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(3) Musculoskeletal Imaging > S2_L2: Trauma & Abnormal Conditions of the Shoulder > Flashcards

S2_L2: Trauma & Abnormal Conditions of the Shoulder Flashcards

1
Q

Enumerate the four parts in the Neer Four-Part Anatomic Classification

A
  1. Humeral head
  2. Greater tuberosity
  3. Lesser tuberosity
  4. Shaft at the level of the surgical neck
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2
Q

Modified TF: Neer Four-Part Anatomic Classification
A. Displaced fractures are characterized as one-part fractures.
B. Non-displaced fractures are characterized as two-, three-, or four-part fractures.

A

FF

A: Non-displaced fractures = one-part fractures
B: Displaced fractures = two-, three-, or four-part fractures

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3
Q

Adhesive capsulitis stages

  1. Increasing stiffness and decreasing pain
  2. Lasts 1 to 3 months
  3. Lasting 3 to 8 months

A. Acute stage
B. Adhesive stage
C. Recovery stage

A
  1. B
  2. C
  3. A
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4
Q

Adhesive capsulitis stages

  1. Minimal pain, severe restriction of movement
  2. Increasing pain at movement or at rest, and at night
  3. Lasts for 4 to 6 months

A. Acute stage
B. Adhesive stage
C. Recovery stage

A
  1. C
  2. A
  3. B
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5
Q

Impingement Syndrome

Modified TF
A. External impingement is the compression of the rotator cuff tendon as they are entrapped in the infraspinatus outlet when the arm is elevated.
B. Internal impingement is the compression of the posterior capsule and rotator cuff between the humeral head and glenoid.

A

FT

A: External impingement is the compression of the rotator cuff tendon as they are entrapped in the supraspinatus outlet when the arm is elevated.

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6
Q

Glenohumeral and Labral Lesions

  1. Impaction fracture of the anterior humeral head
  2. Peeling off of the periosteum (at the back) of the glenoid
  3. Associated with a prior anterior dislocation

A. Anterior Labral Periosteal Sleeve Avulsion
B. Posterior Labral Periosteal Sleeve Avulsion
C. McLaughlin Sign

A
  1. C
  2. B
  3. A
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7
Q

Glenohumeral and Labral Lesions

  1. Associated with a reverse Hill-Sachs lesion
  2. Glenoid fossa is pulled out
  3. Associated with posterior shoulder dislocation

A. Anterior Labral Periosteal Sleeve Avulsion
B. Posterior Labral Periosteal Sleeve Avulsion
C. McLaughlin Sign

A
  1. C
  2. A
  3. B
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8
Q

Impingement Syndrome

Modified TF
A. External impingement is commonly seen in overhead athletes.
B. History and physical examination are sufficient to diagnose impingement syndrome.

A

FT

A: Internal impingement is commonly seen in overhead athletes.

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9
Q

Fractures of the Scapula Classification

  1. Superolateral angle including glenoid neck and fossa
  2. Scapular body
  3. Apophyseal fractures including acromion and coracoid process

A. Type I
B. Type II
C. Type III

A
  1. C
  2. A
  3. B
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10
Q

Fractures of the Clavicle Classification

  1. Comprises 80% of clavicular fractures
  2. 2nd most commonly occurring clavicular fracture

A. Proximal third
B. Middle third
C. Distal third

A
  1. B
  2. C
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11
Q

Glenoid Labrum Tears Classification

  1. Tears within the substance of the labrum
  2. Often seen in acute trauma
  3. Seen in adults over the age of 40
  4. Superior labral anterior and posterior (to the biceps tendon) tear aka SLAP

A. Group 1
B. Group 2
C. Group 3

A
  1. B
  2. A
  3. B
  4. C
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12
Q

Glenoid Labrum Tears Classification

  1. Usually degenerative in nature
  2. Avulsions off the glenoid rim
  3. Tears in relation to the biceps tendon as it blends into the superior labrum to attach to the glenoid tubercle

