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Saragaglia D, Barthomeuf C, Banihachemi JJ. Deciphering acute shoulder trauma with normal initial X-ray: Contributions of ultrasonography and MRI. Orthop Traumatol Surg Res 2021; 107:102965. [PMID: 34033918 DOI: 10.1016/j.otsr.2021.102965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/04/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Shoulder trauma with normal radiographs is a frequent emergency presentation. The predominance of pain makes clinical examination unreliable, and complementary imaging is often needed for diagnosis. The aim of the present study was to assess the contribution of ultrasonography (US) and magnetic resonance imaging (MRI) in deciphering such trauma. The study hypothesis was that MRI can confirm most diagnoses and reveal occult lesions. METHODS 48 patients with a median age of 33 years (IQR, 22-48.75), admitted to the Emergency Department between February and September 2016, were prospectively included. All had normal X-ray and underwent emergency and deferred emergency (D+7-10) clinical examination, and US and MRI at D+7-14. The same examinations were repeated to establish diagnosis and initiate treatment. MRI was considered as gold-standard for definite diagnosis. RESULTS Diagnoses comprised: 14 shoulder contusions; 13 rotator cuff tears; 8 acromioclavicular sprains; 6 fractures: 3 greater tuberosity, 2 humeral head, 1 lateral quarter of the clavicle; 3 subluxations or anterior dislocations with spontaneous reduction; 1 posterior dislocation with spontaneous reduction; 1 case of resorption of calcification in the pectoralis major tendon; 1 case of coracobrachialis strain; and 1 partial pectoralis major detachment. Concordance with final diagnosis was 42% (20/48) on initial clinical examination and 52% (25/48) on reassessment. On US, concordance was 71% (34/48), with 82% positive predictive value for cuff tear and 0% for instability. MRI was contributive in all cases, revealing 48 abnormal signals in 41 patients, thus establishing 48 diagnoses. CONCLUSION Except in precise diagnostic situations such as rotator cuff tear, US is not a contributive examination, completely overlooking shoulder instability and bone contusion. MRI should play an increasing role in deciphering these traumas. LEVEL OF EVIDENCE II; prospective cohort study.
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Affiliation(s)
- Dominique Saragaglia
- Service de Chirurgie de l'Arthrose et du Sport, Urgences Traumatiques des Membres. CHU de Grenoble-Alpes, Hôpital Sud, avenue de Kimberley, BP 338, 38434 Échirolles cedex, France.
| | - Cyril Barthomeuf
- Service de Chirurgie de l'Arthrose et du Sport, Urgences Traumatiques des Membres. CHU de Grenoble-Alpes, Hôpital Sud, avenue de Kimberley, BP 338, 38434 Échirolles cedex, France
| | - Jean-Jacques Banihachemi
- Service de Chirurgie de l'Arthrose et du Sport, Urgences Traumatiques des Membres. CHU de Grenoble-Alpes, Hôpital Sud, avenue de Kimberley, BP 338, 38434 Échirolles cedex, France
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Perry NPJ, Wolfe JA, Nguyen-Ta K, Christensen D, McDonald LS, Dickens JF, LeClere LE. Biceps Tenodesis and Intra-articular Decompression for Treatment of Superior Labral Tear from Anterior to Posterior and Associated Paralabral Cyst in Active Duty Military. Mil Med 2018; 183:e194-e200. [PMID: 29420745 DOI: 10.1093/milmed/usx019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 10/20/2017] [Indexed: 01/02/2023] Open
Abstract
Background To examine the outcomes of combined biceps tenodesis and indirect, intra-articular arthroscopic paralabral cyst decompression for the treatment of active duty military patients with superior labral from anterior to posterior tears and associated paralabral cysts. Methods Retrospective chart review of all active duty patients at our institution from 2011 to 2014 with superior labral from anterior to posterior tears and associated paralabral cysts at the spinoglenoid notch treated with biceps tenodesis and indirect arthroscopic cyst decompression. Patient charts were examined for pre- and post-operative parameters including strength, range of motion, visual analog scale pain score, American Shoulder and Elbow Surgeon Score, and Single Assessment Numeric Evaluation Score. Results Seven patients met study criteria. All patients presented with chronic shoulder pain and decreased external rotation strength, and three patients had clinically apparent muscular atrophy. Pre- and post-operative assessment showed external rotation strength increased from a median of 4 (range 4-4) to 5 (range 4-5; p-value = 0.014), Single Assessment Numeric Evaluation increased from a median of 50 (range 0-70) to 75 (range 30-95; p-value = 0.031), American Shoulder and Elbow Surgeon increased from a median of 46.0 (range 32.0-58.0) to 66.5 (range 58.0-98.0; p-value = 0.068), and visual analog scale pain score decreased from a median of 3 (range 1-8) to 0 (range 0-5; p-value = 0.017). Median follow-up was 66 wk (range 36-138 wk). The change was statistically significant (p <0.05) for external rotation strength, Single Assessment Numeric Evaluation, and VAS reduction. Post-operatively, all patients returned to full duty at a median of 20 wk (range 12-36 wk). Conclusion The use of biceps tenodesis in conjunction with indirect, intra-articular arthroscopic paralabral cyst decompression is an effective technique in an active patient population with superior labral from anterior to posterior tear with associated paralabral cyst.
