Physical Medicine and Rehabilitation Clinics of North America
Review articleRadiologic evaluation of the shoulder girdle
Section snippets
General considerations
The decisions of when to obtain shoulder imaging and subsequently which type of imaging study to obtain are based on several factors, including the acuity of the injury, the suspected tissue involved, the age of the patient, and the demands that the patient places on the shoulder. In general, acute traumatic injuries need to be imaged to exclude fracture or dislocation. Injuries of insidious onset are more likely due to soft tissue pathology, which is not well visualized with plain films. The
Fractures and dislocations
Fractures of the shoulder girdle are common. Although most fractures are the result of acute trauma, pathologic fractures of the shoulder girdle also may be due to cancer metastases or other bone disorders. The most common fractures of the shoulder girdle are fractures of the clavicle, humeral head, and proximal humerus (Fig. 1). Plain films usually are adequate for diagnosing these injuries. CT is the next study of choice to define the nature of an osseous injury and generally is performed to
Chronic acromioclavicular arthropathies
Anteroposterior x-rays can show chronic changes of the AC joint. There are two main patterns of chronic changes seen in the AC joint. The most common pattern consists of typical degenerative joint changes, with formation of osteophytes, subchondral cysts, and subchondral sclerosis (Fig. 9). The other pattern is distal clavicular osteolysis, which sometimes is seen in weightlifters who lift heavy weights. Distal clavicular osteolysis also is seen as a late sequela of AC joint trauma and in
Glenohumeral arthritis
The clinical and radiologic hallmarks of glenohumeral osteoarthritis are the same as with any joint. Patients usually are older and have insidious onset of symptoms, which may include pain, stiffness, and crepitus. The clinical features of osteoarthritis are detailed in the article by Stitik et al elsewhere in this issue. X-rays establish a radiologic diagnosis of osteoarthritis (Fig. 10). One sees narrowing of the glenohumeral joint space, marginal osteophyte formation, subchondral cysts, and
Rotator cuff disorders and impingement
Rotator cuff pathology may include tendinosis, acute tears, tears of attrition (intrinsic tendinopathy), and impingement (extrinsic tendinopathy). Injury to the rotator cuff may occur acutely or gradually. Repetitive overload may result in tendinosis and small or large tears of the rotator cuff muscles and tendons. Impingement of the rotator cuff tendons as they pass underneath the coracoacromial arch may cause mechanical injury to the tendons. Common sites of impingement include underneath an
Labrocapsular pathology
The glenoid labrum can be injured by direct trauma or indirectly via abnormal pull on the biceps anchor at the superior glenoid. Symptoms include impaired performance in overhead athletes, deep pain that may be difficult to localize, clicking and catching, especially with rotatory motions of the shoulder joint. Labral injury is a difficult diagnosis to make clinically. The O'Brien test is believed to have high specificity and sensitivity for a superior labral tear that extends from anterior to
Summary
The radiologic evaluation of the shoulder girdle is an important adjunct to the clinical history and physical examination. Close collaboration between musculoskeletal clinicians and musculoskeletal radiologists improves the diagnostic performance of imaging studies. Technologic advantages, especially in MRI, have improved appreciation of shoulder anatomy, biomechanics, and injury patterns, allowing for the development of more targeted surgical and nonsurgical treatment strategies.
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