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IMAGING > Shoulder > Flashcards

Shoulder Flashcards

S2Q2

1
Q

SHOULDER:

shoulder complex (3)
GHJ ACJ SCJ STJ

A

JOINTS
- shoulder complex: scapula clavicle humerus
- GHJ: glenoid fossa, prox humerus
- ACJ: acromion clavicle
- SCJ: sternum clavicle
- STJ: scapula, thoracic wall

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2
Q

SHOULDER: Ligaments

GH - (3), reinforcement, weak, common dislocation (2)

coracohumeral - reinforcement

coracoclavicular

acromioclavicular

A

GH LIGAMENT
- sup mid inf
- anterior reinforcement
- weak inf = common disloc in antinf, ant

CORACOHUMERAL LIGAMENT
- superior reinforcement

CORACO-CLAVICULAR LIGAMENT
- primary ACJ stabilizer

ACROMIOCLAVICULAR LIGAMENT
- ACJ capsule

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3
Q

SHOULDER: Radiograph

x cuts - see (2)

easier dx - parallel vs. perpendicular view (2.2)

A
  • oblique cuts: anatomy, supraspinatus

easier dx
- parallel view: continuity, tear
- perpendicular: cross-sectional, atrophy

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4
Q

SHOULDER: Radiograph

shoulder AP ER - see (4), pathology (2)

AP IR - see

A

SHOULDER AP ER VIEW
- see: proximal 1/3 of humerus, lat 2/3 of clavicle, acromion, upper scapula
- >5mm = effusion
- deposits in supraspinatus = calcific tendinitis

AP IR VIEW
- same but GT inside instead of lesser tuberosity

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5
Q

SHOULDER: Radiograph

upright - see (4), other version use what

AP - see

lateral - see

which best for scapula

A

UPRIGHT AP VIEW C/S WEIGHTS
- see: entire clavicle, (B) ACJ, GHJ, SCJ
- stress view: use 10-15lbs

AP VIEW
- see: entire scapula (medial only superimposed by lungs & ribs)

LATERAL VIEW
- best for scapula since no superimposition

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6
Q

SHOULDER: Radiograph

axillary - see (3), west point, for

scapular y - other name, see (3), for

A

AXILLARY VIEW OF GHJ
- see: glenoid fossa, GHJ, coracoid process
- west point view: prone
- for: glenoid x humerus relationship in dislocation

ANT OBLIQUE / SCAPULAR Y LATERAL
- acromion coracoid, scapula
- upright; for painful supine

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7
Q

SHOULDER: CT

indications (3.2)

protocol - from to (2)

axial scan, oblique sagittal, oblique coronal, 3D reconstruction (from + 2 purpose)

A

indications
- trauma, displaced fx, loose bodies
- if no MRI: labrum & cuff

basic CT protocol
- GHJ to prox humeral shaft diaphysis
- scapula to deltoid (sagittal)

  • axial scan: perpendicular to humeral shaft
  • oblique sagittal: parallel to glenoid fossa
  • oblique coronal: parallel to supraspinatus
  • 3D reconstruction: from axial + can isolate bones, for complex fx
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8
Q

SHOULDER: CT

anatomy - view, axial vs. sagittal see (2.1)

bone density - pathology (3=1)

cartilaginous space - see (3), smooth shit best in what view

soft tissue - see what + where

A

ALIGNMENT & ANATOMY
- best view: sagittal
- axial: glenoid fossa x humeral head
- sagittal: configuration of acromion

BONE DENSITY
- cyst, hypertrophy, sclerosis = radiolucent

CARTILAGINOUS SPACE
- encroachment at subacromial space, ACJ irregularities, free fx fragments
- smooth chondral surface of GHJ space: axial or sagittal

SOFT TISSUE
- check: avulsion injury in rotator cuff insertion

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9
Q

SHOULDER: CT

axial plane - see (3) + d/t, bankart structure

A

AXIAL PLANE
- GHJ
- bony irregularities at GT d/t avulsion fx
- bony resorption at GT lack of normal tension from rotator cuff d/t tear
- bankart: glenoid rim

