Shoulder radiography

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Shoulder radiography

  1. 1. Shoulder Radiography
  2. 2. Shoulder anatomy• 3 bones: – Humerus – Scapula – Clavicle• 3 joints: – Glenohumeral – Sternoclavicular – Acromioclavicular
  3. 3. Scapula Anatomy Coracoid• Scapula: – Glenoid – Acromion – Coracoid
  4. 4. Scapula Lateral (Y) view
  5. 5. Routine (transthoracic) AP view of the shoulder• AP relative to thorax• Suboptimal view of glenohumeral joint• Good view of AC joint
  6. 6. Scapular/Glenohumeral AP view (aka Oblique view)• Better visualize Glenohumeral joint/space• Suboptimal view of AC joint
  7. 7. Normal AP view
  8. 8. Normal oblique Glenohumeral space
  9. 9. Lateral Scapula “Y” view• Evaluate relationship of humeral head with glenoid – Humeral head should be at bifurcation of the Y
  10. 10. Axillary view• Not routinely performed• Good for evaluating anterior-posterior relationship of glenohumeral joint
  11. 11. Quiz time Diagnosis?AP and Y view
  12. 12. Anterior dislocation
  13. 13. Anterior dislocation• Make up 96% of all shoulder dislocations• May be associated with: – Fracture of greater tuberosity (15%) – Bankart lesion • Fracture of anterior glenoid rim – Hill-Sachs defect (50%) • Impaction fracture of posterolateral humeral head 2/2 impaction of humeral head against glenoid during dislocation
  14. 14. Bankart and Hill-Sachs Hill Sachs deformity
  15. 15. Diagnosis?AP view – not too revealing…
  16. 16. Same patient, axillary and Y views
  17. 17. Answer: posterior dislocation
  18. 18. Posterior dislocation• Makes up about 2-4% of dislocations, may be associated w/ convulsive seizure (boards question)• Common Xray findings: – Rim sign (66%) = distance between medial border of humeral head and anterior glenoid rim >6 mm – Lightbulb sign = Humeral head held in internal rotation, appearing bulb-like on AP view – Trough sign (75%) = "reverse Hill-Sachs" = compression fracture of anteromedial humeral head
  19. 19. Posterior dislocation Lightbulb signTrough sign Rim sign
  20. 20. Diagnosis?
  21. 21. Inferior dislocation, “LuxatioErecta” Accounts for 1-2% of shoulder dislocations, Arm often held above head Results from severe hyperabduction of arm
  22. 22. Diagnosis?
  23. 23. Acromioclavicular separation, grade III
  24. 24. AC separationTreatment:Grade I-II: always conservativeGrade III: usually conservative,surgical in few cases (youngathlete, laborer who does a lotof lifting, etc)Grade IV-VI: surgical
  25. 25. Diagnosis?
  26. 26. Clavicle fracture Fracture80% of fractures in middle third, 15% in distal third, 5% medial thirdTreatment mostly conservativeSurgical mgmt if open fracture, severe skin tenting, neurovascular injury orseverely comminuted/displaced fractures
  27. 27. • Great site for x-ray cases:• http://www.feinberg.northwestern.edu/emer gencymed/residency/ortho- teaching/shoulder/

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