radiography of the shoulder jennifer nicol pgy-1 august 6, 2009
TRANSCRIPT
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Radiography of the Radiography of the ShoulderShoulder
Jennifer Nicol PGY-1August 6, 2009
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ObjectivesObjectivesBRIEF Anatomy ReviewStandard shoulder viewsRadiographs of shoulder injuriesNOT:
◦Treatment◦Other imaging modalities◦Pediatric imaging
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AnatomyAnatomy
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Shoulder ViewsShoulder ViewsOver 15 views of shoulder
describedTrauma series:
◦3 views: AP Trans-scapular “Y-view” Axillary
Modified axillary
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AP viewAP viewTrue AP - 45˚tilt
◦ Glenohumeral joint with no bony overlap
◦ Preferred in traumaAP int/ext rotation
◦ Highlight tuberosities
◦ Soft tissue injuriesClavicle and AC
joint
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Transcapular viewTranscapular viewProjects along
long axis scapulaSimple,
reproducibleGood for
visualising anterior, posterior dislocations
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Acromion Coracoid Body
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Axillary ViewAxillary ViewGlenohumeral
joint in cephalocaudal plane
Lesions of glenoid rim, humeral head, caracoid
Axial view of shoulder
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Modified Axillary ViewModified Axillary View
Reverse axillary when pt can’t abduct
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Retrospective1690 shoulder exams
◦Mod axillary view used 104 times
◦ Identified additional pathology in 30 cases
No comparison b/t standard and modified axillary
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Approach to Shoulder XRApproach to Shoulder XRAP:
◦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)
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Approach to Shoulder XRApproach to Shoulder XROther views:
◦Humeral head to glenoid◦Prox humerus◦Glenoid rim◦Scapula◦Carocoid◦Acromion
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1)GlenoidAlignmentDistancebones
2)ACAlignmentCarocoid-
clavicle space
3)OtherLungs,
scapula, ribs, clavicle
Type I AC injury
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Type III AC injury
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Posterior Dislocation
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Positive Rim Sign
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Trough Sign
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No Mercedes!!!!
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Avulsion Lesser Tuberosity
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Bilateral shoulder dislocation spontaneously reduced with bilateral reverse Hill-Sachs lesions
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Posterior DislocationsPosterior DislocationsHave high suspicion with correct
mechanismDon’t miss – clinical exam
importantLook for associated fracturesTypes:
◦Subacromial (98%)◦Subglenoid◦subspinosus
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Anterior Dislocation
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Scapular View: Anterior Dislocation
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Hill-Sachs deformity
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AP
Bankhart Injury
Axillary
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Greater Tuberosity Fracture
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Anterior DislocationsAnterior Dislocations4 Types
◦Subcoracoid◦Subglenoid◦Subclavicular◦Intrathoracic
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Anterior DislocationsAnterior DislocationsCheck Neurovascular exam pre-
post reductionDon’t delay reduction – NV injury
increases with timeRecurrence high – 80% <30
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Inferior Dislocation
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Subglenoid anterior dislocation
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Pseudodislocation
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