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10
Q

SHOULDER: CT

coronal plane - see (5)

A

CORONAL PLANE
- infsup labrum
- GHJ surface, GT, glenoid rim
- acromion, subacromial joint space

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11
Q

SHOULDER: MRI

axial obliques - T1 vs. T2

A

AXIAL
- proton density
- T2 fat saturated

OBLIQUE SAGITTAL
- T1
- inversion recovery

OBLIQUE CORONAL
- proton density
- inversion recovery

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12
Q

SHOULDER: MRI

anatomy - best view

bone signal - if (2) = what

edema - what, where + condition

soft tissue - signal, pathology (1=1)

A

ANATOMY
- sagittal

BONE SIGNAL
- if white/hyper = abnormal

EDEMA
- footprint of injury
- under coracoacromial arch in impingement syndrome

SOFT TISSUE
- inflam = inc signal
- RA = synovial cyst

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13
Q

SHOULDER: MRI

axial plane - see (1.2) (3)

A

AXIAL PLANE
- biceps tendon at cross-sectional, subscapularis & teres minor at longitudinal
- antpos labrum
- GHJ, GH ligaments

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14
Q

SHOULDER: MRI

oblique sagittal - see (2) (3)

A

OBLIQUE SAGITTAL PLANE
- subscapularis & teres minor at cross-sectional
- GH ligament, acromion, coracohumeral lig & arch

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15
Q

SHOULDER: MRI

oblique coronal - view (2) (4)

A

OBLIQUE CORONAL PLANE
- subscapularis & teres minor at cross-longitudinal
- GHJ, ACJ
- subacromial/subdeltoid bursa
- supinf labrum

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16
Q

SHOULDER:

MR arthrography - purpose, see (4)

A
  • intra-articular distention
  • overcrowded structure: labrum, GHL, biceps anchor, supraspinatus tear
17
Q

SHOULDER: Conditions

x-ray - views (3)
MRI - for/see (3)
CT arthro - purpose
US - for/see (2)

A

x-ray
- AP, axillary, Y lateral
- MRI: labrum, acute subacute shoulder pain c normal x-ray, rotator cuff
- CT arthrography: MRI sub
- US: soft tissue, dynamic

18
Q

SHOULDER: Conditions - Proximal Humeral Fx

epidemiology (age + d/t)

MOI (1.1)

classification - parts (4), (2)

complications - (3), specific condition is seen in what (2)

A
  • epi: elderly d/t osteoporosis
  • MOI: FOOSH (old), high energy trauma (young)

classification
- near four-part anatomic: humeral head, GT, LT, humeral shaft at surgical neck level
- 1 part fx = non-dislaced
- 2-3 part fx = displaced

complications
- avascular necrosis: 3-4 part fx, surgical neck
- axillary artery, axillary nerve, brachial plexus

19
Q

SHOULDER: Conditions - Clavicular Fx

MOI (3)

classification - by, (3)

radio - extra thing is what + purpose, CT purpose

A
  • MOI: FOOSH, direct trauma on shoulder, childbirth trauma

classification
- by location
- middle third > distal third > proximal third

radiograph
- 45 caudal tilt: AP variation; clavicle on top of ribs & scapula
- CT: ddx

20
Q

SHOULDER: Conditions - Scapular Fx

MOI (2.1.1)

classification - (1.2.2)

complications - d/t (5), x nerve is d/t what fx (2)

A

MOI
- body of scapula: direct trauma, MVA
- acromion: direct downward blow
- glenoid: dislocation

classification
- type I: scapular body
- type II: apophyseal fx including acromion & coracoid
- type III: suplat angle including glenoid fossa & neck

complications
- d/t associated injuries: rib fx, pneumothorax, pulmonary contusion, SCI, brachial plexus
- suprascapular nerve: coracoid or scapula fx

