From the Guidelines
The Grashey view is a recommended radiographic projection for evaluating the glenohumeral joint in patients with traumatic shoulder pain, as it profiles the joint by turning the patient into a 30° posterior oblique profile 1. When assessing patients with acute shoulder pain, particularly those with suspected trauma, the Grashey view is a valuable tool for evaluating the glenohumeral joint. This view is especially useful for detecting subtle dislocations, evaluating the congruity of the joint, and identifying potential lesions such as Hill-Sachs or Bankart lesions. Some key points to consider when using the Grashey view include:
- It is typically performed as part of a standard shoulder series, which may include anteroposterior, axillary, and scapular Y views 1
- The view is obtained by positioning the patient with the affected shoulder against the image receptor and rotating the body approximately 30° away from the receptor, as described in the ACR Appropriateness Criteria for acute shoulder pain 1
- The Grashey view is particularly useful for assessing the relationship between the humeral head and glenoid fossa, allowing for the detection of subtle abnormalities that may not be visible on other views
- In patients with suspected instability or dislocation, the Grashey view can be used in conjunction with other views, such as the axillary lateral or scapular Y view, to provide a comprehensive evaluation of the shoulder joint 1
From the Research
Grashey View
The Grashey view is a radiographic projection used to evaluate the shoulder joint. It is particularly useful for assessing damage to the glenohumeral joint caused by various conditions such as osteoarthritis, sclerosis, tumors, fractures, osteophytes, and cystic changes 2.
Uses of Grashey View
- The Grashey view is used to demonstrate loss of articular cartilage in the glenohumeral joint by applying a loading force across the joint through weighted arm abduction 2.
- It is also used as a screening radiograph for further imaging study in rotator cuff tear, and has been shown to be more sensitive than the conventional shoulder AP view in detecting pathognomonic signs of rotator cuff tear 3.
- The true anteroposterior (Grashey) view of the glenohumeral joint is recommended as part of the radiographic evaluation of acute shoulder injuries, including proximal humerus fractures 4.
Comparison with Other Views
- The Grashey view has been compared to other radiographic projections, such as the axillary view and the scapular "Y" view, in terms of accuracy of diagnosis, patient preference, and ease of technique 5.
- The scapular "Y" view has been shown to be preferred by patients and technicians due to less pain and ease of use, although the axillary view and scapular "Y" view visualize associated pathology equally well 5.
Detection of Pathognomonic Signs
- The Grashey view has been shown to be more sensitive than the conventional AP view in detecting pathognomonic signs of rotator cuff tear, including greater tuberosity sclerosis, greater tuberosity osteophyte, subacromial osteophyte, greater tuberosity cyst, and humeral head osteophyte 3.
- The detection rate of these signs is significantly higher on the Grashey view than on the conventional AP view, particularly for medium-sized tears 3.