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ANSWER
From the question on page 173.
Diagnosis
Posterior shoulder dislocation.
Imaging findings
Anteroposterior right shoulder
Several findings compatible with a posterior shoulder dislocation are present (fig 1). The humeral head is fixed in internal rotation, producing a “light-bulb” appearance and there is increased distance between the anterior glenoid rim and the medial aspect of the humeral head. The posterior humeral head is impacted onto the posterior rim of the glenoid (ellipse). A tiny fracture fragment is also seen overlying the axillary recess (arrow).
Anteroposterior radiograph of the right shoulder, with abnormal overlap of the posterior humeral head and posterior glenoid rim (black ellipse) and a loose fracture fragment (arrow).
Transscapular view
This view shows posterior dislocation of the humeral head relative to the glenoid. The humeral head should overlap the glenoid fossa (ellipse) on this view (fig 2).
Transscapular radiograph of the right shoulde, showing glenoid rim (ellipse) with the humeral head positioned posteriorly.
Axillary view
The humeral head is seen impacted onto the posterior rim of the glenoid with an impaction fracture of the anteromedial humeral head (reverse Hill–Sachs or McLaughlin defect). A normal axillary radiograph of the right shoulder is also shown for comparison (fig 3). Orthogonal views more clearly delineate the posterior dislocation and are required for accurate diagnosis with plain radiographs.
(a) A normal axillary radiograph of the right shoulder. (b) In the patient’s radiograph, the humeral head is impacted onto the posterior glenoid rim, with a resulting defect on the anteromedial humeral head (reverse …
Footnotes
I-Test cases are designed as clinical teaching vignettes—they are not designed to be case reports. To protect anonymity of patients and clinicians involved, the authors of the I-Test have altered certain descriptive elements from the original case. Thus, the I-Test does not necessarily represent a specific clinical encounter.
Patient consent: Obtained.