Radiologic Shoulder Eval

Question 1

List indications for routine radiologic exam at the shoulder complex

Answer 1

1. trauma
2. bone involvement with metabolic diseases/systemic disease/nutritional deficiencies
3. neoplasms
4. infection
5. arthropathy
6. pre-op/post-op
7. suspected congenital/developmental abnormality
8. vascular lesions
9. foreign body/soft tissue lesion
10. pain
11. correlation with other studies

Question 2

list the views taken during a routine radiologic exam of the shoulder complex

Answer 2

1. Shoulder
   
   1. AP External rotation
   2. AP Internal rotation
2. AC joint
   
   1. Upright AP
      
      1. stability → one with weights ties to wrists, another without weights
3. Scapula
   
   1. AP
   2. Lateral
4. Others
   
   1. Axillary View of the GH joint
   2. Scapular “Y”

Question 3

in what radiologic view can the lesser tuberosity of the humerus be seen?

Answer 3

AP Internal rotation view

Question 4

what is the purpose of the AP, bilateral with and without weights, view?

Answer 4

allows the radiologist to observe the degree of separation at the shoulder while holding onto weights

too much separation may indicate an unstable AC joint

spatial relationships observed → coracoclavicular distance and AC joint space distance

Question 5

which radiologic view is used to best appreciate the body of the scapula?

Answer 5

AP of the scapula

Question 6

what is the axillary view of the GHJ used for?

Answer 6

looking at the orientation of the humeral head in relation to the glenoid fossa which is helpful when evaluating for dislocations

1. It is an inferior axial projection
2. spatial relationships can be observed → humeral head to glenoid fossa
3. continuity/structures
   
   1. rim of glenoid fossa
   2. coracoid process

Question 7

what type of imaging study is first line for most shoulder patholgies?

Answer 7

X-ray

Question 8

list 3 generalizations with advanced imaging of the shoulder

(SHORT generalizations for when you would use radiographs vs. CT vs. MRI)

Answer 8

1. Radiographs typically first study with suspected bone and soft tissue injuries
2. CT with complex fractures and to assist with surgical decisions
3. MRI when results are anticipated to effect treatment decisions

Question 9

list general indications for CT of the shoulder

Answer 9

1. severe trauma
2. assessing fracture alignment/displacement
3. ID loose bodies in GHJ
4. If MRI contraindicated, rotator cuff pathology and other health conditions for which MRI is typically indicated

Question 10

list the planes/views with CT-scans of the shoulder

• what is oblique sagittal parallel to?*
• what is oblique coronal parallel to?*

Answer 10

1. Axial
2. Oblique sagittal → parallel to glenoid fossa
3. Oblique coronal → parallel to supraspinatus

Question 11

what is best seen in the axial view of a shoulder CT? (5)

Answer 11

1. Glenohumeral articulation
2. Articular cartilage injury
3. Avulsions at greater tubercle
4. Bankart lesions
5. Hill-Sach’s lesions

Question 12

what is best seen in the oblique sagittal view of a shoulder CT?

Answer 12

1. ACJ degeneration
2. Subacromial space
3. Acromion morphology

Question 13

what is best seen in the oblique coronal view of a shoulder CT?

Answer 13

1. Labrum
2. GH joint surfaces
3. Glenoid rim
4. Greater tubercle
5. Subacromial space
6. Acromion morphology

Question 14

what are MRIs of the shoulder generally indicated for?

Answer 14

1. soft tissue injuries
2. infections
3. vascular conditions
4. neurologic conditions
5. staging/monitoring certain health conditions → frozen shoulder, inflammatory arthropathy, etc.
6. a number of clinical scenarios

Question 15

list clinical scenarios at the shoulder that require and MRI

Answer 15

1. chronic/unexplained shoulder pain
2. acute trauma
3. GHJ instability
4. Impingement syndrome
5. mechanical symptoms
6. limited/painful ROM
7. swelling/mass/atrophy
8. planned arthroscopy
9. residual symptoms following surgery

Question 16

list the 2 ACR appropriateness criteria for imaging at the shoulder

Answer 16

1. Shoulder pain - atraumatic
2. Shoulder pain - traumatic