What is the role of imaging studies in the workup of shoulder dislocation?

Updated: Nov 29, 2018
  • Author: Sharon R Wilson, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Arteriography, angiography, and Doppler flow studies may be used to evaluate suspected vascular injury. Electromyography (EMG) may be used later to evaluate nerve injuries. [10]

In a study of computed tomography for the detection of Hill-Sachs lesions, 142 shoulders were evaluated preoperatively by CT (30 with primary instability and 112 with recurrent instability) before arthroscopic Bankart repair. Hill-Sachs lesions were detected in 90 shoulders by initial CT evaluation and were found in 118 shoulders at arthroscopy. In patients with primary subluxation, the prevalence of Hill-Sachs lesions was 26.7%; primary dislocation, 73.3%; and all shoulders, 56.3%. In patients with recurrent episodes of complete dislocation, the prevalence of Hill-Sachs lesions was increased, and the lesions were larger. [21]

Horst et al used magnetic resonance imaging to identify the correlation between Bankart and Hill-Sachs lesions in 105 patients with anterior shoulder dislocation. They found that the co-occurrence of injuries was high [odds ratio (OR) = 11.47; 95% confidence interval (CI) = 3.60-36.52; P< 0.001] and that Bankart lesions co-occurred more often with large Hill-Sachs lesions (O  = 1.24; 95% CI = 1.02-1.52; P = 0.033). In addition, patients older than 29 years more often presented with a bilateral injury (OR = 16.29; 95% CI = 2.71-97.73; p = 0.002). If either lesion was diagnosed, the patient was 11 times more likely to have suffered the associated injury. [22]

Magnetic resonance angiography has been shown to have a high sensitivity when used to identify associated injuries in shoulder dislocation. [32]

In a study of point-of-care ultrasonography for shoulder dislocation in emergency departments, sensitivity and specificity for identifying dislocation were both 100%. For excluding shoulder fracture, point-of-care ultrasound had a sensitivity of 100% and a specificity of 84.2%. [33]

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