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Forum Name: Bone trauma and fractures

Question: dislocated shoulder not seen on x ray?


 chess1 - Sun Jun 06, 2010 4:29 pm

Hello, i recently had a fall where i landed on my right shoulder that resulted in extreme pain, and my shoulder not looking right( my collar bone is sticking out where it never was before, and i think the shoulder is sitting lower than normal). I went immediately to the er and after a brief exam and an x ray i was told a had bruised by collar bone and sent on my way with a sling and advise to take over the counter ib for the pain and swelling. that was yesterday, today the pain is much worse (yesterday i would not have thought it possible) and i am still experiencing limited movement, i cant really raise my arm above the shoulder.
so i guess my question is, is it possible i have a dislocated/ separated shoulder or other injury that was overlooked on the x ray?
 Dr.M.Aroon kamath - Thu Jul 15, 2010 7:05 am

User avatar Hi,

Your history is more suggestive of an "acromioclavicular joint (AC joint) separation".

This joint is betwen the outer end of the clavicle and the acromion process of the scapula.Via the clavicle, it takes part in connecting the upper limb to the axial skeleton.

Separation occurs usually by one of two mechanisms:
- Direct injury: wherein a person falls on to the point of the shoulder, with the arm usually by the side(adducted shoulder). About 70% of AC joint injuries are the result of a direct injuries.

- indirect injury: wherein a person falls onto an outstretched arm.

Clinical picture: In dislocations,there is loss of the normal contour of the shoulder and the outer part of the collarbone appears prominent with a noticeable 'step deformity'.

Routine anteroposterior views of the shoulder are good to visualize the shoulder joints(glenohumeral joints).The AC joint is over-penetrated by the X-rays and therefore appears too dark ans therefore difficult to interpret. Reduced exposures improve visualization of the AC joint. Weighted views (stress X-rays) which are taken with 10-15lb weights not held but suspended from the patient's wrists,may help occasionally(not preferred by some).

Therefore, it is possible that an AC joint separation may be missed in a conventional AP X-ray of the shoulder, which is commonly performed in an emergency situation.

You must consult an orthopedic surgeon and get thoroughly assessed, as improperly managed AC joint separations may result in chronic shoulder pain.
Best wishes!

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