Reading Shoulder X-rays
Grashey, scapular Y, and the dislocation you confirm before you pull.
Aug 31, 2026 · 3 refs
At a glance
A shoulder series is not one AP. You need a Grashey (true AP of the glenoid), a scapular Y or axillary, and often a Velpeau if they cannot abduct. Never reduce a “dislocation” you have not seen on a second view — you need to know it is out, and you need a baseline for iatrogenic fracture.
Technique pointers
Minimum series
- Grashey: glenohumeral joint space, greater tuberosity
- Scapular Y or axillary: anterior vs posterior dislocation
- Look at the scapula, clavicle, and AC joint on the same cassette
After a reduction attempt (theirs or yours)
- Repeat the series before you pull again
Decision-making
Posterior dislocations hide on a sloppy AP. If the exam says locked internal rotation, get an axillary or Velpeau before you declare it reduced. Proximal humerus fracture-dislocations change who reduces it and how.
High-yield / exam
- Two views before any reduction
- Grashey is not a standard chest-like AP
- Axillary / Y for anterior vs posterior
- Repeat films after failed attempts
Questions
Ortho Skills (Real Life) and Boards items for this topic are coming.
Your pearl
One line you’d tell a junior at 2am.
References
- 01
Radiographic evaluation of the shoulder
2011 · Journal of the American Academy of Orthopaedic Surgeons · review
Grashey plus a lateral/axillary view is the working series.
- 02
ASES / AAOS teaching on shoulder dislocation imaging
2016 · American Academy of Orthopaedic Surgeons (guidelines / AUC) · guideline
Confirm direction on a second view before reduction.
- 03
OTA teaching on proximal humerus and glenohumeral radiographs
2019 · Orthopaedic Trauma Association · guideline
Fracture-dislocation identification changes who reduces and how.
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