A. Group 1
B. Group 2
C. Group 3

A
  1. B
  2. A
  3. C
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13
Q

Dislocations of the GH Joint: Associated Fractures

  1. Antero-inferior glenoid rim fracture
  2. Compression fracture of the postero-lateral aspect of humeral head

A. Hill-Sachs Lesion
B. Bankart Fracture
C. Greater tubercle, surgical neck, or glenoid rim fracture

A
  1. B
  2. A
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14
Q

Rotator Cuff Tears Classification

  1. One side is intact
  2. Hypovascular region located 1 cm proximal to supraspinatus tendon insertion
  3. Blood supply is decreased, very prone to injury & does not heal as quickly

A. Critical zone
B. Complete (full-thickness)
C. Incomplete (partial-thickness)

A
  1. C
  2. A
  3. A
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15
Q

Adhesive Capsulitis Classification

  1. Appears spontaneously without identifiable stimulus, idiopathic
  2. With pre-existing trauma to shoulder or prolonged immobilization of shoulder
  3. Seen in >50 yo, women > men
  4. Wearing an arm sling for a long time (~1 wk)

A. Primary
B. Secondary

A
  1. A
  2. B
  3. A
  4. B
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16
Q

Glenoid labrum tears imaging evaluation

  1. Excellent in evaluating related biceps tendon abnormalities due to the dynamic examination
  2. Most appropriate procedure to assess labral tears
  3. 2nd procedure of choice if MRI is contraindicated or not available
  4. Contrast media is applied that distends the joint permitting better visualization of labrum, capsular structures, and
    underside of RC

A. MR arthrogram
B. CT arthrogram
C. Ultrasound

A
  1. C
  2. A
  3. B
  4. A
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17
Q

Rotator cuff tears findings

  1. Fluid signal in the gap between torn edges
  2. Erosion of inferior aspect of acromion due to superior migration of humeral head
  3. Discontinuity of tendon

A. X-ray findings in chronic RC tears
B. MRI findings in RC tears

A
  1. B
  2. A
  3. B
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18
Q

Rotator cuff tears findings

  1. Retraction of musculotendinous junction
  2. Muscle atrophy and/or fatty infiltration
  3. Irregularity of Greater Tuberosity (flattened, atrophied, sclerotic)

A. X-ray findings in chronic RC tears
B. MRI findings in RC tears

A
  1. B
  2. B
  3. A
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19
Q

Rotator cuff tears findings

  1. Narrowing of distance between acromion and humeral head due to atrophy of RC and unopposed pull of deltoid muscle
  2. Bursal fluid in subacromial or subdeltoid bursae

A. X-ray findings in chronic RC tears
B. MRI findings in RC tears

A
  1. A
  2. B
20
Q

Rotator cuff tear imaging evaluation: Arthrography

  1. The contrast media travels up and fills subacromial-subdeltoid bursa
  2. The contrast media is confined within joint capsule, sheath of biceps tendon and subscapular bursa

A. Intact RC
B. Complete tear of RC

A
  1. B
  2. A

NOTE: Today, arthrography is recommended only if a patient cannot have an MRI and ultrasound expertise is not available.

21
Q

Dislocation of the GH joint MOI

  1. Direct blow to the front of shoulder or seizures/convulsions
  2. Forceful external rotation and extension while abducted

A. Anterior dislocation
B. Posterior dislocation

A
  1. B
  2. A
22
Q

Associated Fractures of Dislocations of the GH joint

Modified TF
A. A Bankart lesion occurs with the pathology solely within the labrum without osseous damage.
B. If bones are already involved, it is called a Bankart fracture.

A

TT

23
Q

Dislocations of GH joint: Complications

Recurrent anterior shoulder dislocations

  1. Occur in 90% of athletes
  2. Occur in 15% of athletes
  3. Occur in 60% of athletes

A. Age 20
B. Age 30
C. Age 40

A
  1. A
  2. C
  3. B

NOTE: Younger = more chance of recurrent dislocation

24
Q

Dislocations of GH joint: Complications

Modified TF
A. Most recurrences of anterior shoulder dislocation happen within 3 years after initial dislocation.
B. Chronic joint instability can occur, where slight position changes cause dislocations.

