Updated: 9/3/2021

Shoulder Imaging

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
1
0
0
0%
0%
Evidence
5
0
0
0%
0%
Videos / Pods
2
Topic
Images
https://upload.orthobullets.com/topic/3038/images/complete shoulder series.jpg
https://upload.orthobullets.com/topic/3038/images/scapular y technique_moved.jpg
https://upload.orthobullets.com/topic/3038/images/true ap shoulder techniques_moved.jpg
https://upload.orthobullets.com/topic/3038/images/axillary lateral technique_moved.jpg
https://upload.orthobullets.com/topic/3038/images/supraspinatous outlet view_moved.jpg
https://upload.orthobullets.com/topic/3038/images/zanca imaging techniques_moved.jpg
https://upload.orthobullets.com/topic/3038/images/shoulder imaging ap ir.jpg
https://upload.orthobullets.com/topic/3038/images/shoulder image ap er.jpg
  • Radiographs
    • Complete trauma series
      View
      Focus
      Shoulder AP
      Glenohumeral joint space, DJD
      Grashey view (True AP)
      Glenohumeral joint space, DJD, and proximal migration of humerus
      AP in ER
      Hill Sachs lesion
      AP in IR
      Hill Sachs lesion
      Axillary lateral
      Anterior and posterior dislocation, acromion 
      Velpeau view
      Axillary lateral modification if unable to abduct the arm
      Scapular Y lateral
      Anterior and posterior dislocation
    • Additional views
      View
      Focus
      Supraspinatous Outlet
      Allows classification of acromion (Type I-flat, Type II-curved, Type III-hooked). Hooked acromion is associated with impingement and rotator cuff pathology.
      Zanca
      Help visualize the AC joint. Shows AC joint disease and distal clavicle osteolysis.
      Stryker notch
      Hill-Sachs lesion
      West point axillary
      Anteroinferior glenoid, bony bankart, proximal humerus fx
      Garth
      Anteroinferior glenoid, bony bankart
      Hobbs
      Anterior and posterior sternoclavicular dislocation
      Serendipity
      Anterior and posterior sternoclavicular dislocation
  • Computed Tomography
    • Overview
      • provides better detail of cortical and trabecular bone structures than MRI at cost of higher radiation exposure
      • there for optimal for visualization of bony defects
      • magnification artifacts that are associated with radiographs do not occur with CT
    • Axial Shoulder Images
      • useful to visulaize
        • Reverse Hill Sachs
    • Coronal Shoulder Images
      • useful to visualize
        • fractures
    • Sagittal Shoulder Images
      • useful to visualize
        • anterior-inferior glenoid insufficiency
    • 3D Reconstructions
      • useful to visualize
        • glenoid version for total shoulder arthroplasty
  • Magnetic Resonance Imaging
    • Overview
      • MRI is best for evaluating soft tissue structures and evaluating bone contusions or trabelcular microfractures
      • the stronger the magnet, the higher the intrinsic signal-to-noise ratio (e.g. a 3 Tesla MRI machine has 9x the proton energy of a 1.5 Tesla MRI machine)
    • T1-weighted sequence
      • uses a short repetition time (TR) and short echo time(TE)
        • bright= fat
        • dark= fluid, bone, ligament, bone marrow, and fibrocartilage
      • often combined with MR arthrograms
      • useful to visualize
        • Hill Sachs Lesion
    • T2-weighted sequence
      • uses a long TR and long TE
        • bright= fluid (inflammation) and bone marrow
        • dark= bone, ligament, muscle, and fibrocartilage
      • useful to visualize
        • rotator cuff pathology
          • full thickness tear
    • Short tau inversion recovery (STIR)
      • Fat saturation (e.g. suppression) technique
        • technique that reduces signal from fat and increases signal from fluid and edema
        • helps to determe edema versus fatty infiltration in the rotator cuff muscles
      • useful to visualize
        • rotator cuff pathology
    • ABER (abduction external rotation) position
      • sequence beyond the conventional 3 sequences (coronal, sagittal, and axial)
        • patient places affected hand behind their head instead of a true 90-90 degree abduction-external rotation position
        • position tensions the anteroinferior glenohumeral ligament and labrum and relaxes the capsule
      • useful to visualize
        • Bankart lesions
        • partial- and full-thickness tears of the rotator cuff tendons
        • internal impingement
    • MR arthrogram
      • commonly used to augment MRI to diagnose soft-tissue problems such as SLAP tears
        • dilute gadolinium-containing solution is percutaneously injected into the joint.
      • optimal for
        • labral and ligament pathology
          • Bankart lesion
          • Superior labrum anterior-posterior tear (SLAP)
          • Glenoid labral articular disruption (GLAD)
          • Anterior labral periosteal sleeve avulsion (ALPSA)
          • Humeral avulsion of the glenohumeral ligament (HAGL)

Please rate this review topic.

You have never rated this topic.

Thank you. You can rate this topic again in 12 months.

Flashcards (0)
Cards
1 of 0
Questions (1)

(OBQ11.131) The proton energy produced by a 1.5 Tesla magnetic resonance imaging (MRI) machine most closely approximates what percentage of a 3.0 Tesla machine?

QID: 3554
1

11%

32%

(772/2415)

2

1%

3%

(77/2415)

3

66%

20%

(485/2415)

4

33%

42%

(1008/2415)

5

99%

2%

(55/2415)

L 5 D

Select Answer to see Preferred Response

Evidence (5)
VIDEOS & PODCASTS (2)
EXPERT COMMENTS (9)
Private Note