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Shoulder

Shoulder

CLAVICLE & STERNO-CLAVICULAR JOINT

  • Medial clavicular and SCJ injuries are associated with mediastinal trauma, suspect great vessel injury.

GLENOHUMERAL JOINT

Introduction

  • Views: AP, axial, Y-view, apical view.
  • Glenoid = golf-tee; humeral head = golf ball; coracoid projects anteriorly; acromion process projects posteriorly.
  • Neer classification: a part is only a part if it is significantly displaced, > 1cm or > 45 degrees.

A. Alignment: axial view

  • Anterior dislocation: most common (> 95% of dislocations).
  • Posterior dislocation: less common (< 5%), caused by electric shock, seizures. Commonly missed, humeral head appears like a lightnulb due to forced internal rotation.

B. Bones

  • Anterior dislocation A/W Hill Sachs deformity, wedge-shaped compression fracture of the posteriolateral aspect of the humeral head.
  • Anterior dislocation A/W bony or cartilagenous Bankart lesion, fracture/cartilagenous injury of the anterior-inferior lip of the glenoid. If you don’t see both lesions then suspect a cartilagenous Bankart lesion.
  • Anterior dislocation A/W loose body within the shoulder joint, which may prevent successful reduction.

S. Soft tissue

  • Increased soft tissue swelling can imply trauma or an infectious process.

ACROMIOCLAVICULAR JOINT

A. Alignment

  • The inferior cortex of the acromion should align with the inferior cortex of the clavicle.
  • The width of the joint should be no more than 8mm.
  • If equivocal, detect dislocation by using a weight-bearing film.
  • Grading: grade 1 = partial tear of the AC ligament; grade 2 = complete disruption of the AC ligament; grade 3 = disruption of AC ligament + coracoclavicular ligaments (widening of the coracoclavicular interval > 13mm or >5mm of the normal side).

B. Bones

S. Soft tissue

  • Look for soft tissue swelling, which will point to the pathology.

PROXIMAL HUMERUS

A. Alignment

B. Bones

  • Neer classification of humeral fracture: diaphysis, humeral head, greater tuberosity, lesser tuberosity.

S. Soft tissue

  • Look for soft tissue swelling, which will point to the pathology.


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REFERENCES

1. Goodman, L. and Felson, B. (2015). Felson's principles of chest roentgenology. 3rd ed. Philadelphia, PA: Elsevier, Saunders.
2. Dähnert W. Radiology Review Manual. LWW. (2011) ISBN:1609139437. Read it at Google Books - Find it at Amazon
3. Elizabeth Puddy, Catherine Hill; Interpretation of the chest radiograph, Continuing Education in Anaesthesia Critical Care & Pain, Volume 7, Issue 3, 1 June 2007, Pages 71–75, https://doi.org/10.1093/bjaceaccp/mkm014

Ⓒ A. Manickam 2018

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