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Imaging II > Shoulder > Flashcards

Shoulder Flashcards

1
Q

What makes the shoulder so susceptible to fractures, joint dislocations and soft-tissue cartilage injuries?

A

Less mechanical protection and less bony stability than any other large joint in the body

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2
Q

What radiographs does the ACR recommends for trauma cases to rule out fractures and dislocations?

A

AP and axillary (or scapular Y)

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3
Q

When is an MRI recommended?

A

If initial radiograph is normal and if RTC, instability or labral tear suspected

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4
Q

When is CT recommended?

A

If MR unavailable or contraindicated

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5
Q

When is ultrasound recommended?

A

With appropriate expertise in evaluation of soft tissue pathology

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6
Q

What traumatic events might cause a RTC tear?

A

GH dislocation
Fall on outstretched hand
Forceful abduction of arm

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7
Q

What chronic actions might lead to RTC tears?

A

Progressive tendon irritation from repetitive overhead movements or impingement

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8
Q

What may predispose someone to a rupture even with relatively minor trauma?

A

Degenerative changes in hypovascular region of the cuff (>50 yo)

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9
Q

What is the most common area for a tear?

A

hypovascular critica zone in supraspinatus tendon, 1 cm above its insertion on greater tuberosity

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10
Q

What occurs in an arthrography with a complete tear of the supraspinatus tendon?

A

Contrast medium travels up and fills the subacromial-subdetloid bursa, making it radiopaque

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11
Q

When are arthographies recommended?

A

If patient can’t have MRI and ultrasound not available

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12
Q

Why are MRIs preferred?

A

Noninvasive, provides surgeon with info regarding tendons involved, location, size, quality of torn edges, amount of muscle atrophy and tendon retraction

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13
Q

What are the secondary changes evident on radiographs for a chronic RTC tear?

A

Irregularity of greater tuberosity, may appear flattened, atrophied, sclerotic

Narrowing of distance b/w acromion and humeral head

Erosion of inferior aspect of acromion, changes can include: sclerosis, subchondral cyst formation and loss of bone

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14
Q

What is the treatment for RTC tears?

A 
Conservative = rest, NSAIDS, cortisone
Sugical = most don't heal well with time, require surgery
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15
Q

What is the rehabilitation for RTC?

A

extensive beginning in acute phase with controlled motion and culminating with return to full function in 4-6 months

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16
Q

What complications can occur from RTC injury?

A
  • degenerative joint changes at GH and AC
  • failure to regain full ROM and strength following surgery (impaired scapulohumeral rhythm, chronic tendon irritation/inflammation, poor function)
17
Q

What does SICK stand for?

A

Scapular malposition
Inferior medial border prominence
Coracoid pain and malposition
Dyskinesis of scapula

18
Q

What does SICK present as clinically?

A 
Postero-superior shoulder pain
Anterior shoulder pain
Proximal lateral arm pain
C-spine pain
TOS
19
Q

What are the 3 types of dyskineis?

A 
I = inferior medial scapular prominence
II = medial scapular border prominence
III = superomedial border prominence
20
Q

What are types I and II associated with? Type III?

A

I and II = SLAP lesion

III = impingement and RTC lesion

21
Q

What are the 2 functions of the labrum?

A 
1 = deepen glenoid fossa so humeral head stays in place
2 = serves as attachment site for capsular ligaments and biceps tendon
22
Q

What are the symptoms for a labral tear?

A

Pain worse with overhead movements, clicking or catching, sense of instability

23
Q

How can the labrum be injured acutely?

A

associated with dislocations, forceful lifting manuevers, falls on outstretched hand

24
Q

How can the labrum be injured chronically?

A

Repetitive arm movements, overhead athletes susceptible to biceps tendon stress at superior labrum

Muscle imbalances that decentralize position of humeral head

25
Q

What ligaments does a twisting motion elongate?

A

middle and inferior GH ligaments (anterior band)

26
Q

What is the most appropriate technique for assessing instability and labral tears?

A

MR arthrography, contrast distends joint permitting better visualization

27
Q

What are the second and third options for instability and labral tears?

A

MRI with high resolution and appropriate expertise

CT arthro if MRI contraindicated, not available

28
Q

What is the treatment for labral tears?

A

Conservative = usually works due to rich blood supply

Surgery = avulsions reattached, torn edges debrided, large tears suture repairs, biceps tenodesis performed in patients older than 40 (cut and reattached somewhere else)

29
Q

What is the rehab for labral tears?

A

After repair, rehab delayed 4-6 weeks to allow full healing

Overhead athletes with SLAP can expect 6 months

Imaging II (9 decks)

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