(see also: Physical Exam; Radiographic Studies for the Shoulder)
– Position: – place patient in a beach chair position w/ torso flexed 45 deg and the knees flexed to 30 deg; – move patient to the edge of the table (operative side), and use a McConnel positioner to prevent the patient from failing off the table; – patient must lie … Read more
– Discussion: – injuriy to long thoracic nerve (serratus anterior) leads to medial winging; – injury to the spinal accessory (trapezius) leads to lateral winging; – diff dx: – brachial plexus injury /preganglionic injury – serratus anterior / long thoracic nerve – trapezius – fascioscapulohumeral muscular dystrophy – parsonage turner Original Text by Clifford R. Wheeless, III, … Read more
– Discussion: – used to better visualized the acromio-clavicular joint by eliminating overlying structures; – Technique: – AP view w/ beam is directed at the a-c joint with 10 deg cephalic tilt; – use 1/3 to 1/2 the voltage used for the AP shoulder view (soft tissue technique)
– See: – Shoulder Arthrography – MRI – Impingement Radiographic Series: – axillary view: may reveal an Os Acromiale, which is associated w/ impingment; – scapular outlet view – allows assessment of acromial morphology; – examination of cadavera reveal: … Read more
– Discussion: – consequences of anterior instability include Bankart lesion, Hill Sachs lesion, erosion of the anterior glenoid, loose body formation, and stretching of the joint capsule; – features: – degree of trauma involved – distinguish between traumatic dislocations and recurrent … Read more
– See: brachial plexus – Discussion: – hx: persistant pain > 6 months: (poor prognosis); – diff dx: – breast cancer (lower plexus and painful) – radiation therapy (upper plexus and painless) – … Read more
– Discussion: – useful in identifying anterior glenoid abnormalities (Bankart Lesion) in pts w/ hx indicating traumatic instability of the shoulder; – Technique: – pt is placed prone on x-ray table w/ involved shoulder on a pad raised 7.5 cm from the top of the table; – head & … Read more
– See: Multidirectional Instability: – Radiographic Subtypes: – Subcoracoid – most common type of anterior dislocation – head of humerus is displaced anteriorly w/ respect to glenoid, & is inferior to coracoid process; – greater tuberosity is fixed on anterior glenoid rim; – neck … Read more
– Discussion: – encountered in infants and young children; – this frx is difficult to diagnose since humeral epiphysis since it is mostly cartilage; – Treatment: – if arm is shortened and abducted then restore length & alignment by applying longitudinal traction w/ arm in 90 deg of abduction, … Read more
– Discussion: – see shoulder replacement discussion (total shoulder vs hemiarthroplasty vs reverse arthroplasty) – the indications for total shoulder arthroplasty (versus hemiarthroplasty) are controversial; – there is some controversy regarding pain relief and component survivorship; – Gartsman GM, et al (2000), the authors compared hemiarthroplasty (24 … Read more