Imaging of the shoulder - Premier Radiology Services...Shoulder MRI • Question: –Rotator Cuff...
Transcript of Imaging of the shoulder - Premier Radiology Services...Shoulder MRI • Question: –Rotator Cuff...
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Imaging of the shoulder
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Overview
• X-Ray techniques of the Shoulder
• CT Arthrogram
• MRI of the shoulder
• MR Arthrogram
• Ultrasound of the Shoulder
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X-ray Techniques
• Internal rotation
• External rotation
• Axillary view
– Stryker notch
– Westpoint
• Modified Grashey
• ? Y-view
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Internal RotationExternal Rotation
Stryker Notch
West Point
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clavicle
Sternoclavicular joint
Acromioclavicular joint
coracoid
Greater
tuberosity of
humerus
Lesser
tuberosity or
tubercle
External Rotation View
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anterior
posterior
humerus
coracoid
glenoid
acromion
West Point View
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CT Arthrogram
• Pros
– Labral tears = 95 % Accuracy*
– Evaluation in a Non MR safe patient
– Cartilage evaluation
– Multi-planar evaluation with isotropic voxels
• Cons
– Invasive
– Radiation
– Evaluate integrity not tissue morphology
*Am J Sports Med 1988;16(4):352-61
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CT Arthrogram
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Shoulder MRI
• Question:
– Rotator Cuff Tear or No Tear
– Labral Tear or No Tear
– Cartilage Loss/Arthritis or No Arthritis
• Answer:
– Etiology of the patient’s pain.
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Shoulder MRI
• Rotator Cuff– Supraspinatus Tendon
– Infraspinatus Tendon
– Teres Minor Tendon
• Biceps Tendons– Long Head
• Origin = Supraglenoid Tubercle
– Short Head• Origin = Coronoid
process
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Pectoralis majordeltoid
rhomboid
trapezius
subscapularis
deltoidinfraspinatus
scapula
humerus
Lung
pectoralis minor
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Shoulder MRI
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supraspinatus
infraspinatus
Teres minor
deltoid
anterior subscapularis posterior
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Quadrangular space
Coronal oblique MRI of the shoulder (posterior)
Infraspinatus muscle and tendonacromion
deltoid muscle
humerus
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Coronal oblique MR image of the shoulder (central)
Biceps tendon,
long head
acromion
Supraspinatus muscle
and tendon
glenoid
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Chronic Massive
Rotator Cuff Tear
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Acute Hill-Sachs Fracture
and Bankart Lesion
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Anterior labral tear
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Impingement Syndromes
• Subacromial
– Most common
– Encroachment of subacromial space
– Loss of normal glide of GH joint and CA arch
• External (Subcoracoid)
– Between humeral head and coracoid process
• Internal (posteriorsuperior)
– Overhead throwing athletes
– Infraspinatus and posteriorsuperior glenoid labrum
GH=glenohumeral
CA= coracoacromial
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Subacromial Impingement
Type 3 acromion
• Type 1– flat acromion (17% of
shoulders)
– 3% of all cuff tears have
this type of acromion;
• Type 2– curved acromion (43%)
– 27% of all cuff tears have
this type of acromiom
• Type 3– hooked acromion (40%)
– majority (70 - 90%) of
rotator cuff tears may be
seen in pts w/ type-2 or a
type-3 acromion
LU Bigliani et al. Orthop. Trans. Vol 10. p 228. 1986.
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MR Arthrogram
• Pros
– Labral evaluation
– Cartilage evaluation
– Very sensitive for evaluation of tissue integrity
• Cons
– Invasive procedure
– Increased number of sequences
– Limited ability to see tissue morphology
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Ultrasound
• Pros
– Dynamic
– Real Time
– Provocative maneuvers
• Cons
– Depth of vision
– Limited field of view
– Technically dependent
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Calcific Tendinosis
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Calcium
SST
Humeral Head
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Calcific Tendinosis(injection)
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Thank you