Radiographs Shoulder

Radiographic images of frontal views of shoulders before and after total shoulder arthroplasty. (A) The preoperative anatomy and (B) the placement of the humeral component can be clearly seen. The UHMWPE glenoid component in (B) is radiolucent and is evident only as a space between the humeral component and bone of the glenoid (images courtesy of Jon jP Warner, Massachusetts General Hospital). 

Sanchez-Sotelo J., T.W. Wright, S.W. O Driscoll, et al. 2001. Radiographic assessment of uncemented humeral comjxjnents in total shoulder arthroplasty. / Arthroplasty 16 180-187. 

Shoulder Radiographs 18 AP Shoulder Girdle 18 AP Shoulder Joint 18 Axial Shoulder (Supero-inferior/ Infero-superior Projection) 19 Lateral Scapula (Y-View) 19... 

Fig. 11.10. Radiograph of the left shoulder shows a healing fracture of the tip of the acromion (curved arrow), the left proximal humeral metaphysis (arrowhead) and the associated subperiosteal new bone formation (arrows)...

This is usually the result of forces transmitted through the axial skeleton from an impact into the head and shoulders through to the lower limbs. There may be symphyseal diastasis, anterior arch fractures or posterior disruption of the sacroiliac joints with cephalic displacement. Vertical injuries are often severe with disruption of all the ligaments plus associated pelvic instability. Radiographs demonstrate ipsilateral or contralateral pubic rami fractures, with disruption of the sacroiliac joint. The major differentiating feature from compression injuries is the cephalic displacement of the pelvis on the side of the impact (Fig. 12.14). 

Injuries of the medial end of the clavicle account for under 1% of clavicle fractures in children. They can occur if there is compression to the shoulder during contact sports such as ruby. Rather than the sternoclavicular dislocation seen in adults, which they mimic, these are Salter-Harris type I or II fractures (Denham andDiNGLEv 1967). They are poorly seen on radiographs and CT or MR imaging are indicated, especially if (with posterior displacement) there is evidence of dysphagia or respiratory or vascular compromise (Fig. 17.2). If there is evidence of... 

Any joint in the upper extremity may dislocate if sufficient force is applied to it. The glenohumeral joint is especially prone to dislocating, usually in an anterior direction. A prominent end of the clavicle and loss of roundness of the shoulder may indicate a dislocation. Frequently there is an associated tear of the capsule. With any joint dislocation, radiographic imaging should be obtained to rule out an associated fracture. 

Martinoli C, Bianchi S, Prato N et al (2003) US of the shoulder non-rotator cuff disorders. RadioGraphics 23 381-401 Martinoli C, Bianchi S, Gotten A (2005) Imaging of rock climbing injuries. Semin Musculoskelet Radiol 9 334-345 Masear VR, Hill JJ, Cohen SM (1988) Ulnar compression neuropathy secondary to the anconeus epitrochlearis muscle. J Hand Surg [Am] 13 720-724... 

Fig. 6.66a-f. Types of acromial morphology, a-c Schematic drawings of a sagittal view through the shoulder with d-f corresponding outlet view radiographs demonstrate a,d type 1 or flat acromion, b,e type II or curved acromion and c f type III or hooked acromion. Arrows indicate the different acromial shapes... 

Fig. 6.67a,b. Anterior shoulder instability, a Chronic anterior instability in an elderly patient. Note the anterior dislocation of the humeral head (HH) relative to the acromion (Acr) and the coracoid (asterisk).b Anterior glenohumeral dislocation, subcoracoid type. Anteroposterior radiograph demonstrates anterior displacement of the humeral head, which appears located inferior to the coracoid process. A Hill-Sachs deformity is present (arrow)... 

Avulsion lesions of the tuberosities can also be encountered in shoulder instability. Greater tuberosity fractures are the commonest and derive from an excessive pulling force exerted by the supraspinatus on its bony insertion. The examiner must be aware that these fractures can also be secondary to a direct blow on the shoulder and that they are often missed on standard radiographs. Therefore, in a post-traumatic setting, US examination of the shoulder must include a careful search of bone irregularities in the greater tuberosity, even in the presence of previous... 

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