A

FT

A: Most recurrences of anterior shoulder dislocation happen within 2 years after initial dislocation.

25
Q

Modified TF
A. Diagnostic ultrasound with appropriate expertise is recommended for soft tissue pathology.
B. Its only limitation is it is operator independent, so it is difficult to diagnose without the MSK ultrasonologist.

A

TF

B: Its only limitation is it is operator dependent, so it is difficult to diagnose without the MSK ultrasonologist.

26
Q

Modified TF
A. MRI is recommended for acute and subacute shoulder pain if initial X-rays are normal and if RC pathology, instability, or labral tears are suspected.
B. CT arthrography is an alternative to MRI if it is contraindicated.

A

TT

27
Q

Dislocations of the GH joint

Modified TF
A. Dislocations of the GH joint are common due to relative lack of bony stability and a large, redundant capsule.
B. This dislocation is the 2nd most common joint dislocation in the body.

A

TF

B: This dislocation is the most common joint dislocation in the body.

28
Q

Dislocations of the GH joint

Modified TF
A. Dislocations of the GH joint are most common in children, followed by young adults, then elderly.
B. For pediatric patients, they may have a fracture but rarely have a dislocation.

A

FT

A: Dislocations of the GH joint are most common in young adults followed by elderly, then children (rare).

29
Q

Adhesive capsulitis imaging evaluation

Modified TF
A. In contrast arthrography, the only amount available to be injected in frozen shoulder is < 10 ml contrast media.
B. The normal amount of contrast media that can be injected in the shoulder is 15 ml.

A

FT

A: In contrast arthrography, the only amount available to be injected in frozen shoulder is < 5 ml contrast media.

30
Q

Adhesive capsulitis imaging evaluation

Modified TF
A. Contrast arthrography is an invasive procedure done that documents a decrease in joint volume.
B. MRI is used to assess capsular thickening.

A

TT

NOTE: There is an absence of contrast media in axillary and subscapular recess.

31
Q

Radiologic Evaluation: Dislocations of the GH joint

Modified TF
A. Posterior shoulder dislocations are difficult to determine on AP views only.
B. The AP view, axillary view, and scapular Y view are used to evaluate shoulder dislocations.

A

TT

32
Q

Radiologic Evaluation: Dislocations of the GH joint

Modified TF
A. CT scan is used to check for humeral head or glenoid impaction fractures, loose bodies, and anterior labral bony avulsion.
B. MRI is used to assess the rotator cuff, capsule, and labrum.

A

TT

33
Q

Radiologic evaluation of AC joint separation

Modified TF
A. The AP view, axillary view, scapular Y view, and bilateral AP views of AC joint with or without weights are used to assess AC joint separation.
B. The bilateral AP views of AC joint with or without weights, in particular, can be used to assess ligamentous injury.

A

TT

34
Q

TRUE OR FALSE: Proximal humerus fractures occur in the elderly population due to osteoporosis, and accounts for 5% of all fractures.

A

True

35
Q

Modified TF
A. The radial artery is the most commonly affected in proximal humerus fractures.
B. Avascular necrosis occurs in 25-30% of patients, especially in 3 part and 4 part fractures and anatomic neck fractures, because the blood supply is in the anatomical neck.

A

FT

A: The axillary artery is the most commonly affected in proximal humerus fractures.

36
Q

Radiologic Evaluation of fractures of the clavicle

Modified TF
A. A CT Scan of the proximal third of the clavicle fracture can help to differentiate the fracture from growth plate or SC joint injury.
B. The distal third is also assessed to identify articular involvement.

