From the Guidelines
For clavicular joint dysfunction, an anteroposterior (AP) view in internal and external rotation, along with an axillary or scapula-Y view, is the recommended initial imaging study. This recommendation is based on the American College of Radiology (ACR) Appropriateness Criteria for shoulder pain-traumatic, as outlined in a 2018 study published in the Journal of the American College of Radiology 1. The AP views in internal and external rotation provide a comprehensive assessment of the clavicle and its articulations, while the axillary or scapula-Y view is crucial for evaluating the acromioclavicular and glenohumeral joints, as well as detecting potential dislocations that may not be apparent on AP views alone.
Key considerations for imaging clavicular joint dysfunction include:
- The importance of radiography in assessing bony anatomy and shoulder alignment, which are primary concerns in managing acute traumatic shoulder pain 1.
- The need for upright radiography, as supine radiography may underrepresent malalignment of the shoulder 1.
- The potential utility of additional views, such as the Bernageau view, in demonstrating the degree of bone loss of the glenoid or humeral head, although these may not be necessary for all cases of clavicular joint dysfunction 1.
In clinical practice, the choice of imaging study should prioritize the patient's safety, the availability of imaging modalities, and the potential for each study to provide diagnostic information that will guide treatment decisions. Given the recommendations outlined in the ACR Appropriateness Criteria and the importance of accurately assessing the clavicle and its articulations, an AP view in internal and external rotation, along with an axillary or scapula-Y view, should be considered the standard initial imaging approach for clavicular joint dysfunction 1.
From the Research
Recommended X-ray for Clavicular Joint Dysfunction
- X-ray is usually the first-line imaging modality for clavicle injuries, including clavicular joint dysfunction 2, 3
- The goals of imaging evaluation for clavicle fractures include reviewing the imaging features, common classification systems, and relative surgical indications 3
- For distal clavicle fractures, which represent 15-30% of all clavicle fractures, radiographic evaluation is crucial to understand the local osseoligamentous anatomy and deforming forces 4
- Clavicle and acromioclavicular joint injuries can be evaluated using imaging techniques, and treatment options include conservative management and surgical repair 5
- Current concepts in clavicle fracture treatment involve a paradigm shift towards an increase in operative treatment, with conservative treatment reserved for non-displaced fractures and operative treatment considered for displaced fractures, especially in young and active patients 6
Imaging Evaluation
- Plain radiography is typically used to diagnose and follow clavicle fractures 3
- Specialized views, such as those illustrated in pictorial essays, can enhance care and ensure patients are directed to appropriate management 4
- Radiologists should become familiar with the surgical techniques used to fixate clavicle fractures, as well as the post-operative appearance and potential complications 5
Treatment Options
- Conservative management is preferred for patients with uncomplicated and nondisplaced clavicular fractures, with immobilization lasting 4 weeks, followed by range-of-motion exercises and full return to activities by 12 weeks 2
- Operative treatment is considered for displaced clavicle fractures, especially in young and active patients, with the aim of reducing non-union rates and improving outcomes 6