The Veil of Obscuration: Additional Radiographic Sign of Posterior Shoulder Dislocation

Authors

  • Lana Hirai Gimber Department of Medical Imaging, The University of Arizona, College of Medicine, Banner-University Medical Center, Tucson, Arizona
  • Mihra S. Taljanovic Department of Medical Imaging, The University of Arizona, College of Medicine, Banner-University Medical Center, Tucson, Arizona
  • Zachary A. Rockov The University of Arizona, College of Medicine, Tucson, Arizona
  • Elizabeth A. Krupinski Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
  • Tyson S. Chadaz Department of Orthopaedic Surgery, The University of Arizona, College of Medicine, Banner, University Medical Center Tucson, Tucson, Arizona
  • Lee F. Rogers Department of Radiology, University of Arizona Health Sciences Center, Tucson, Arizona

DOI:

https://doi.org/10.5644/ama2006-124.228

Keywords:

Posterior, Shoulder, Glenohumeral, Dislocation, Radiograph

Abstract

Objective. To describe a new radiographic sign, “veil of obscuration”, associated with posterior glenohumeral joint (shoulder) dislocations and determine its incidence and validity compared to other known classic radiographic signs.

Methods. Four-year retrospective study identified 30 acute posterior shoulder dislocation patients. Radiographs reviewed in consensus by 2 musculoskeletal radiologists for the “veil of obscuration”, seen on AP shoulder radiographs and representing a comminuted fracture of the lesser tuberosity projecting over the humeral head or glenohumeral joint. Incidence of this radiographic sign of posterior glenohumeral joint dislocation in addition to other previously described classic radiographic signs, and association with other fractures, surgery, and mechanism of injury were evaluated. Continuous data was analysed with student t-test and categorical data with Chi-Square test.

Results. There were 20 right and 10 left posterior shoulder dislocations. Majority of injuries resulted from vehicle crash (44%). In most cases, reverse Hill-Sachs lesion (83%) and fixed internal rotation of the humeral head (76%) were present, followed by trough line (43%) and “veil of obscuration” (40%). Trough line was seen in significantly more major trauma and vehicle crashes (78% and 46%; P=0.015), while “veil of obscuration” was seen in more seizures (86%; P=0.037) and in all surgical patients.  No significant difference in presence of other classic radiographic signs in regards to surgery.

Conclusion. The newly described radiographic sign of posterior shoulder dislocations named the “veil of obscuration” has comparable incidence as other classic radiographic signs and may be useful in the recognition and diagnosis of these injuries.

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Published

2018-12-26

How to Cite

Hirai Gimber, L., Taljanovic, M. S., Rockov, Z. A., Krupinski, E. A., Chadaz, T. S., & Rogers, L. F. (2018). The Veil of Obscuration: Additional Radiographic Sign of Posterior Shoulder Dislocation. Acta Medica Academica, 47(2), 165. https://doi.org/10.5644/ama2006-124.228

Issue

Section

Clinical Science

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