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Differential Diagnosis/Imaging > Shoulder Imaging > Flashcards

Shoulder Imaging Flashcards

1
Q

What body structures/functions are most injured in the shoulder

A
  • Humerus anatomy & fractures
  • RTC (rotator cuff) tear
  • Subacrominal pain syndromes
  • Dislocation
  • AC joint separation
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2
Q

Differential diagnosis for shoulder imaging

A
  • Radiograph = initial study, acute pain, fx, dislocation, calorific tendonitis, arthritides
  • MRI = MRA (arthrogram) = most frequently performed MRI study, glenoid labrum, RTC tear, tendon & bursa pathology, impingement in older adult
  • CT = complex fractures, scapular fx, osseous glenoid fossa, humeral head
  • Ultrasound = equivalent to MRI, bursitis, long head biceps tendinopathy or displacement, impingement in older adult, AC joint integrity, RTC re-tear, tendinopathy of RTC with/out arthroplasty
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3
Q

Shoulder radiograph basic projections

A
  • GH joint (routine series): AP with IR (able to see lesser tuberosity); AP with ER (able to see greater tuberosity), Axillary view, Scapular Y view (anterior oblique view)
  • AC joint: Ap with and w/o weights
  • Scapula: AP, lateral, Y view
  • Trauma series: Axillary view of GH, anterior oblique view
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4
Q

Describe acromiohumeral intervals

A
  • AP view
  • > 12 mm: shoulder dislocation, inferior subluxation
  • 9-10 mm or 8-12 mm = normal
  • 6-7 mm = thinning of supraspinatus tendon
  • <6 mm = supraspinatus tear
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5
Q

What part of the clavicle is the most commonly fractured

A
  • middle 1/3
  • this is due to it being the thinnest part of the bone & it’s the only part of the bone not reinforced by attached musculature & ligaments
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6
Q

What is the typical MOI of an acromion fracture

A
  • result from a downward blow to the shoulder
  • superiorly displaced fractures may occur as a result of a superior dislocation of the shoulder
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7
Q

How are humerus fractures typically treated

A
  • treated with supportive/hanging cast followed by a supportive splint & infrequently require open reduction
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8
Q

Describe the different fracture types of the scapula in an AP view

A
  • Body or spine fracture (40-75%): usually result from a severe direct blow, as in a fall or MVA
  • Coracoid fx (3-13%): coracoid process fractures usually result from a direct blow to the superior point of the shoulder or humeral head in an anterior shoulder dislocation or an avulsion fracture
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9
Q

MOI of a scapula fracture

A
  • requires high energy trauma
  • direct trauma to the shoulder region
  • indirect trauma through falling on outstretched hand (FOOSH)
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10
Q

Describe a Bankart lesion

A
  • fracture of the adjacent anteroinferior glenoid
  • injury commonly occurs in the setting of an anterior glenohumeral dislocation
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11
Q

Describe a Hill-Sachs lesion

A
  • posterolateral humeral head compression fracture
  • typically secondary to recurrent anterior shoulder dislocations, as the humeral head comes to rest against the anteroinferior part of the glenoid
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12
Q

CT scans is diagnosing shoulder injries

A
  • CT is comparable to MR in diagnosing Bankart lesions, Hill-sachs deformities, superior labral anterior to posterior (SLAP) tears, & full thickness RTC tears but is inferior to MR for diagnosing partial thickness RTC tears including burial sided tears
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13
Q

CT scan ABCS for shoulder

A
  • Alignment of anatomy: deviations in alignment signal possible fracture, dislocation, or bone destruction
  • Bone density: assess for any bone destruction, signifying disease or infection
  • Cartilage/joint space: assess the glenohumeral & acronioclavicular joints for smooth chondral surfaces
  • Soft tissues: asses the points of attachment of the rotator cuff tendons to bone
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14
Q

Basic shoulder protocol for MRI

A
  • Alignment/anatomy: asses for disruption at points of soft tissue attachment to bone
  • Bone signal: assess for marrow edema, stress fx, & osteochondral injuries, or define radiographically ambiguous fractures
  • Cartilage: assess for abnormalities at the glenohumeral joint surfaces
  • Edema: the “footprint of injury” edema will image as intermediate signal on anatomy, defining sequences & high signal on fluid sensitive sequences
  • Soft tissues: assess continuity of rotator cuff muscles & tendons; assess the glens-humeral ligaments, 3 thickenings of the anterior capsule
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15
Q

What imaging modality best identifies & discriminates labral lesions in the shoulder

A
  • MRA (MR arthography)
  • Ultrasound and MRI are equivalent in allowing appreciation of focal tendon abnormalities
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16
Q

Appropriate imaging for acute shoulder pain of any etiology

A
  • X-ray
17
Q

Appropriate imaging for radiographs noncontributory, persistent significant pain, physical exam & Hx nonspecific

A
  • MRI shoulder without contrast
18
Q

Appropriate imaging for radiographs noncontributory, age less than 35 yrs, suspect labral tear with or w/o instability on physical exam

A
  • MR shoulder without contrast
19
Q

Appropriate imaging for radiographs noncontributory, questionable bursitis or long head of biceps tenosynovitis based on clinical findings including physical exam

A
  • MRI shoulder without contrast
  • Ultrasound shoulder
20
Q

Appropriate imaging for normal radiograph or radiographs that demonstrate coracoacromial arch osteophytes/syndesmophytes, suspect rotator cuff tear/impingement over age 35 yrs

A
  • MRI shoulder without contrast
  • Ultrasound shoulder
  • MR arthography shoulder
21
Q

Appropriate imaging for radiographs noncontributory, previous total shoulder arthroplasty, suspect rotator cuff tear

A
  • Ultrasound shoulder
  • X-ray arthrography shoulder
  • CT arthrography shoulder
22
Q

Appropriate imaging for radiographs noncontributory, status post prior rotator cuff repair, suspect re-tear

A
  • MRI shoulder without contrast
  • MR arthrography shoulder
  • Ultrasound shoulder
23
Q

Appropriate imaging for radiographs noncontributory, suspect septic arthritis

A
  • Ultrasound arthrocentesis (joint aspiration) shoulder
  • X-ray arthrocentesis shoulder
  • Aspiration is the procedure of choice
  • If clinical concern warrants: MRI shoulder without & with contrast
24
Q

Describe fracture of the proximal humerus

A
  • Fx of surgical neck common in osteoporotic females & typically nondisplaced
  • MOI: ground level falls in elderly, MVA in younger adults
  • Imaging: radiographs for diagnosis; CT may be needed to define complex humeral head fractures
25
Q

Describe a labral tear SLAP lesion

A
  • Due to avulsion, tearing within substance, or tearing in relation to biceps tendon
  • Symptoms: pain worse with overhead movements; clicking, catching, a sense of instability
  • MOI: injured acutely in a fall or dislocation or from repetitive overhead movements
  • Imaging: initial radiographs followed by MR arthrography
26
Q

Describe impingement syndrome

A
  • Mechanical compression of the rotator cuff tendons &/or posterior capsule in subacromial space
  • Symptoms: pain is reproduced with overhead movement
  • Imaging: initial radiographs followed by MRI or MSUS
27
Q

Describe a rotator cuff tear (RTC tear)

A
  • most tears are in the supraspinatus
  • MOI: result from an acute trauma (dislocation, fall, or forced abduction of the arm)
  • Imaging: radiographs to rule out Fx, MRI or MSUS to define tear

Differential Diagnosis/Imaging (20 decks)

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