Which Comes First in Posterior Shoulder Dislocation; X-Ray or Computed Tomography?

The glenohumeral joint is the most commonly dislocated joint in the human body. Anterior dislocatin is the most common type and posterior dislocations account for <1% of shoulder dislocations. A 28-year-old man was brought to the emergency department by ambulance after a high-velocity motor vehicle accident. At the time of admission he was suffering left shoulder pain. On local physical examination, there was severe pain on the proximal humerus. The left arm was in internal rotation in the adducted position. Radiographs of his left shoulder were performed and no significant pathology was identified in the left shoulder anteroposterior X-ray. Axillary radiography could not be performed because of painful arm movements. Therefore we performed a computed tomography scan, instead of X-ray. The success rate of diagnosing the posterior shoulder dislocations with X-ray is very low. We believe that X-ray, as a primary imaging method, will cause delay in the diagnosis for this group of patients. In the case of suspicion of posterior shoulder dislocations, computed tomography should be the first choice of investigation rather than X-ray.