Shoulder Radiology
Shoulder Radiology
Significance of Radiology in Shoulder treatment is usually overestimated. Philosophy of shoulder starts and finishes
with muscles but muscles cannot be seen on x-rays. Visible changes on radiographs usually not match symptoms of patients and even so obvious signs on x-rays or even on MRI or CT are just laboratory findings which are just additional help to establish correct clinical diagnosis.
It is impossible to learn shoulder radiology just reading x-ray pictures. You have to go through: general radiographs reading principals, shoulder positioning, specific radiology signs and shoulder geometry, Shoulder implant and general principals of action of metalwork and everyday practice to read x-rays, collect interesting pictures in your personal library and show these to your colleagues.
To remember radiology general principals it is easier with Mnemonic ‘Kamasutra’:
1. Are you Keen for specific positioning?
2. Go and help for radiologist to get Accurate positioning.
3. Is this picture Manufactured properly or it is just Mirage
4. Follow Along the bone surface.
5. Clinical Symptoms are important Scale and Sacrifice pictures.
6. Unmask, Unexpected, Unhappy, Upset.
7. Take your time the Top Target could be not main Thing.
8. To achieve good resolution Refine and Recognize all Rrats.
. Official report is important Ask Academic Advice, Answer.
Positioning of the patient is time consuming but crucial to get proper diagnosis: obligatory for everyone is AP,
lateral or axillary, for subacromial impingment - AP and ‘Y’ view, for coracoid impingment - Axilary lateral, for Hill-Sachs lesion – Stryker Notch view, for Bankart - Garth View or West Point Axillary View, for sternoclavicle pathology –
Serendipity or Hobb’s view, for acromioclavicular changes -Acromion proliferation view, for clavicle fractures or acromioclavicle joint – Zanca view, for non traumatic shoulder instability - Semi Axial view, for brachial plexus or
thoracic outlet syndrome neck spine AP and lateral, for thoracic Kyphosis – Spine Thoracic AP and lateral.
Most popular specific changes are related with irreversible osteoarthritis of the shoulder. Signs and stages were
described in article ‘Radiological assessment of osteo-arthrosis. J. H. Kellegren and J.S. Lawrence. Ann. Rheum. Dis. 1957. 16. 494.
1. Osteophytes
2.Heterotopic ossification
3. Narrowing of joint gap and subchondral sclerosis
4. Subchondral cysts
5. Irregularity of articular surface
Humerus head - shaft inclination angle is 130-150 degrees. Head retroversion angle is 20-30 degrees. Glenoid has superior tilt 3 degrees and retroversion 7 degrees. Scapula is in 30 degrees of anteversion.
Acromion process shape in outlet view can be described as too straight, curved and hooked by Bigliani but it is not very associated with subacromial impingment. Coracoid impingment could be associated with too laterally placed or too long coracoid, very prominent lesser tuberosity or metal work in the neck of the scapula. It is become popular to measure Coracoid Index. Rotator cuff arthropathy associated with Anterosuperior migration – femoralizasion. Every long tendon in a body, especially rotator cuff tendons, can be affected by infarct and later calcifying tendinitis can appear on radiograph like small cloud. Posterior dislocation is diagnosed by ‘Loss of half moon overlap’ sign, ‘Light bulb’ sign, Rim sign. ‘Trough Line’ Sign, Hill – Sachs lesion and reverse Hill – Sachs lesion is specific for shoulder fracture dislocations.
Significance of Radiology in Shoulder treatment is usually overestimated. Philosophy of shoulder starts and finishes
with muscles but muscles cannot be seen on x-rays. Visible changes on radiographs usually not match symptoms of patients and even so obvious signs on x-rays or even on MRI or CT are just laboratory findings which are just additional help to establish correct clinical diagnosis.
It is impossible to learn shoulder radiology just reading x-ray pictures. You have to go through: general radiographs reading principals, shoulder positioning, specific radiology signs and shoulder geometry, Shoulder implant and general principals of action of metalwork and everyday practice to read x-rays, collect interesting pictures in your personal library and show these to your colleagues.
To remember radiology general principals it is easier with Mnemonic ‘Kamasutra’:
1. Are you Keen for specific positioning?
2. Go and help for radiologist to get Accurate positioning.
3. Is this picture Manufactured properly or it is just Mirage
4. Follow Along the bone surface.
5. Clinical Symptoms are important Scale and Sacrifice pictures.
6. Unmask, Unexpected, Unhappy, Upset.
7. Take your time the Top Target could be not main Thing.
8. To achieve good resolution Refine and Recognize all Rrats.
. Official report is important Ask Academic Advice, Answer.
Positioning of the patient is time consuming but crucial to get proper diagnosis: obligatory for everyone is AP,
lateral or axillary, for subacromial impingment - AP and ‘Y’ view, for coracoid impingment - Axilary lateral, for Hill-Sachs lesion – Stryker Notch view, for Bankart - Garth View or West Point Axillary View, for sternoclavicle pathology –
Serendipity or Hobb’s view, for acromioclavicular changes -Acromion proliferation view, for clavicle fractures or acromioclavicle joint – Zanca view, for non traumatic shoulder instability - Semi Axial view, for brachial plexus or
thoracic outlet syndrome neck spine AP and lateral, for thoracic Kyphosis – Spine Thoracic AP and lateral.
Most popular specific changes are related with irreversible osteoarthritis of the shoulder. Signs and stages were
described in article ‘Radiological assessment of osteo-arthrosis. J. H. Kellegren and J.S. Lawrence. Ann. Rheum. Dis. 1957. 16. 494.
1. Osteophytes
2.Heterotopic ossification
3. Narrowing of joint gap and subchondral sclerosis
4. Subchondral cysts
5. Irregularity of articular surface
Humerus head - shaft inclination angle is 130-150 degrees. Head retroversion angle is 20-30 degrees. Glenoid has superior tilt 3 degrees and retroversion 7 degrees. Scapula is in 30 degrees of anteversion.
Acromion process shape in outlet view can be described as too straight, curved and hooked by Bigliani but it is not very associated with subacromial impingment. Coracoid impingment could be associated with too laterally placed or too long coracoid, very prominent lesser tuberosity or metal work in the neck of the scapula. It is become popular to measure Coracoid Index. Rotator cuff arthropathy associated with Anterosuperior migration – femoralizasion. Every long tendon in a body, especially rotator cuff tendons, can be affected by infarct and later calcifying tendinitis can appear on radiograph like small cloud. Posterior dislocation is diagnosed by ‘Loss of half moon overlap’ sign, ‘Light bulb’ sign, Rim sign. ‘Trough Line’ Sign, Hill – Sachs lesion and reverse Hill – Sachs lesion is specific for shoulder fracture dislocations.
