Bois Bernard Private Hospital
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What examinations to prescribe?
Standard x-rays: Mandatory
An ultrasound?
CT arthrography and/or MRI?
Standard x-rays
Front Profile basic balance sheet
Profile of Lamy basic balance sheet
Humerus 3 rotations search for calcifications
Face Rotation Neutral
External Rotation Face
Internal Rotation Face
Profile of Bernageau Shoulder instability
Garth's bearing Shoulder instability
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External Rotation Face. Face Rotation Neutral Internal Rotation Face
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1. Anterior inferior border of the glenoid.
2. Anterior superior edge of the glenoid.
3. Posterior edge of the glenoid.
4. Acromium.
5. Coracoid process.
1.Scapula seen in profile.
2. Subacromial space.
3. Humeral diaphysis.
4. Clavicle.
5. Acromium.
6. Coracoid process
Ultrasound
Examination very dependent on the Radiologist
Unscrambling exam
Not enough in isolation
Interesting review for the purpose of dynamic exploration
Bicep instability
CT arthrography
Examination of choice
Specifies rotator cuff rupture (size and seat)
Specifies a rupture in the deep face (Sometimes traumatic)
Specifies the state of the muscles (fatty degeneration) (Goutallier classification)
Specifies the condition and position of the long head of the biceps
Excellent exploration of the bead
Search for labral lesions
Search for SLAP lesions
Assessment of glenoid bone stock (Feasibility of shoulder arthroplasty)
DEFAULTS :
does not specify the existence of an isolated tendonitis
Does not specify subacromial space bursitis
Does not explore the Bursal side of the cuff (Superficial side) (False negative for a superficial partial tear of the cuff = Non-permeating tear)
The Burso-scanner explores superficial lesions (rare examination)
BOUNDARIES
Iodine intolerance
Patients with diabetes or renal failure
MRI
Interest ++ if isolated subacromial impingement (subacromial bursitis)
Examination of choice if inflammatory cuff (Tendinitis or Bursitis)
Specifies rotator cuff rupture (size and seat)
Specifies the state of the muscles (fatty degeneration) (Less efficient than arthroscanner)
Specifies the condition and position of the long head of the biceps
Exploration of the bead (less efficient than arthroscanner)
Very good examination to quantify the inflammatory character of an acromioclavicular arthropathy
Assessment of glenoid bone stock (feasibility of shoulder arthroplasty)
Spinoglenoid cysts
Capsulitis (But the diagnosis is clinical)
Specifies bursal effusion
Specifies a partial rupture (on the superficial face)
DEFAULTS :
False Positives of Cap Breaks
Sometimes confusion between a rupture and a significant tendinitis
BOUNDARIES
Patient Claustrophobia
Patients with metal implants (Pace-maker, vascular clips, etc.)
Choice of examination / suspected diagnosis
Rupture of the rotator cuff: Arthro-scan and/or MRI?
Sometimes you have to think about it...
When the clinical diagnosis is not consistent with imaging
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After eliminating adhesive capsulitis (Clinical examination +++)
In front of a deficient shoulder or pseudo-paralytic, and/or with amyotrophy of the supraspinous and infraspinous fossae, or of the deltoid…
Rule out a neurological cause
Cervicobrachial neuralgia, or radicular or spinal cord compression
Consider Parsonage Turner Syndrome
Ask for a neurological opinion…and
An ELECTROMYOGRAM of the upper limb
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Incidentally a check-up of the cervical spine
Cervical spine X-rays
Cervical spinal cord MRI
In front of a hyper-algic shoulder...
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A scintigraphy
Eliminate algo-neurodystrophy
Doubt about the organicity of the symptoms (sinistrosis?)
Doubt about an infectious etiology
Doubt about a secondary location...
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Very rarely
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Arthro-MRI
A Burso scanner
If difficulty in diagnosing a rupture of the superficial face
And that MRI is contraindicated...