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Health

Clavicle X-ray in two projections

, medical expert
Last reviewed: 20.11.2021
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In clinical practice, X-ray imaging remains one of the leading methods of instrumental diagnostics for injuries and diseases of the musculoskeletal system. Quite often, an X-ray of the clavicle is also performed - the paired tubular bone, which is part of the girdle of the upper limb (shoulder girdle): it keeps the shoulder joint at a distance from the chest and connects the brachial process (acromion) of the scapula to the sternum.[1]

Indications for the procedure

The indications for an X-ray of this bone are symptoms that give the doctor reason to suspect the patient has:

  • subluxation and  dislocation of the clavicle  (sternoclavicular or acromioclavicular joints);
  • cracks or fractures of the clavicle due to trauma;
  • cysts of the bone of the  shoulder girdle;
  • bone tumors, in particular  sarcomas  or chondrosarcomas;
  • osteolysis or aseptic necrosis of the sternal (sternal) end of the clavicle.
  • osteosclerosis associated with deforming osteodystrophy;
  • inflammation of the periosteum of the body of the clavicle, acromioclavicular or sternoclavicular joints -  periostitis .

An X-ray of the clavicle in children is required in cases of suspected post-traumatic osteolysis, osteosarcoma, metastases of Ewing's sarcoma. X-ray can be used to diagnose a  fracture of the clavicle in a newborn during childbirth , as well as congenital anomalies (dysplasia / hypoplasia of the clavicle or clavicular-cranial dysostosis). [2

Preparation

No special preparation is required before an X-ray of the clavicle; the patient needs to undress to the waist and remove all metal accessories and jewelry.

And the thyroid gland and genital area are protected with aprons with lead plates.

Technique of the clavicle x-ray

 Clavicle X-ray is performed in a horizontal position (lying) or vertical (standing) - in frontal and lateral projections; an axial view of the clavicle may be required.

The technique for carrying out this diagnostic procedure includes correct placement (position) of the patient, positioning of the cassette and centering of the X-ray tube, which should ensure that an adequate image is obtained. [3]

Frontal image in a direct posterior projection requires laying the patient on his back (straight arms are parallel to the body); pictures in frontal projection are taken either in a horizontal position (the patient lies on his stomach) or standing (from the back).

The image in the axial projection (lying on the back with a contralateral rotation of the head) allows you to determine where the bone fragments were displaced during the fracture of the clavicle.

What can be seen on an X-ray of the clavicle?

An X-ray of a healthy clavicle / X-ray of a clavicle normally gives a clear (light) image of the contour of the bone body, its ends - the sternum and shoulder, joints (acromioclavicular and sternoclavicular), as well as the humeral process of the scapula. [4]

All structures are anatomically correct, there are no darkening. [5]

X-ray signs of a clavicle fracture include the presence of a darkening zone on the contour of the bone body in the form of a crack of various widths and configurations (indicating a violation of the integrity of the clavicle) and a lower displacement of its distal part. Often, clavicle fractures are displaced by a combination of the weight of the upper limb pulling the distal fragment downward and the sternocleidomastoid muscle pulling the medial fragment upward. But in a proximal fracture, good ligament support prevents displacement. [6]

Dislocation of the clavicle on X-ray is determined by the position of the lower edge of the clavicle: when the sternoclavicular joint is dislocated, the image shows the displacement of the sternal end of the clavicle upward. And with dislocation of the acromioclavicular joint, the lower contour of the clavicle and the lower contour of the humeral process of the scapula are at the same level. [7]

Contraindications to the procedure

X-rays are not performed during pregnancy and lactation, internal bleeding, in the acute period of infectious diseases and with fever. [8]

The X-ray of the clavicle does not give any complications, and there is no need for care after the procedure.

With the advent of other imaging methods, the question may arise: which is more informative, an ultrasound scan or an X-ray of the clavicle? As experts emphasize, for the clinical diagnosis of a fracture or dislocation of the clavicle, there is enough information provided by an X-ray, but an ultrasound scan of bones -  ultrasound of bones  - visualizes the contours of the bone, its surface and the cortical layer. In addition, ultrasound examines damage to ligaments, tendons and cartilage.

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