0:00

Here is a shoulder of a 16-year-old boy who injured himself.

0:05

He was, I think, wrestling and fell on the shoulder.

0:09

So what do we notice here?

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First of all, it's very hard to see the abnormality.

0:14

I think.

0:15

If we look carefully,

0:16

you could argue that we we have a relatively skeletally,

0:21

mature person because I don't see much of lucency involving the physis.

0:27

This is...

0:27

Some areas have fused already, so there's physeal scarring.

0:30

But if you look here at the very medial aspect,

0:33

there is still some opening of the physis.

0:35

There's still a little bit of lucency

0:36

going through here, maybe a little lucency going through here.

0:39

So technically, if there is a physeal injury,

0:43

we can still, barely classify this under the Salter Harris system.

0:48

So if we follow the physis, there's a little lucency over here

0:52

and becomes sort of dark physeal scar, physeal scar,

0:55

and we sort of lose it here, don't we?

0:57

We don't see very much over here and then it reconstitutes somewhere over here.

1:01

So there may be something going on in this location.

1:05

Hard to say.

1:06

Let's look at the obliquities.

1:09

As we look at this, we know that there is no shoulder dislocation.

1:13

This is a great way to look for shoulder dislocation.

1:16

This is the Y-view.

1:18

Again, we call it a Y

1:19

because here's the coracoid,

1:22

That's the most anterior aspect in your shoulder of the scapula.

1:26

There's one, here is the acromion, and here is a scapula tip.

1:30

So if you draw a line like this, extended out, extended out, it looks like a Y.

1:36

And the glenoid is going to be right in the center, right over here.

1:39

So we know that the humeral head is

1:41

articulating in the glenoid and there's no anterior or posterior dislocation.

1:46

A great view to look for dislocation.

1:49

So, you typically don't have to obtain this also.

1:52

But sometimes when the orthopedic surgeons

1:54

are a little unsure, they also get this axillary Y-view.

1:58

So with this axillary Y-view, again, look for the coracoid.

2:02

That's your friend. The coracoid tells you where you are in your joint.

2:05

It's the most anterior structure.

2:07

So we know this is anterior, this is posterior because this is the coracoid.

2:12

Once you've found the coracoid,

2:13

you can find the glenoid surface, which is right over here.

2:16

And you notice that there is nice

2:18

articulation of the humeral head with the glenoid.

2:22

Again, I think we could see the physis a little better on this projection.

2:25

We can see that there is still some patency over here.

2:28

Now the question is, is this patency because it's actually

2:32

injured or is it just hasn't quite fused yet?

2:36

And that's where some of our cross-sectional imaging,

2:38

such as MRI, is going to help us.

2:40

So here's a little part,

2:41

I can't see the physis very well over here, probably because lots of it is fused.

2:45

And that other area we saw on the frontal

2:48

projection, here, I can't evaluate very well.

2:51

So this is a perfect candidate to get an MRI to see if there's injury.

2:55

I also don't like what's happening over here, but sometimes that's projectional,

2:59

sometimes it's just an area that's a little hard to evaluate.

3:02

So MRI is really indicated

3:04

to this patient, who has lots of shoulder pain.