It is always nice to hear from our colleagues from across the pond. Recently, Angus Wallace, surgeon to Nottingham, posted on ResearchGate: "I agree with Rick Matsen and Bob Neviaser, you should train your radiographer to provide high quality AP and Axillary or Axial radiographs. I carry out 110 shoulder Arthroplasties per year and only order CT scans about twice per year, even for difficult cases." As Mr Wallace says, it is essential that the techs take the films properly as shown here.
We refer to the axillary view as the 'truth' view because it often lets us know what's really going on. Here's an example from our clinic yesterday. An active person in the mid 60s is having difficulty kayaking. The range of motion was restricted by about 20% in all planes. The AP view in the plane of the scapula looked unremarkable except for a small inferior osteophyte.
However, the axillary view showed posterior displacement of the humeral head on the glenoid and bone on bone contact between the center of the humeral head and the posterior glenoid - indicating complete loss of cartilage in these areas.
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