Clinical presentation:
Adult female with dissociated sensory loss and depressed upper limb reflexes.

The heart and lungs appear grossly normal. There is an old fracture of the left 8th rib. Both shoulders appear deformed and slcerotic. There is sclerosis and flattened contours of the adjacent gleno-humeral joint surfaces of both shoulders. The appearance of both shoulders suggests painless subluxation. The margins of the vertebral canal are projected to the right in this rotated view, but still imply a possible widened vertebral canal.