Postoperative Shoulder X-ray Views After Rotator Cuff Repair
For a patient 2 weeks post-arthroscopic rotator cuff repair, obtain a standard 3-view shoulder series consisting of: anteroposterior (AP) view in neutral or internal rotation, Grashey view (true AP of glenohumeral joint), and either an axillary lateral or scapular Y view. 1
Recommended Views
The ACR Appropriateness Criteria establishes that shoulder radiographic protocols should include at minimum 3 views, with 2 being orthogonal 1. For your postoperative rotator cuff patient, this translates to:
Essential Views:
- Frontal AP projection - Can be performed with humerus in neutral or internal rotation to assess overall shoulder alignment and hardware positioning 1
- Grashey projection - True AP of the glenohumeral joint obtained by turning the patient 30° posterior oblique; this profiles the joint space optimally 1
- Axillary lateral OR scapular Y view - Provides the critical orthogonal view to assess glenohumeral joint alignment and rule out dislocation 1
Timing Considerations
Radiographs are typically obtained 3-6 weeks after shoulder surgery according to standard postoperative protocols 2. At 2 weeks post-op, you're within the appropriate window for initial postoperative imaging assessment.
Important Caveat:
Recent evidence questions the routine use of radiographs in asymptomatic patients during the first postoperative year 2, 3. A 2025 study found that routine radiographs in asymptomatic patients rarely led to management changes, with zero revision rates in asymptomatic patients with positive findings 3. However, for symptomatic patients experiencing pain or limited range of motion, radiographs remain essential 3.
Clinical Context Matters
If your patient is asymptomatic with expected postoperative progress, consider whether imaging will change management. The evidence suggests it likely won't 3.
If your patient has concerning symptoms (unexpected pain, weakness, limited motion, instability concerns), then the 3-view series is absolutely indicated to evaluate for:
- Hardware positioning and anchor placement
- Fracture (particularly if trauma occurred)
- Joint alignment
- Unexpected complications
Practical Approach
Order: "Shoulder series, 3 views: AP, Grashey, and axillary (or scapular Y if axillary too painful)"
The axillary view may be uncomfortable for postoperative patients, so the scapular Y view serves as an acceptable alternative if patient positioning is problematic 1.