A pictorial presentation and the clinical use of the modified trauma axial (MTA) shoulder x-ray view

Abstract

Anteroposterior (AP) and lateral shoulder projections are routinely performed as part of a post-reduction shoulder x-ray series in the emergency department (ED). Research has shown that these projections alone are insufficient to demonstrate post-dislocation injuries, particularly Hill-Sachs and Bankart lesions. These concomitant pathologies are best demonstrated on axial shoulder projections but are difficult to obtain in trauma patients with limited range of motion. The diagnostic quality and the pathology demonstrated by different projections is crucial so that doctors and other ED staff can triage patients appropriately, radiologists can report on the presence or absence of post-dislocation shoulder injuries, and the orthopaedic team can plan for follow-up or treatment. Different modified axial views were reported to improve the post-dislocation pathology sensitivity in the shoulder series. However, all of these shoulder axial views require patient movement. The modified trauma axial (MTA) is an alternative projection that is suitable for trauma patients that does not depend on patient movement. This paper presents several cases where the MTA shoulder projection had clinical importance when used as part of the post-reduction shoulder series in the ED or radiology department.