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Updated: Sep 3 2021

Shoulder Imaging

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  • 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)
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