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633: Human Imaging II > Shoulder > Flashcards

Shoulder Flashcards

1
Q

The shoulder region possesses less mechanical _____ and less bony _____ than any other large joint in body

A

protection

stability

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2
Q

What 2 radiographic views are recommended as an initial study for all trauma cases to the shoulder?

A
  • AP

- Axillary or scapular Y

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3
Q

When is an MRI of the shoulder recommended?

A

For acute and subacute shoulder pain if the initial radiograph is normal, or RC pathology, instability, or labral tears are suspected

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4
Q

When is a CT of the shoulder recommended?

A

When the MRI is unavailable or contraindicated

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5
Q

The 4 tendons of the RC muscles fuse to form what?

A

The fibrous capsule of the GH joint

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6
Q

RC tears may result for what 3 MOIs?

A
  • GH dislocation
  • Fall on outstretched hand
  • Forceful abduction of arm
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7
Q

What is a non-traumatic MOI for a RC tear?

A

Progressive tendon irritation caused by repetitive overhead movements or impingement

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8
Q

Where does the most common RC tear occur?

A

In the hypovascular critical zone of the supraspinatus tendon 1 cm above its insertion on greater tuberosity

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9
Q

How are complete RC tears diagnosed via radiographs (arthrography)?

A

A complete RC tear will allow the contrast medium to travel up through the tear and fill the subacromial-subdeltoid bursa, this causes the bursa to be radiopaque

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10
Q

How are incomplete RC tears diagnosed via radiographs (arthrography)?

A

There is a collection of contrast medium at the tear site

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11
Q

When is an arthrography recommened in the diagnosis of a RC tear?

A

Only when the patient cannot have MRI and ultrasound expertise is not available

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12
Q

What are the 3 secondary changes in chronic RC tears that are evident on radiographs?

A

1) Irregularity of the greater tuberosity
2) Narrowing of the distance between the acromion and humeral head
3) Erosion of the inferior aspect of the acromion

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13
Q

How may the greater tuberosity appear in chronic RC tears? Why?

A

Flattened, atrophied, or sclerotic because of the rupture of the supraspinatus tendon and lack of traction stress at insertion site.

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14
Q

What are the 2 reasons why there is a narrowing of the distance between the acromion and humeral head in chronic RC tears?

A
  • There is atrophy of the cuff muscles

- The weak RC muscles do not oppose the pull of the deltoid muscle

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15
Q

In chronic RC tears the humeral head migrates ____.

A

superiorly

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16
Q

The upward migration of the humeral head may cause changes to what bony structure?

A

The acromion

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17
Q

What are most complications following a RC tear due to?

A

Degenerative changes at the GH and AC joints

18
Q

Failure to regain full ROM and strength following RC repair surgery can lead to what?

A
  • Impaired scapulohumeral rhythm
  • Chronic tendon irritation and inflammation
  • Poor function
19
Q

A “SICK” scapula may develop following RC tear, what does this stand for?

A 
S = Scapular malposition
I = Inferior medial border prominence
C = Coracoid pain and malposition
K = DysKinesis of the scapula
20
Q

Describe the positioning of a “SICK” shoulder

A

It sits inferior, lateral, and is upwardly rotated

21
Q

A “SICK” scapula represents with pain in what 4 distributions?

A
  • Postero-superior scapular pain
  • Anterior shoulder pain
  • Proximal lateral arm pain
  • C-spine pain
22
Q

What are the 3 types of scapular dyskinesis?

A
  • Type I: Inferior medial scapular prominence
  • Type II: Medial scapular border prominence
  • Type III: Superomedial border prominence
23
Q

Type I and type II scapular dyskinesias are associated with what?

A

SLAP lesions

24
Q

Type III scapular dyskinesia is associated with what?

A

impingement and rotator cuff lesions

25
Q

What are the 2 basic functions of the labrum?

A
  • deepen the glenoid fossa so the humeral head stays in place
  • serve as attachment site for capsular ligaments and the biceps tendon
26
Q

What are the symptoms of a labral tear?

A
  • pain that is worse with overhead movements
  • clicking or catching
  • sense of instability
27
Q

What are the 3 acute MOIs for a labral tear?

A
  • dislocation
  • forceful lifting manuever
  • fall on an outstretched hand
28
Q

What can also injure the labrum?

A

Repetitive movements of the arm, especially in overhead athletes

29
Q

What aspects of the labrum are susceptible to injury in overhead athletes?

A

Biceps tendon stress at the superior labral attachement as well as repetitive impingement of the posterior humeral head against the rotator cuff and labrum

30
Q

The action of throwing overhand includes high velocity abduction and ER rotation during the cocking phase, which ligaments are twisted and elongated?

A

The middle GH ligament and anterior band of the inferior GH ligament

31
Q

The active motion produce during the cocking phase of throwing tends to translate the humeral head _____, toward what structures?

A

anteriorly, toward the anterior glenoid labrum and the subscapularis muscle

32
Q

Other than overhead throwing, what may be cause abnormal shear forces at labrum?

A

Muscle imbalances that decentralize the position of the humeral head within the glenoid fossa which can trigger a cascade of abnormal shoulder biomechanics

33
Q

What is the most appropriate procedure to assess suspected instability and labral tears?

A

An MR anthrography

34
Q

What is an advantage of MR anthrology in detecting labral pathologies?

A

The contrast medium distends the joint permitting better visualization

35
Q

What is the second procedure of choice when assessing suspected instability and labral tears?

A

CT arthrography

36
Q

How are labral tears treated?

A

Conservatively, due to the rich blood supply to the labrum

37
Q

What are 3 surgical interventions for labral tears?

A
  • Avulsions are reattached to glenoid rim with sutures and anchors
  • Torn edges of minor tears debrided, whereas.large tears require suture repair
  • Biceps tenodesis surgery
38
Q

When are biceps tenodesis performed

A

In patients with labral tears over the age of 40

39
Q

Describe the procedure behind a biceps tenodesis

A

The biceps is cut from where it attaches to labrum and reinserted into another area on the labrum

40
Q

How long can overhead athletes with SLAP repairs expect to be out?

A

6 months

633: Human Imaging II (11 decks)

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