threaten nearby vessels if posteriorly displaced. He also noted that prior surgery, such as Mumford procedure or acromioplasty, can mimic pathology and confuse interpretation.<br /><br />For the elbow, he reviewed the standard three-view series and common clues like fat pad signs indicating effusion and occult fracture. He discussed radial head fractures, lateral condyle/capitellum fractures, coronoid and medial epicondyle injuries, and triceps avulsion fractures. He also warned that not all posterior elbow ossifications are fractures—some may represent venous malformations.<br /><br />Overall, the talk stressed careful review of alignment, subtle fracture lines, soft tissues, and the value of cross-sectional imaging when radiographs are equivocal.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 124

Topic Elbow

Keywords

4th Edition

4th Edition, Case 124

Elbow

shoulder X-ray

clavicle fracture

elbow radiograph

ABCDE approach

glenohumeral dislocation

AC joint injury

Hill-Sachs lesion

Bankart lesion

fat pad sign

CT MRI escalation