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New standards for treating traumatic shoulder injuries to improve patient care

Traumatic shoulder injuries that result in a patient visit to the ER often contain a secondary injury that can cause pain and discomfort in that part of the body after the primary injury has healed. By focusing on the primary injury, radiologists sometimes miss the secondary injury, which can compromise treatment effectiveness. Trainees in the Brigham and Women's Hospital Radiology Residency Program developed new protocols aimed at drawing ER radiologists' attention to the potential presence of secondary should injuries. Better identification of these injuries could lead to improved patient outcomes. These protocols, which have been awarded the 2012 Gold Medal by the American Roentgen Ray Society (ARRS) , will be presented on April 28, 2012 at the 2012 ARRS Annual Meeting in Vancouver, Canada.

"The severity of shoulder injuries are often underestimated," said Dr. Scott Sheehan, radiology resident at Brigham and Women's Hospital and lead author for the study. "Subtle injuries can have significant consequences if not recognized and treated promptly."

Dr. Sheehan and his team used images from multiple imaging modalities to illustrate the force mechanisms that cause the five most common types of traumatic shoulder injuries (dislocation, proximal humerus fracture, shoulder separation, clavicle fracture, and scapula fracture). For each type of injury, the team developed guidelines for the optimal use of imaging in diagnosing the injury. For example, they recommended that the goal of imaging acute shoulder dislocations is to "address immediate complications and identify risk factors which could lead to the development of chronic shoulder instability." (Sheehan, et al.) During their presentation at the 2012 ARRS Annual Meeting in Vancouver, BC Sheehan and his team will present simple and practical protocols for understanding the mechanisms of primary shoulder injuries and the most commonly used injury classification systems.

"When radiologists understand the common mechanisms of primary shoulder injuries, they can more appropriately direct their attention to the most clinically significant associated secondary bony or soft tissue injuries," said Dr. Sheehan. "Early detection of these injuries can ideally lead to improved timeliness of appropriate treatment and ultimately improved functional outcomes."

Sheehan and his co-authors began studying the effects of traumatic shoulder injuries after one of his radiology mentors suffered a shoulder dislocation with a subtle yet significant associated injury.

Contact: Bryan Murphy
Brigham and Women's Hospital

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