From the Guidelines
Joint space widening on X-ray is typically caused by ligamentous injuries or instability, which can result from traumatic or athletic injuries. The degree of joint widening can be used to assess the severity of instability, with greater widening indicating more severe instability 1.
- In cases of elbow dislocation, joint widening can be evaluated under fluoroscopy to determine the degree of instability, with mild instability (less than 10 degrees of widening) often treated conservatively, while moderate to severe instability may require surgical fixation 1.
- The use of dynamic fluoroscopy can help distinguish among different stages of collateral ligament injury, allowing for more accurate diagnosis and treatment planning 1.
- Treatment for ligamentous injuries or instability may involve conservative measures, such as pain management with medications like acetaminophen or ibuprofen, immobilization, and physical therapy, while severe cases may require surgical intervention 1.
From the Research
Joint Space Widening on X-ray
The cause of joint space widening on X-ray can be attributed to several factors, including:
- Acromioclavicular (AC) joint injuries, which can result in separation of the joint and subsequent widening of the joint space 2, 3
- Trauma, such as direct blows to the shoulder, which can cause AC joint separations and joint space widening 4, 3
- Degenerative joint disease, which can lead to osteoarthrosis of the AC joint and joint space widening 4, 5
- Surgical complications, such as those that can occur after reconstruction of the coracoclavicular ligament 6
Imaging Findings
Imaging findings that may indicate joint space widening on X-ray include:
- Increased distance between the acromion and clavicle on anteroposterior (AP) X-ray 6
- Displacement of the clavicle in relation to the acromion 2, 3
- Evidence of osteoarthrosis, such as joint space narrowing or osteophyte formation 4, 5
Diagnosis and Management
Diagnosis of joint space widening on X-ray typically involves:
- Clinical evaluation, including history and physical examination 4, 2
- Imaging studies, such as X-ray or other modalities 2, 3
- Classification of AC joint injuries using systems such as the Rockwood classification 4, 2 Management of joint space widening on X-ray may involve:
- Conservative management, such as activity modification and nonsteroidal anti-inflammatory drugs 4, 5
- Surgical intervention, such as reconstruction of the coracoclavicular ligament or resection of the lateral clavicle 4, 6, 5