A

TT

37
Q

The following are complications of fractures of the scapula, except:

A. Rib fractures
B. Pulmonary contusion and pneumothorax
C. Brachial plexus and vascular avulsions
D. Spinal cord injuries
E. None

A

E. None

NOTE: The serious complications are from associated injuries.

38
Q

Complications of fractures of the scapula

TRUE OR FALSE: A suprascapular nerve injury can result from acromion or scapular neck or body fractures, after a MVA.

A

False, a suprascapular nerve injury can result from coracoid or scapular neck or body fractures, after a MVA.

39
Q

Proximal humerus fracture

Modified TF
A. AP view, scapular Y view, and CT scan are used to evaluate proximal humerus fractures.
B. Neural injury occurs in 6% of fractures, affecting the brachial plexus or axillary artery along the surgical neck.

A

TT

40
Q

Radiologic Evaluation: Fractures of the clavicle

Modified TF
A. A 55º caudal tilt is a variation of the AP view with the central ray angled to project the clavicle above the ribs and scapula.
B. This variation is done to be able to see if the clavicle displaced anteriorly or posteriorly.

A

FT

A: A 45º caudal tilt is a variation of the AP view with the central ray angled to project the clavicle above the ribs and scapula.

41
Q

Radiologic Evaluation: Fractures of the clavicle

TRUE OR FALSE: AP view weighted and unweighted AC joint view can be used to check for abnormalities, especially in the proximal third clavicle with ligamentous injury.

A

False, AP view weighted and unweighted AC joint view can be used to check for abnormalities, especially in the distal third clavicle with ligamentous injury.

42
Q

Trauma at the shoulder MOI

  1. FOOSH in elderly population, high energy trauma in younger population
  2. Child Birth Trauma
  3. Downward force to the acromion from a fall on the shoulder or direct blow
  4. Direct Trauma to the shoulder

A. AC joint separation
B. Rotator cuff tears
C. Glenoid labrum tears
D. Fractures of the clavicle
E. Proximal humerus fracture
F. A, B, C, and D only

A
  1. E
  2. D
  3. A
  4. D
43
Q

Trauma at the shoulder MOI

  1. Ongoing bony pathology like tumors in a young patient without trauma but has a fracture
  2. Forceful abduction
  3. After a GH dislocation
  4. Progressive tendon irritation from repetitive overhead movement
  5. Impingement

A. AC joint separation
B. Rotator cuff tears
C. Glenoid labrum tears
D. Fractures of the clavicle
E. Proximal humerus fracture
F. B and C only

A
  1. E
  2. B
  3. F
  4. B
  5. B
44
Q

Trauma at the shoulder MOI

  1. Forceful lifting
  2. Fall on a flexed elbow
  3. FOOSH (in general)
  4. Repetitive overhead arm movement (swimming, baseball, volleyball)
  5. Traction of the arm

A. AC joint separation
B. Rotator cuff tears
C. Glenoid labrum tears
D. Fractures of the clavicle
E. Proximal humerus fracture
F. A, B, C, and D only

A
  1. C
  2. A
  3. F
  4. C (Repetitive & external impingement of posterior humeral head against RC and labrum)
  5. A

Note: In repetitive overhead arm activities, the biceps tendon is stressed at the superior labral attachment

45
Q

The most commonly fractured bone in the body

A

Clavicle

46
Q

Fractures of the scapula MOI

  1. Associated with dislocations
  2. Especially when there is a direct downward to blow to it
  3. Direct blow to scapula or violent trauma, MVA comprises >50%

A. Body
B. Glenoid
C. Acromion

A
  1. B
  2. C
  3. A
47
Q

Radiologic Findings on Imaging: Impingement Syndrome (Yes or No)

  1. Subacromial proliferation of the bone
  2. Osteophytes on the medial surface of acromion or AC joint
  3. Cysts or sclerosis of greater tuberosity at the RC insertion
A
  1. Yes
  2. No (Osteophytes on the inferior surface of acromion or AC joint)
  3. Yes

(3) Musculoskeletal Imaging (25 decks)

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