Shoulder

Question 1

AP external rotation

Answer 1

• places greater tuberosity in picture GH space averages 5 mm 5 mm effusion or dislocation

Question 2

AP internal rotation

Answer 2

• places lessor tuberosity in picture musculocutaneous attachments could be screened for avulsions or bone destruction

Question 3

Axillary view

Answer 3

• helps determine the exact relationship of humeral head to glenoid fossa in evaluating GH jt dislocation
• cocacoid also well defined views through arm pit

Question 4

anterior oblique view

Answer 4

• scap view is used to assess fracrure or dislocations of prox humerus and scap advantage: pts arm in neutral

Question 5

MRI indications

Answer 5

• RTC pathology
• long head of the biceps pathology
• glenoid labrum pathology
• impingement syndromes
• loose bodies
• neoplasms or infections of bone, soft tissue, or joint

Question 6

MRI orthogonal planes

Answer 6

• axial-* top to bottom (long head of biceps, subscap muscle and tendon, labrum, capsule and GH ligaments, GH jt)
• oblique coronal*- frontal (supraspinatus endon bursa, ac jt, acromion, subacromial/subdeltoid bursa, labrum, and GH jt)
• oblique sagittal*- L and R (rotator intervals, coracoacromial ligament, ac jt, bone marrow)

Question 7

MR arthorogram

Answer 7

• MOST specific test for labral tears
• Good for diagnosing RTC tears

Question 8

Indications for CT of shoulder

Answer 8

• severe trauma alignment and displacement of fracture fragments
• loose bodies in GH jt
• used for soft tissue eval if MRI contraindicated
• same orthogonal planes as MRI

Question 9

MSUS indications of shoulder

Answer 9

• define tears, tendinosis, and/or calcification of RC muscles
• eval subacromial/subdeltoid bursa
• eval biceps tendon
• assess ac jt laxity
• differentiate effusion
• guide needle aspiration of the joint

Question 10

Fractures of the proximal humerus

Answer 10

• Neutral AP and scapular Y lateral is sufficient for eval
• Complex fractures may require a CT

Question 11

Fractures of the clavicle

Answer 11

• An AP view as well as a 45 deg caudal tilt sufficient
• Distal third fractures may require a weighted and unweighted CT of the AC joint

Question 12

Fractures of the scapula

Answer 12

• Rare injury.
• Direct blow or violent trauma
• AP, axillary, and scapular Y lateral view for most scap fractures
• CT might be needed to assess glenoid

Question 13

GH dislocations

Answer 13

• AP, axillary, and scapular Y lateral views to determine exact relationship of humeral head to glenoid fossa
• CT to check for loose bodies, impact ion fractures, and avulsions
• MRI to assess injury to RC, capsule, and labrum

Question 14

AC joint separation

Answer 14

• Bilateral AP views of the AC joints, with and without weights to assess ligament injury

Question 15

Rotator cuff tears

Answer 15

• Arthrography is recommended only if the patient cannot have an MRI or US expertise not available available

Question 16

Glenoid Labrum tears

Answer 16

• MR arthrography is the most appropriate procedure to assess suspected instability and labral tears
• Contrast gives a better visualization of the labrum, capsular structures, and underside of the Rotator cuff
• US is great to view biceps tendon abnormalities assoc with labral tears

Question 17

Impingement syndrome

Answer 17

• MRI or diagnostic US can identify various assoc soft tissue pathologies- bursitis, tendinitis, and tears of RC and labrum

Question 18

Routine radiograph eval of the shoulder

Answer 18

• AP view with arm ER
• AP view with arm IR

Question 19

Routine radiograph eval of the AC joint

Answer 19

• Bilateral AP with and without weights

Question 20

Routine radiograph eval of the scapula

Answer 20

AP Lateral

Question 21

Advanced imaging with CT and MRI

Answer 21

• Planes: axial, oblique sagittal, and oblique coronal
• CT-ABCs
• MRI- ABCDs.
• T1 to define anatomy and T2 to highlight pathology

Question 22

Trauma imaging

Answer 22

• AP with arm in neutral, axillary view of the GH jt, and ant oblique (scapular Y lateral view)
• MRI recommended for acute and subacute shoulder pain if initial radiographs normal and if RC pathology, instability, or labral tears suspected