The Clinical Utility of Additional Axillary and Velpeau Radiographs in the Evaluation of Suspected Shoulder Trauma.

Objectives: To investigate the clinical utility of additional axillary or Velpeau views in evaluating potential shoulder trauma after a standard radiograph series of anteroposterior, Grashey, and/or trans-scapular views.

Design: Retrospective study.

Setting: Level I academic medical center.

Patients: All patients in a 10-year span who received an initial shoulder radiograph series followed by additional axillary/Velpeau views within 24 hours.

Main Outcome Measurements: The clinical utility of the additional axillary/Velpeau views, including the final diagnosis and treatment plan, as ascertained through examination of radiology reports, progress notes, and radiograph images.

Results: A total of 271 cases were reviewed, with 35 patients being excluded from the final cohort because they received post-treatment radiographs to confirm a successful therapeutic outcome. The additional axillary/Velpeau views did not affect clinical decision making in 230 (97.5%) of the remaining 236 cases. All 6 patients whose care benefitted from the additional views carried the diagnosis of shoulder instability, accounting for 40% of this diagnostic group. The additional views confirmed an equivocal finding in 5 of these 6 cases and changed the diagnosis (demonstrating a posterior dislocation that was not evident on initial radiographs) and treatment plan (leading to a closed glenohumeral reduction procedure) in the other case.

Conclusions: Additional axillary/Velpeau views of suspected shoulder trauma rarely led to a change in the final treatment plan, except in patients in which a definitive diagnosis of stability or instability could not be made based on initial radiographs. A cost/benefit analysis is required to weigh the cost of additional radiographs with the benefit of capturing infrequent yet serious dislocations (usually posterior).

Level Of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.