Informative Post About Shoulder Images

She said, she fell last night while playing volley ball. She landed on her right shoulder and heard a pop sound, too. She did not take any pain medicines. She applied icepack and felt burning pain. This was an interesting musculoskeletal assessment case. We assessed her right shoulder and compared with the left one. We found slight dislocation of the shoulder joint. She had good circulation in her right arm, no swelling noted in the right hand and the capillary refill was < 2 secs. Mary said, since she had burning pain, it could be a nerve injury, too. We also noted a slight swelling of her trapezius muscle on the right side. She complained of pain on palpation. Mary applied a sling to her right arm to keep it elevated. She may need an MRI to see the damage. Mary sent her to the urgent care. She told her that, since she heard the popped sound, the ER or Urgent care doctor can replace it. It will be a painful procedure, and she will need a strong pain medicine. She gave her the note for her teacher and asked her friend to drive her to the urgent

Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90 degrees limited by pain and abduction to 75 degrees limited by pain. Hawkin’s test, Neer’s test, Shoulder crossover test, Empty Cans test, Lift-off test, and Apprehension test is positive. On palpation, tenderness is noted in the acromioclavicular joint and subdeltoid

On examination of the right shoulder, there is pain on range of motion. Abduction was 160 degrees. Forward flexion was 165 degrees.

Client reported this week she is having shoulder pain. She also submitted MRI Rx. With the following findings:

Patient came into the hospital as an outpatient claiming that they were experiencing tenderness and stiffness in their left shoulder. Upon reading the requisition as well as asking the patient more questions I discovered that the patient had slipped and fell onto the ice 3 days previous. This patient explained that they were reluctant to go to the doctors as they already had stiffness in the left shoulder and they were convinced it was nothing serious. After taking the first image (the AP) it became clear that there was a comminuted fracture of the proximal humerus. A

Based on progress report dated 03/09/15, the patient reported of persistent left shoulder pain. She has attended at least 12 PT sessions with non resolution of her symptoms. Due to left shoulder pain with positive impingement test despite 7 weeks of conservative care with NSAIDS, muscle relaxant and PT, left shoulder MRI for further evaluation is recommended. PT for 3 times a week for 4 weeks is also requested. She was advised to continue Anaprox and Flexeril.

In 1990 the acronym “SLAP lesion” (Superior Labral Anterior and Posterior) was coined by Synder et al, a shoulder pathology previously made known after arthroscopically identified by Andrews et al in 1985. 2,3 The prevalence of SLAP lesions in recreational athletic and athletic populations ranges from 3.9 %- 11.8%. 4 Kim, et al noted out of 544 shoulders arthroscopically evaluated, 25% were diagnosed with a SLAP lesion, and 88%, about 120 subjects, presented with another pathology.6

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

Thus helps in treatment planning and prognosis. Multiple factors are to be considered during treatment planning. It is important to identify the disorder and its clinical implications, to ensure the most appropriate treatment. Nevertheless, the choice of imaging test depends on personal experience, preference, local availability and the cost of imaging. The American College of Radiology has developed informative criteria that rate the relative usefulness of various imaging modalities for the evaluation of shoulder pain in different clinical scenarios. However, the diagnostic algorithm will ultimately be influenced by the therapeutic approach. The use of various imaging techniques to determine rotator cuff injuries is very controversial. Thus a technique used should not only be informative but cost effective as well. Arthrography is invasive with much health risk. US is a non-invasive, relatively inexpensive, no risk of exposure to radiation and therefore, can be used as initial line of investigation. MRI is sensitive and specific, to detect correct site and extent of tear and also non-rotator cuff related pathologies like

In order to measure the shoulder function, I asked the patient to put both hands together behind her head. The patient performed the shoulder’s test without difficulty or limitations in mobility due to pain. I did not ask the patient to perform the test as indicated to avoid over stretching the abdominal area that was inflamed and red due to the pseudo-aneurism.

On 3/15/17 due to a schedule conflict Laurie Wawrzyniak met Mr. Rife at the office of Dr. Wines. Mr. Rife has made positive gain in range of motion with physical therapy. He still reports pain when raising the left arm. A cortisone injection was recommended along with a MRI. The injection was done under ultra sound in the office. While performing the injection under ultra sound Dr. Wines noted the rotator cuff was thinning and he was concerned there was a tear. Dr. Wines recommended a MRI of the shoulder. Physical therapy will continue and treatment options will be. The MRI will be done on 3/15/17. I have advised Mr. Rife to obtain a copy of the MRI CD to bring to the appointment on 3/23/17 with Dr. Wines.

Arthroscopic Bankart repair of first-time anterior shoulder dislocations significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared to traditional non-operative rehabilitation.

A largest and the most complex joint in our body is a shoulder joint. Shoulder joints form when the humerus bone fits into the scapula thus creates a ball and socket structure. Ligament, muscles, padding, tendons, cartilage are totally comprised by the shoulder joint. When anything goes wrong the total mobility of shoulder becomes painful and discomfort. Some common problems affect shoulders such as Nerve compression, Arthritis, Rotating cuff problem, arthroscopy, and shoulder joint dislocation.

Traditionally rehabilitation physicians have not been involved with viewing the images, and reading the radiologist’s report has been considered sufficient. This is based on misconception that viewing images is only useful in making clinical diagnosis and thus not of great utility to rehabilitation physicians. However, more and more rehabilitation physicians are realizing that knowing the anatomy and correlating the clinical finding with imaging findings is very important to achieve relevant information from the imaging report, most significantly, view the pathology with their own eyes and thus helping in accurate treatment planning. Moreover, imaging can provide objective aspect to the clinical evaluation, which have an inherent degree of

As far as procedures that I could observe, I watched an XR chest with lateral rotation, C/T of the pelvis w/o contrast, Venogram/CT angiography, shoulder x-ray, chest x-ray, MRI of the head with contrast, X-ray of the left knee and lastly an x-ray of the L 3-5 and pelvis in both open and rotated position. The first procedure had the sole purpose of creating an image of the shoulder joint with the focus on the acromion of the joint and the spacing within the joint. The second procedure was to allow for the visualization of possible injury to the pelvis from a motor vehicle accident in which the patient had a chief complaint of pain in the hip area. The Venogram was for determining the state of the veins and possible deep vein thrombosis (DVT).