What is the role of a scapula Y view in assessing a suspected scapular fracture or dislocation?

Scapula Y View in Shoulder Trauma Assessment

The scapula Y view is a mandatory component of the standard shoulder trauma radiographic series and is vital for accurately diagnosing glenohumeral and acromioclavicular dislocations, which can be misclassified on anteroposterior views alone. 1

Essential Role in Initial Trauma Evaluation

Standard Trauma Series Requirements

• A complete shoulder trauma radiographic protocol must include at minimum three views: anteroposterior (AP) views in internal and external rotation, plus either an axillary or scapula Y view. 1
• The scapula Y view (or axillary view) is specifically vital because acromioclavicular and glenohumeral joint dislocations can be completely missed or misclassified when relying solely on AP projections. 1
• The American College of Radiology emphasizes that these orthogonal views are essential for assessing proper shoulder alignment, which is one of the two primary concerns in acute traumatic shoulder management (the other being fracture identification). 1

Diagnostic Advantages Over Axillary Views

• In direct comparison studies, the scapula Y view demonstrated superior diagnostic accuracy, with the axillary view failing to provide correct diagnosis in 8% of cases when compared to the scapula Y view. 2
• Patient preference strongly favors the scapula Y view, with 81% of patients reporting less pain compared to the axillary view. 2
• Once technical proficiency is achieved, the scapula Y view is easier to obtain than the axillary view, particularly in patients with acute pain and limited mobility. 2

Specific Applications for Scapular Fractures

Initial Fracture Detection

• When scapular fracture is suspected or identified, the scapula Y view (also called Neer II view) is specifically used to assess translation, angulation, and overlapping of fragments of the lateral borders of the scapular body. 3
• Scapular fractures are frequently missed on standard radiographs, especially when nondisplaced, making the scapula Y view critical for initial detection. 1
• The complex osteology of the scapula and overlying rib structures make fractures easily underappreciated on conventional radiography alone. 1

Limitations and Next Steps

• While the scapula Y view is essential for initial assessment, it cannot fully characterize scapular fracture patterns or determine surgical indications. 3
• CT without contrast is the most useful modality for comprehensive scapular fracture characterization, particularly for assessing intra-articular extension, glenopolar angulation, AP angulation, and lateral border offset. 1
• Three-dimensional CT reconstruction is the only method capable of fully determining the personality and complexity of scapular fractures. 3

Clinical Pitfalls to Avoid

Common Diagnostic Errors

• Never rely on AP views alone for shoulder trauma—dislocations will be missed. 1
• Supine radiography can underrepresent shoulder malalignment; upright positioning is preferred when clinically feasible. 1
• Scapular fractures represent a common diagnostic pitfall due to overlying structures and incomplete imaging from poor patient positioning. 4

When to Escalate Imaging

• If radiographs including the scapula Y view show a scapular fracture, CT without contrast should be obtained next to characterize fracture morphology and guide surgical decision-making. 1
• CT is particularly indicated when assessing for glenoid involvement, displacement, or angulation that may require surgical fixation. 1, 3
• Contrast is generally unnecessary unless there is concern for associated arterial injury. 1