This prospective study asked which shoulder radiographs actually reflect the true acromial spur in impingement syndrome. Preoperative measurements from four views were compared against direct intraoperative measurements in 23 patients undergoing open acromioplasty. Four blinded readers scored each view for reliability.
When you order imaging for refractory impingement, the goal is to confirm a bony spur before committing to acromioplasty. This paper tells you which views to trust. The 30° caudal tilt view is the workhorse: it is the easiest to obtain, the most reproducible across readers, and it correlates with the actual three-dimensional spur length. It also lets you confirm adequacy of resection afterward.
The supraspinatus outlet view adds complementary information by capturing anterior acromion thickness and acromial shape, which ties back to the Bigliani flat/curved/hooked classification you need for boards.
The teaching point: don't rely on the axillary view for the spur. Its job is to catch an os acromiale and glenohumeral arthritis. A measurement can be reliable yet clinically meaningless, as the acromial tilt angle demonstrates here.
This prospective study asked which shoulder radiographs actually reflect the true acromial spur in impingement syndrome. Preoperative measurements from four views were compared against direct intraoperative measurements in 23 patients undergoing open acromioplasty. Four blinded readers scored each view for reliability.
When you order imaging for refractory impingement, the goal is to confirm a bony spur before committing to acromioplasty. This paper tells you which views to trust. The 30° caudal tilt view is the workhorse: it is the easiest to obtain, the most reproducible across readers, and it correlates with the actual three-dimensional spur length. It also lets you confirm adequacy of resection afterward.
The supraspinatus outlet view adds complementary information by capturing anterior acromion thickness and acromial shape, which ties back to the Bigliani flat/curved/hooked classification you need for boards.
The teaching point: don't rely on the axillary view for the spur. Its job is to catch an os acromiale and glenohumeral arthritis. A measurement can be reliable yet clinically meaningless, as the acromial tilt angle demonstrates here.