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Swimmers view or supine oblique views to visualise the cervicothoracic junction
  1. Nasreen Contractor, Specialist Registrar,
  2. Martin Thomas, Specialist Registrar,
  3. K Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether swimmer's views were better than superior oblique views at visualising the C7/T1 junction. Eleven papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

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    Checked by Martin Thomas, Specialist Registrar
 Report by Nasreen Contractor, Specialist Registrar

    Clinical scenario

    A 36 year old man is brought to the emergency department after a road traffic accident. He complains of neck pain. A “pulled” lateral is taken, but fails to show the C7/T1 junction. You wonder whether a pair of supine oblique views or a swimmer's view would be best to visualise this region.

    Three part question

    In a [trauma patient in whom standard lateral views of the cervical spine are inadequate] is a [swimmer's view better than supine oblique views] at [visualising the C7/T1 junction]?

    Search strategy

    Medline 1966- 07/02 using the OVID interface. [supine oblique.mp OR trauma oblique.mp OR swimmers view.mp OR twining.mp] AND [exp X-Rays OR x-ray$.mp or radiograph.mp OR exp radiography OR radiography.mp] AND [exp cervical vertebrae OR cervical spine.mp OR exp neck injuries OR neck injur$.mp OR cervicothoracic junction.mp.] LIMIT to human AND English.

    Search outcome

    Altogether 11 papers were found of which only one was relevant to the original question (see table 1).

    Table 1

    Comments

    While there are numerous articles expressing personal views, there is only this one paper that attempts to answer the question. This paper showed no difference in visualising the vertebral bodies of C7/T1 junction between swimmers or supine obliques, but supine obliques did visualise the posterior elements better. But 9 of 62 of supine oblique data were lost, which could have swayed the results either way. Therefore more research is needed in this area.

    ▸ CLINICAL BOTTOM LINE

    Local advice should be followed.

    Checked by Martin Thomas, Specialist Registrar
 Report by Nasreen Contractor, Specialist Registrar

    References

    View Abstract

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