21
Q

SHOULDER: Conditions - GHJ

epidemiology - common d/t (2), age (3)

MOI - ant vs. pos (2.2)

classification - by, (4)

associated fx - hill sachs, bankart fx, bankart lesion

radio - x is hard in what AP, CT see (2)

complications - recurrence of x type

A

epidemiology
- most common joint
- common d/t large capsule, no bony stability
- young>elder>kid

MOI
- ant: forceful ER EXT in ABD
- pos: direct trauma on ant shoulder, seizure

classification
- by direction of humeral head
- sup inf ant pos

associated fx
- hill sachs lesion: compression fx on poslat humeral head
- bankart fx: glenoid rim
- bankart lesion: labrum

radiograph
- pos dislocation: hard in AP
- CT scan: impaction, loose bodies

complications
- ant recurrence: 2y

22
Q

SHOULDER: Conditions - ACJ

MOI (4)

classification - by, (3)

A
  • MOI: downward force on acromion, arm traction, FOOSH, fall on extended elbow

classification
- by degree of coracoclavicular ligament disruption
- mild mod severe

23
Q

SHOULDER: Conditions - RC

MOI (5)

classification - critical zone what + where, (2)

radio - if (2=1), if (2=1), irregularity of x = (3), narrowed distance between (2) is d/t (2)

complications (2)

A
  • MOI: FOOSH, impingement, GH dislocation, forceful ABD, overhead

classification
- critical zone: hypovascular area 1cm proximal to supraspinatus insertion (GT)
- complete vs. incomplete

radiography
- if contrast media stays in joint or biceps tendon = intact
- if contrast media go up to subacromial/subdeltoid bursa = complete tear

  • irregularity of GT: flat, atrophy, sclerosis
  • narrowed distance between acromion & humeral head: atrophy, unopposed deltoid

complications: GHJ ACJ arthritis

24
Q

SHOULDER: Conditions - Labral Tear

MOI (3), (1=2G)

classification - structure fx d/t, structure + age, condition

A

MOI
- FOOSH, GH dislocation, forceful lift
- repetitive overhead = biceps tendon stress against sup labrum + repetitive impinge of pos humeral head against cuff & labrum

classification
- group 1: glenoid rim avulsion fx d/t acute trauma
- group 2 labrum, >40y
- group 3: SLAP tear (biceps stress)

25
Q

SHOULDER: Conditions - Impingement

external - (1) in what + when

internal - (2) in (2) + d/t

radio - exam, findings (3) + where (0.2.1)

A
  • external impingement: compress rotator cuff in supraspinatus outlet when elevating arm
  • internal impingement: pos capsule & cuff between glenoid fossa & humeral head d/t overhead

radiograph
- hx & PE >
- subacromial proliferation of bone
- osteophytes at inf acromion & ACJ
- cyst or sclerosis of GT at cuff insertion

26
Q

SHOULDER: Conditions - AdCaps

pathology + structure

classification - cause age sex, d/t (2)

stages - when pain (2), sx (2), sx (1)

radio - x’s findings (1.2), MRI see (1)

A
  • chronic inflammatory fibrosis of GHJ capsule

classification
- primary: idiopathic, >50y, F>M
- secondary: trauma, prolonged immob

stages
- acute painful (3-8m): at rest or night
- adhesive (4-6m): inc stiff dec pain
- recovery (1-3m): LOM

radiograph
- contrast arthrography: joint vol is <15mL of contrast media, no media in axillary & subscapular recess
- MRI: capsular thickening

27
Q

SHOULDER: Conditions - Labrum

ALPSA, POLPSA, McLaughlin, hill sachs - d/t + associated dislocation

A

anterior labral periosteal sleeve avulsion
- d/t ant dislocation

posterior labral periosteal sleeve avulsion
- d/t pos dislocation

mclaughlin
- d/t impaction on ant humeral head
- associated with pos dislocation

hill sachs
- d/t impaction on pos humeral head
- associated with ant dislocation

IMAGING (8 decks)

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