The Shoulder

Question 1

Why is the shoulder so frequently injured?

Answer 1

A lot of ROM at the shoulder joint with little bony stability (increases susceptibility to injury)

Question 2

What is the most common dislocation at the GH joint?

Answer 2

95% of dislocation at the GH joint are ANTERIOR

Question 3

What are three injuries associated with an anterior GH dislocation?

Answer 3

Hill-Sachs lesion: compression fracture of the posterolateral humeral head sustained during the dislocation

Bankart lesion: detachment of the labrum from the anterior glenoid rim.

Bankart fracture: if there is a bony avulsion of the glenoid rim.

Question 4

What is the imaging study commonly used for initial examination of the shoulder?

Answer 4

Radiographs (x-ray)

Question 5

List 4 pathologies an X-ray can identify at the shoulder.

Answer 5

1. Fractures
2. Dislocations
3. Calcific tendinitis
4. Arthritis

Question 6

What are CT scans primarily used to visualize at the shoulder?

Answer 6

Optimal visualization of complex fractures, especially in characterizing fracture/dislocations of the humeral head

Question 7

List 5 soft tissue abnormalities at the shoulder that can be visualized by an MRI.

Answer 7

1. Glenoid labrum tears
2. Rotator cuff tears
3. Impingement syndromes
4. Instability
5. Tendon and bursa abnormalities.

Question 8

What joint is MRI most frequently performed on?

Answer 8

SHOULDER

Question 9

List 3 pathologies for which musculoskeletal ultrasound (MSUS) equally evaluates at the same level of using MRI.

Answer 9

1. Bursitis
2. long head of the biceps tenosynovitis
3. Re-tears of prior surgical rotator cuff repairs.

Question 10

What pathology is musculoskeletal ultrasound (MSUS) better at visualizing compared to MRI?

Answer 10

Rotator cuff tears after total shoulder arthroplasty

Question 11

What are 2 available imaging guidelines?

Answer 11

1. Appropriateness Criteria

2. Diagnostic Imaging Pathways

Question 12

What 4 projections make up the routine radiologic examination of the shoulder?

Answer 12

1. a. AP ER
2. AP IR
3. Axillary view
4. Scapular Y view

Question 13

What 2 sequences are included in the MRI protocol of the shoulder?

Answer 13

Anatomy-defining sequences (T1)

Fluid-sensitive sequences (T2)

Question 14

What is an MR arthrography?

Answer 14

Contrast is injected into the GH joint prior to MRI examination

Question 15

What are the ABCDs of MRI?

Answer 15

1. Alignment/Anatomy
2. Bone signal
3. Cartilage
4. eDema
5. Soft tissue

Question 16

When are CT scans used at the shoulder?

Answer 16

1. Modality of choice for most skeletal conditions
2. When structural or spatial information of the bones and joint articulations is needed. 

3. To visualize any condition typically evaluated by MRI if MRI is unavailable or contraindicated

Question 17

What are the 5 CT imaging principles (radiolucent to radiopaque)?

Answer 17

1. Air: black
2. Fat: gray black
3. Water (soft tissues): gray
4. Bone: gray white
5. Contrast medium  brightest shade of white

Question 18

What are the ABCs of CT scans?

Answer 18

1. Alignment
2. Bone Density
3. Cartilage
4. Soft tissue