What X-rays (radiographs) should be ordered for scapular dyskinesia?

X-ray Imaging for Scapular Dyskinesia

For scapular dyskinesia, plain radiographs of the shoulder are the first-line imaging modality, including anteroposterior (AP), lateral, and specialized views to evaluate for underlying structural abnormalities that may contribute to the condition. 1

Initial Imaging Approach

Primary Radiographic Views

• AP view of the shoulder - Evaluates overall shoulder anatomy and alignment
• Lateral view of the scapula - Assesses scapular position and morphology
• Stryker notch view - Helps identify bony lesions that may affect scapular mechanics 1

Additional Specialized Views

• Y-view (Neer II view) - Evaluates translation, angulation, and overlapping of fragments of the lateral borders of the scapula 2
• AP view of the entire shoulder girdle - Should cover the entire scapula, clavicle, acromioclavicular and sternoclavicular joints 2

When to Consider Advanced Imaging

If plain radiographs are normal but symptoms persist, consider:

1. MRI of the shoulder:

   • Gold standard for evaluating soft tissue pathology with 86-100% sensitivity 1
   • Particularly useful to distinguish lesions secondary to nerve injuries (long thoracic or accessory nerve) 3
   • Helps rule out other shoulder disorders that may present with similar symptoms 3

2. CT scan with 3D reconstruction:

   • Consider if bony abnormalities are suspected but not clearly visualized on radiographs
   • Provides detailed evaluation of the scapular morphology 2
   • Particularly useful for evaluating fractures or bony lesions affecting scapular mechanics 2

Clinical Correlation

The imaging findings should be correlated with clinical assessment:

• Use the "yes/no" method for clinical assessment of scapular dyskinesis, which has higher sensitivity (76%) and positive predictive value (74%) compared to other methods 4
• Testing in forward flexion shows a higher frequency of multiple-plane scapular asymmetries in symptomatic individuals 4

Important Considerations

• Scapular dyskinesia is primarily a clinical diagnosis based on observed abnormal scapular movement 3, 5
• Imaging is mainly used to identify underlying structural causes or rule out other pathologies 3
• Remember that asymmetries in scapular motion can be present in asymptomatic individuals, so clinical correlation is essential 4
• Consider the entire kinetic chain and neuromuscular system when evaluating scapular dyskinesia, as it is often part of a broader movement dysfunction 6

Pitfalls to Avoid

• Relying solely on imaging without proper clinical assessment may lead to misdiagnosis
• Failing to obtain adequate radiographic views that visualize the entire scapula and shoulder girdle
• Not considering neurological causes (like long thoracic or accessory nerve dysfunction) which may require specific MRI protocols 3
• Overlooking the need for bilateral comparison views to assess for asymmetry

By following this systematic approach to imaging for scapular dyskinesia, clinicians can better identify underlying structural abnormalities that may contribute to the condition and guide appropriate treatment decisions to improve patient outcomes.