Imaging and Assessment Guidelines for Anterior Shoulder Dislocation

Initial Diagnostic Imaging

The American College of Radiology recommends obtaining standard three‑view shoulder radiographs (AP in internal and external rotation plus an axillary or scapula‑Y view) as the first step to evaluate joint alignment and exclude fractures. 1
An axillary or scapula‑Y view is essential because anteroposterior views alone can miss glenohumeral dislocations. 1
When a Hill‑Sachs lesion is suspected, a Stryker notch view can be added to identify the defect. 1

Radiographs must be performed after the initial assessment (or after any field reduction) to confirm whether the shoulder is currently reduced or remains dislocated. 2
Following successful reduction, post‑reduction radiographs are required to verify anatomic alignment of the glenohumeral joint. 1

A focused neurovascular exam documenting axillary nerve function (deltoid sensation and motor strength) should be completed after reduction. 2
Documentation of neurovascular status both before and after reduction is a mandatory element of the clinical record. 3

For young patients with an acute anterior shoulder dislocation, the American College of Radiology recommends MRI without intravenous contrast as the next imaging modality to assess labroligamentous injuries. 3
The presence of an acute joint effusion or hemarthrosis provides intrinsic contrast, eliminating the need for MR arthrography. 3
MRI provides comprehensive evaluation of Bankart lesions, Hill‑Sachs lesions, rotator‑cuff tears, glenoid bone loss, and capsular injuries. 3
CT without contrast is reserved only when MRI cannot adequately assess bone loss or is contraindicated. 3

Post‑reduction radiographic confirmation must be recorded in the patient’s chart. 1

Regardless of operative or non‑operative management, a typical timeframe for returning to contact sports is 5–6 months after injury. 5

All facts are derived from cited sources; strength of evidence was not explicitly graded in the referenced literature.