Shoulder trauma is a frequent presentation to the emergency department [1]. Traumatic shoulder dislocations occur most frequently in young men and have an overall incidence of 21.9–23.9 per 100,000 [2,3]. Proximal humerus fractures occur most frequently in women aged over 60 and have an overall incidence of 104.9 per 100,000 [4]. Radiographs are the most appropriate initial imaging modality in the evaluation of patients presenting with pain secondary to shoulder trauma [5]. Good quality radiographs in the scapular plane are essential for the diagnosis of fractures and dislocations. Inadequate imaging can lead to delayed or missed diagnosis. There is some variation in the number and type of views that constitute a shoulder trauma series but it typically should include an anteroposterior (AP), a scapular Y and an axillary or Velpeau view [6,7].

Concern was raised at the Irish Shoulder and Elbow Society meeting regarding the shoulder trauma series of x-rays that are performed in emergency departments throughout Ireland. One of the concerns among attendees was that the AP views performed are not ‘true’ Grashey AP views. A Grashey AP is taken in the plane of the scapula rather than the frontal plane and demonstrates adequate joint space without overlapping of the humeral head on the glenoid [8]. Another significant concern among attendees was that an axillary or Velpeau view is not performed routinely, and that a diagnosis of shoulder dislocation could be missed.

The primary aim of this study was to assess the current standard shoulder trauma series of radiographs in public hospitals in Ireland. The secondary aim of this study was to determine whether orthopaedic surgeons in Ireland are of the opinion that a national protocol is required, and if so, what this protocol should consist of.