Patients with shoulder dislocations commonly present to emergency departments with anterior dislocations accounting for 90-95% of these cases1. Diagnosis is based on history and clinical examination with radiography confirmation. Following reduction, radiography is traditionally obtained to confirm gleno-humeral enlocation and to look for associated fractures. Pre- and post-reduction x-rays are obtained to confirm dislocation and reduction respectively and to rule out fractures. The most common fractures associated with anterior shoulder dislocations are Hill-Sachs and Bankart lesions which rarely alter acute management2. Emergency physicians are often...

Literature review: We conducted a literature search for guidelines and recommendations for ordering shoulder x-rays in the setting of a suspected shoulder dislocation. We searched the literature in Medline via Ovid and PubMed, Cochrane Library, Embase and Google Scholar. Search results were screened by title and abstract then relevant articles were retrieved. References of these articles were then screened in a similar manner to look for relevant articles. Clinical factors predicting fracture-dislocations and guidelines for pre- and post-reduction radiography were then identified. Algorithms for guidelines...

Literature review: We found 3 retrospective and 5 prospective primary studies evaluating the use of x-rays for shoulder dislocation in the acute setting for pre- and post-reduction (Table 1). Similar clinical factors were identified in these articles mainly involving age, mechanism of injury and recurrence. Three algorithms were suggested from three research groups studying this topic. Figure 1 represents the Banff Shoulder Dislocation Guideline proposed by Shuster et al4. Figure 2 represents the algorithm suggested by Hendey et al for management of patients with suspected...

Discussion We have reviewed the literature for current guidelines for radiography of suspected shoulder dislocations. The studies demonstrated that routine ordering of radiographs before and after reducing dislocated shoulders is no longer necessary. Emergency physicians are often certain of both diagnosis and reduction of shoulder dislocations3,4. In addition, certain patient characteristics such as age, mechanism of injury and recurrence can help in determining which patients need x-rays to rule out possible associated fractures5,6,9,10. Harvey et al questioned the need for post-reduction x-rays first after concluding...

Matsumoto K, Itoh Y, Fukuta M, Itokazu M, Shimizu K. Anterior dislocation of the shoulder: a simple and sitting method for reduction. Current orthopaedic Practice 2009;20:281–4. Chen AL, Hunt SA, Hawkins RJ, Zuckerman JD. Management of bone loss associated with recurrent anterior glenohumeral instability.Am J Sports Med.2005;33:912–925. Shuster M, Abu-Laban RB, Boyd J. Prereduction radiographs in clinically evident anterior shoulder dislocation. Am J Emerg Med 1999;17:653-8. Shuster M, Abu-Laban RB, Boyd J, et al. Prospective evaluation of a guideline for the selective elimination of pre-reduction...