Radiologic Shoulder Eval Flashcards
List indications for routine radiologic exam at the shoulder complex
- trauma
- bone involvement with metabolic diseases/systemic disease/nutritional deficiencies
- neoplasms
- infection
- arthropathy
- pre-op/post-op
- suspected congenital/developmental abnormality
- vascular lesions
- foreign body/soft tissue lesion
- pain
- correlation with other studies
list the views taken during a routine radiologic exam of the shoulder complex
- Shoulder
- AP External rotation
- AP Internal rotation
- AC joint
- Upright AP
- stability → one with weights ties to wrists, another without weights
- Upright AP
- Scapula
- AP
- Lateral
- Others
- Axillary View of the GH joint
- Scapular “Y”
in what radiologic view can the lesser tuberosity of the humerus be seen?
AP Internal rotation view
what is the purpose of the AP, bilateral with and without weights, view?
allows the radiologist to observe the degree of separation at the shoulder while holding onto weights
too much separation may indicate an unstable AC joint
spatial relationships observed → coracoclavicular distance and AC joint space distance
which radiologic view is used to best appreciate the body of the scapula?
AP of the scapula
what is the axillary view of the GHJ used for?
looking at the orientation of the humeral head in relation to the glenoid fossa which is helpful when evaluating for dislocations
- It is an inferior axial projection
- spatial relationships can be observed → humeral head to glenoid fossa
- continuity/structures
- rim of glenoid fossa
- corcicoid process
what type of imaging study is first line for most shoulder patholgies?
X-ray
list 3 generalizations with advanced imaging of the shoulder
- Radiographs typically first study with suspected bone and soft tissue injuries
- CT with complex fractures and to assist with surgical decisions
- MRI when results are anticipated to effect treatment decisions
list general indications for CT of the shoulder
- severe trauma
- assessing fracture alignment/displacement
- ID loose bodies in GHJ
- If MRI contraindicated, rotator cuff pathology and other health conditions for which MRI is typically indicated
list the planes/views with CT-scans of the shoulder
- Axial
- Oblique sagittal → parallel to glenoid fossa
- Oblique coronal → parallel to supraspinatus
what is best seen in the axial view of a shoulder CT?
- Glenohumeral articulation
- Articular cartilage injury
- Avulsions at greater tubercle
- Bankart lesions
- Hill-Sach’s lesions
what is best seen in the oblique sagittal view of a shoulder CT?
- ACJ degeneration
- Subacromial space
- Acromion morphology
what is best seen in the oblique coronal view of a shoulder CT?
- Labrum
- GH joint surfaces
- Glenoid rim
- Greater tubercle
- Subacromial space
- Acromion morphology
what are MRIs of the shoulder generally indicated for?
- soft tissue injuries
- infections
- vascular conditions
- neurologic conditions
- staging/monitoring certain health conditions → frozen shoulder, inflammatory arthropathy, etc.
- a number of clinical scenarios
list clinical scenarios at the shoulder that require and MRI
- chronic/unexplained shoulder pain
- acute trauma
- GHJ instability
- Impingement syndrome
- mechanical symptoms
- limited/painful ROM
- swelling/mass/atrophy
- planned arthroscopy
- residual symptoms following surgery
list the 2 ACR appropriateness criteria for imaging at the shoulder
- Shoulder pain - atraumatic
- Shoulder pain - traumatic
what initial imaging is most appropriate for a pt with traumatic shoulder pain of any etiology?
radiography of shoulder
what next imaging study should be performed in a pt with traumatic nonlocalized shoulder pain and negative radiographs?
- Usually appropriate
- MRI shoulder
- May be appropriate
- CT arthrography shoulder
- MR arthrography shoulder
- US shoulder
what next imaging study should be performed in a pt with traumatic shoulder pain and their radiographs show a humeral head or neck fracture?
CT shoulder
what next imaging study should be performed in a pt with traumatic shoulder pain and their radiographs show a scapular fracture?
CT shoulder
what next imaging study should be performed in a pt with traumatic shoulder pain and their radiographs show a Bankart or Hills-Sachs lesion?
- Usually appropriate
- MR arthrography
- MRI
- May be appropriate
- CT arthrography
- CT shoulder
what next imaging study should be performed in a pt with traumatic shoulder pain and physical exam/history consistent with dislocation event or instability but radiographs were normal?
- Usually appropriate
- MR arthrography shoulder
- MRI shoulder
- May be appropriate
- CT arthrography
- CT shoulder
what next imaging study should be performed in a pt with traumatic shoulder pain whose physical exam findings are consistent with a labral tear but radiographs were normal?
MR arthrography, CT arthrography, and MRI shoulder
what next imaging study should be performed in a pt with traumatic shoulder pain whose physical exam findings are consistent with a rotator cuff tear but radiographs were normal?
- Usually appropriate
- MRI shoulder
- MR arthrography
- US shoulder
- May be appropriate
- CT arthrography shoulder
what next imaging study should be performed in a pt with traumatic shoulder pain whose physical exam findings are consistent with vascular compromise and radiographs were already performed?
- Usually appropriate
- CTA shoulder
- Arteriography shoulder
- May be appropriate
- US duplex Doppler shoulder
what next imaging study should be performed in a pt with traumatic shoulder pain with neuropathic syndrome (excluding plexopathy) and radiographs have already been performed?
MRI shoulder
what initial imaging study should be performed with atraumatic shoulder pain?
Radiography shoulder
what next imaging study should be performed for a pt with atraumatic shoulder pain but has a suspected rotator cuff disorder and initial radiographs were normal or inconclusive?
MRI shoulder or US shoulder
what next imaging study should be performed in a pt with atraumatic shoulder pain with a suspected labral tear and instability but initial radiographs were normal or inconclusive?
MR arthrography or MRI shoulder
what next imaging study should be performed in a pt with atraumatic shoulder pain with suspected bursitis and initial radiographs were normal or inconclusive?
MRI shoulder or US shoulder
what next imaging study should be performed in a pt with atraumatic shoulder pain and suspected adhesive capsulitis but initial radiographs were normal or inconclusive?
MRI shoulder
what next imaging study should be performed in a pt with atraumatic shoulder pain and suspected biceps tendinitis, bursitis, dislocation, or tear but initial radiographs were normal or inconclusive?
MRI shoulder or US shoulder
what next imaging study should be performed in a pt with pain after a rotator cuff repair but initial radiographs were normal or inconclusive?
MR arthrography shoulder, MRI shoulder, US shoulder
what initial imaging should be performed in a pt with atraumatic shoulder pain and neurogenic pain (excluding plexopathy)?
MRI shoulder
