AAOS Comprehensive Orthopaedic Review 4: Print + Ebook (AAOS - American Academy of Orthopaedic Surgeons)

Chapter 72 I maging of the S houlder and E lbow

SHADLEY C. SCHIFFERN, MD, FAAOS NICHOLAS C. DUETHMAN, MD NADY HAMID, MD, FAAOS

I. SHOULDER A. Radiographic evaluation of the shoulder

shoulder dislocation in a patient who exhib its a lack of passive external rotation. The axillary view is also helpful in evaluation of glenoid morphology in glenohumeral osteoar thritis and provides good visualization of the coracoid process, acromion, and distal clav icle. The abducted arm position required for this view can be painful in the posttraumatic shoulder. The Velpeau view is considered an alternative in this scenario. d. Scapular Y view: This view provides visual ization of the coracoacromial arch and can reveal coracoacromial spurs, which have been closely associated with the presence of rotator cuff pathology. The scapula Y view is also a reliable alternative for evaluation of glenohu meral subluxation and dislocation. It can also show scapular body abnormalities (eg, osteo chondroma, fracture) and acromial shape. 3. Special shoulder views—Described in Table 1 4. Normal radiographic parameters a. The acromiohumeral distance is normally 7 to 14 mm. The width of the glenohumeral joint space should be symmetric superiorly and inferiorly. b. The coracoclavicular distance is normally 1.1 to 1.3 cm. c. Neer classified acromial morphology as fol lows: type I (flat), type II (curved), and type III (hooked). Type III acromial morphology has been shown to have a correlation with the presence of rotator cuff disease; however, no direct causal relationship has been demon strated. The classification has shown relatively poor interobserver reliability.

1. Indications—Conventional radiographs are appropriate for patients presenting with shoul der pain with any history of trauma, dislocation, night pain, or chronic shoulder pain. 2. Shoulder series—The standard shoulder series should include orthogonal views of the shoulder, including a true AP view in the scapular plane, an AP view, an axillary view, and a scapular Y view. a. True AP view in the scapular plane: Visualizes anterior greater tuberosity in profile. The x-ray beam is positioned perpendicular to the plane of the scapula, and the arm is held in neutral rotation with the shoulder in slight abduction (dynamic loading of cuff and deltoid), which can reveal proximal humeral migration. b. AP view: The arm is held in internal rotation. This view visualizes the posterior aspect of the greater tuberosity and the lesser tuberosity in profile. The x-ray beam is positioned perpen dicular to the coronal plane of the body. c. Axillary view: Necessary view in evaluation of glenohumeral joint instability. This view enables to determine the humeral head posi tion in the glenoid fossa. Often overlooked, this view may detect occult, locked posterior

6 | Shoulder and Elbow

Dr. Schiffern or an immediate family member serves as a paid con sultant to or is an employee of Medacta. Dr. Hamid or an immediate family member serves as a paid consultant to or is an employee of Stryker. Neither Dr. Duethman nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this chapter. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

AAOS Comprehensive Orthopaedic Review 4

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