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2017 ; 11
(ä): 882-896
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Imaging of the Unstable Shoulder
#MMPMID29114335
Baudi P
; Rebuzzi M
; Matino G
; Catani F
Open Orthop J
2017[]; 11
(ä): 882-896
PMID29114335
show ga
BACKGROUND: Unstable shoulder can occur in different clinical scenarios with a
broad spectrum of symptoms and presentations: first-time (or recurrent) traumatic
acute shoulder anterior dislocation or chronic anterior instability after
repeated dislocations.Imaging in unstable shoulder is fundamental for choosing
the right treatment preventing recurrence.The goal of imaging depends on clinical
scenario and patient characteristics. METHOD: Careful selection and evaluation of
the imaging procedures is therefore essential to identify, characterize and
quantify the lesions. Proper imaging in unstable shoulder cases is critical to
the choice of treatment to prevent recurrence, and to plan surgical intervention.
RESULTS: In acute setting, radiographs have to roughly detect and characterize
the bone defects present. At about 7 days, it is recommended to perform a MR to
demonstrate lesions to labrum and/or ligaments and bone defects: in acute
setting, the MRA is not necessary, because of effusion and hemarthrosis that
behave as the contrast medium.In recurrence, it is fundamental not only to detect
lesions but characterize them for planning the treatment. The first study to do
is the MRI (with a magnetic field of at least 1.5 Tesla), and if possible MRA,
above all in younger patients. Then, on the basis of the pathologic findings as
bipolar lesion or severity of bone defects, CT can be performed. PICO method on
2D or 3D CT is helpful if you need to study a glenoid bone loss, with the "en
face view" of glenoid, while a 3D CT reconstruction with the humeral head "en
face view" is the gold standard to assess an Hill-Sachs lesion. CONCLUSION: The
clinical diagnoses of anterior shoulder instability can be different and
acknowledgement of imaging findings is essential to guide the treatment
choice.Imaging features are quite different in chronic than in acute scenario.
This requires appropriate indications of many different imaging techniques.
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