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Radiography of the Shoulder

Radiography of the Shoulder. Jennifer Nicol PGY-1 August 6, 2009. Objectives. BRIEF Anatomy Review Standard shoulder views Radiographs of shoulder injuries NOT: Treatment Other imaging modalities Pediatric imaging. Anatomy. Shoulder Views. Over 15 views of shoulder described

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Radiography of the Shoulder

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  1. Radiography of the Shoulder Jennifer Nicol PGY-1 August 6, 2009

  2. Objectives • BRIEF Anatomy Review • Standard shoulder views • Radiographs of shoulder injuries • NOT: • Treatment • Other imaging modalities • Pediatric imaging

  3. Anatomy

  4. Shoulder Views • Over 15 views of shoulder described • Trauma series: • 3 views: • AP • Trans-scapular “Y-view” • Axillary • Modified axillary

  5. AP view • True AP - 45˚tilt • Glenohumeral joint with no bony overlap • Preferred in trauma • AP int/ext rotation • Highlight tuberosities • Soft tissue injuries • Clavicle and AC joint

  6. Transcapular view • Projects along long axis scapula • Simple, reproducible • Good for visualising anterior, posterior dislocations

  7. Acromion Coracoid Body

  8. Axillary View • Glenohumeral joint in cephalocaudal plane • Lesions of glenoid rim, humeral head, caracoid • Axial view of shoulder

  9. Modified Axillary View • Reverse axillary when pt can’t abduct

  10. Retrospective • 1690 shoulder exams • Mod axillary view used 104 times • Identified additional pathology in 30 cases • No comparison b/t standard and modified axillary

  11. Approach to Shoulder XR • AP: • If ext/int rotation look at tuberosity orientation • Glenohumeral region • Alignment • Distance b/t humeral head and glenoid • Bones • AC region • Other regions (clavicle, ribs, scapular spine,lungs)

  12. Approach to Shoulder XR • Other views: • Humeral head to glenoid • Prox humerus • Glenoid rim • Scapula • Carocoid • Acromion

  13. Type I AC injury • Glenoid • Alignment • Distance • bones • AC • Alignment • Carocoid-clavicle space • Other • Lungs, scapula, ribs, clavicle

  14. Type III AC injury

  15. Posterior Dislocation

  16. Positive Rim Sign

  17. Trough Sign

  18. No Mercedes!!!!

  19. Avulsion Lesser Tuberosity

  20. Bilateral shoulder dislocation spontaneously reduced with bilateral reverse Hill-Sachs lesions

  21. Posterior Dislocations • Have high suspicion with correct mechanism • Don’t miss – clinical exam important • Look for associated fractures • Types: • Subacromial (98%) • Subglenoid • subspinosus

  22. Anterior Dislocation

  23. Scapular View: Anterior Dislocation

  24. Hill-Sachs deformity

  25. Bankhart Injury AP Axillary

  26. Greater Tuberosity Fracture

  27. Anterior Dislocations • 4 Types • Subcoracoid • Subglenoid • Subclavicular • Intrathoracic

  28. Anterior Dislocations • Check Neurovascular exam pre-post reduction • Don’t delay reduction – NV injury increases with time • Recurrence high – 80% <30

  29. Inferior Dislocation

  30. Subglenoid anterior dislocation

  31. Pseudodislocation

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