Stephen Bird


Great images!

What you are seeing is a little “fluid” beneath the coraco-acromial ligament.

Fluid here can either be burial or joint related fluid.

Given there is no fluid in any of the other burial recesses this is almost certainly a little bit of joint fluid.

Just adjacent to the coracoid you often see a little fluid recess that communicates with the joint. Some call it the sub-coracoid recess or bursa, but in my eyes it is just a little recess of GH joint fluid.

So if you have a little joint fluid there the next question is “is there a significant GH joint effusion”. To answer this I look in the long head of biceps sheath for fluid surrounding the long head of biceps tendon. Then I look at the posterior shoulder, and not at the level of infra and the labrum, but a little lower where you see trees minor and look for fluid in the axillary recess of the GH joint. If you see fluid in these locations you have an effusion. If not it is probably just physiological fluid.

The next question I have is “why does the fluid contain echoes?”
If it is blood and part of a haemarthrosis, this would explain the echoes.

So do we have a blood filled joint effusion?

Given the recent dislocation, a Hill Sachs deformity of the posterior humeral head or a Bankart fracture of the glenoid are possibilities.

So a set of plain X-rays at the very least are warranted.

If you see blood in the LHBT sheath or axillary recess then you will need some cross sectional imaging to complete the picture.

If there is no fluid or blood anywhere else it is possible the appearance might be from some normal fat or joint capsule.

But I would be chasing these other options first.

Nice case,


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