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Affiliation(s)
- Nicholas P J Perry
- Department of Orthopaedics, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134-3300
| | - Jared A Wolfe
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Kim Nguyen-Ta
- Medical Education and Telemedicine 120, UC San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093
| | - Daniel Christensen
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Lucas S McDonald
- Department of Orthopaedics, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134-3300
| | - Jonathan F Dickens
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Lance E LeClere
- United States Naval Academy, Naval Health Clinic Annapolis, Annapolis, MD, 626 MacCubbin Ln, Gambrills, MD 21054
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Passanante GJ, Skalski MR, Patel DB, White EA, Schein AJ, Gottsegen CJ, Matcuk GR. Inferior glenohumeral ligament (IGHL) complex: anatomy, injuries, imaging features, and treatment options. Emerg Radiol 2016; 24:65-71. [PMID: 27530740 DOI: 10.1007/s10140-016-1431-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/09/2016] [Indexed: 11/25/2022]
Abstract
The inferior glenohumeral ligament (IGHL) complex is comprised of three components supporting the inferior aspect of the shoulder. It consists of an anterior band, a posterior band, and an interposed axillary pouch. Injuries to the IGHL complex have a unifying clinical history of traumatic shoulder injury, which are often sports or fall-related, with the biomechanical mechanism, positioning of the arm, and individual patient factors determining the specific component of the ligamentous complex that is injured, the location of the injury of those components, and the degree of bone involvement. Several acronyms are employed to characterize these features, specifying whether there is involvement of a portion of the anterior band, posterior band, or midsubstance, and if there is avulsion from the humeral attachment, glenoid attachment, or both. Imaging recommendations for the evaluation of the IGHL complex include magnetic resonance imaging (MRI), and injuries to this complex are best visualized with magnetic resonance arthrography. Additionally, a brief description of clinical management of inferior glenohumeral ligament injuries is included.
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Affiliation(s)
- Giovanni J Passanante
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor Imaging, Los Angeles, CA, 90033-5313, USA
| | - Matthew R Skalski
- Department of Radiology, Southern California University of Health Sciences, Whittier, CA, 90604, USA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor Imaging, Los Angeles, CA, 90033-5313, USA
| | - Eric A White
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor Imaging, Los Angeles, CA, 90033-5313, USA
| | - Aaron J Schein
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor Imaging, Los Angeles, CA, 90033-5313, USA
| | - Christopher J Gottsegen
- Department of Radiology, Langone Medical Center, New York University, New York, NY, 10016, USA
| | - George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor Imaging, Los Angeles, CA, 90033-5313, USA.
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Advanced imaging of glenohumeral instability: the role of MRI and MDCT in providing what clinicians need to know. Emerg Radiol 2016; 24:95-103. [DOI: 10.1007/s10140-016-1429-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
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Khor AYK, Wong SBS. Clinics in diagnostic imaging (151). Acromioclavicular joint geyser sign with chronic full-thickness supraspinatus tendon (SST) tear. Singapore Med J 2015; 55:53-6; quiz 57. [PMID: 24570312 DOI: 10.11622/smedj.2014015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
An 82-year-old man presented with neck pain, right upper limb radiculopathy and right shoulder pain. Physical examination revealed a soft lump over the right shoulder joint, as well as reduced range of shoulder movements. On magnetic resonance imaging, the soft lump was shown to be a cystic mass over the acromioclavicular joint and was related to a full-thickness supraspinatus tendon tear. This is the classic geyser sign. The pathophysiology and clinical features of the geyser sign, and its imaging features with various imaging modalities, are discussed.
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Affiliation(s)
- Andrew Yu Keat Khor
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608.
| | - Steven Bak Siew Wong
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608.
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Draghi F, Scudeller L, Draghi AG, Bortolotto C. Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study. J Ultrasound 2015; 18:151-8. [PMID: 26191110 DOI: 10.1007/s40477-015-0167-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The presence of the subacromial-subdeltoid (SASD) bursa inflammation has recently been proposed as a primary radiologic factor predicting persistent limitation and pain in operated patients. The aim of the study was to verify the hypothesis that pain, or increased shoulder pain, could be associated with SASD bursitis not only in operated patients but also in general population. METHODS A consecutive series of 1940 shoulder ultrasound examinations were performed by our Department over a 5-year period using linear multi-frequency probes. All reports of examination executed for shoulder pain were reviewed. The video clips were independently reviewed by two radiologists: effusion in the SASD bursa and the presence of other pathological conditions were evaluated and confirmed. RESULTS A total of 1147 shoulder video clips were re-evaluated, and 1587 pathologies were detected; 65.5 % of patients had only one pathology, 30.4 % had two and 4.1 % presented three pathologies. The difference between the group with and without effusion is statistically significant for acromioclavicular joint arthritis, supraspinatus tendon calcific tendinopathy, full-thickness and superficial tear of the supraspinatus, traumas and rheumatoid arthritis with a p value <0.01. CONCLUSIONS Our study shows that the effusion in the SASD bursa is frequently associated with shoulder pain often independently from the underlying pathology; further studies are needed to confirm the statistical significance of this relationship by clarifying possible confounding factors.
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Affiliation(s)
- Ferdinando Draghi
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy
| | - Luigia Scudeller
- Biostatistics and Clinical Epidemiology Unit, IRCCS Policlinico San Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy
| | - Anna Guja Draghi
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy
| | - Chandra Bortolotto
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy
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