Shoulder/Humerus

Question 1

What are the findings & dx of this case?

Answer 1

• Non-uniform loss of inferior GH joint
• Inferior Osteophytes at inferior GH
• Concretion type of calcifications in axillary pouch
• OA (or DJD) of GH joint with secondary synovial osteochondrometaplasia

Question 2

Degenerative joint disease is more common in what area of the shoulder

Answer 2

AC joint (more than GH - GH is likely secondary to something else)

Question 3

Decrease joint space, subchondral sclerosis, osteophytes, small subchondral cysts are seen in what shoulder condition

Answer 3

DJD/OA

Question 4

What condition is likely the cause of these findings?

Answer 4

Question 5

What condition is likely the cause of these findings?

Answer 5

Supraspinatus tear (R)

(Left is normal)

Question 6

What are the findings & likely dx of this case?

Answer 6

• Articular surace of humeral head appears absent/resorbed → GH joint not visibile as a result
• DX: Neuropathic Arthropathy (atrophic pattern); septic arthritis, avascular necrosis are less likely ddx
• Reccs: cervical spine MRI for possible syrinx to confirm neuropathic arthropathy

Question 7

Characteristics of ____ in the shoulder include:

• Sharp amputation of articular ends
• Tapered appearance - “licked candy stick”
• Lack of hypertrophic features

Answer 7

Atrophic Neuropathic Arthropathy

Question 8

What condition is likely the cause of these findings?

Answer 8

Atrophic pattern of Neuropathic Arthropathy

Question 9

What condition is likely the cause of these findings?

Answer 9

(syrinx in spinal cord)

Question 10

Characteristics of ____ in the shoulder include:

• Bilateral symmetric GH & AC joint involvement → typically results in a uniform loss of joint space
• Erosions on the humeral head/greater tubercle
• Erosions at AC joint
• Rotator cuff rupture → resulting in superior migration of the humeral head

Answer 10

RA

Question 11

What two different conditions are demonstrated here?

Answer 11

Question 12

Characteristics of ____ in the shoulder include:

• Erosive changes at superolateralportion of humerus
• Can see enthesopathy at coracoclavicular ligaments

Answer 12

Ankylosing spondylitis

Question 13

____ is MC location for hydroxyapatite deposition disease (HADD)

Answer 13

Supraspinatus tendon

Question 14

What condition is likely the cause of these findings?

Answer 14

Hydroxyapatite deposition disease (HADD)

Question 15

What condition is likely the cause of these findings?

Answer 15

Question 16

What condition is likely the cause of these findings?

Answer 16

Question 17

What condition is likely the cause of these findings?

Answer 17

Question 18

Calcificaiton/OA of both GH joints is suscpicious for ____

Answer 18

Calcium Pyrophosphate deposition disease (CPDD) arthropathy

Question 19

Characteristics of ___ include:

• Unusual distribution, GH joint
• Unusual intraarticular distribution
• Prominent subchondral cysts
• Severe, subchonral bone changes
• Variable osteophyte formation

Answer 19

CPDD

Question 20

What condition is likely the cause of these findings?

Answer 20

Question 21

What condition is likely the cause of these findings?

Answer 21

Acute transverse fx through mid clavicle

Question 22

• Mechanism of injury usually fall on an outstretched hand or direct trauma
• Medial fragment elevated by the sternocleidomastoid muscle
• MC type

What type of clavicular fx?

Answer 22

Middle

Question 23

• Mechanism of injury usually inferiorly oriented forces on humerus and scapula
• Look for intra-articular extension
• 2nd MC (15%)

What type of clavicular fx?

Answer 23

Lateral

Question 24

What condition is likely the cause of these findings?

Answer 24

Question 25

What condition is likely the cause of these findings?

Answer 25

Grade III AC joint separation

Question 26

Normal AC joint space =

Answer 26

2-4 mm (no more than 8mm) No more than 2mm bilateral difference

Question 27

Normal coracoclavicular joint space =

Answer 27

10-13 mm - No more than 5mm difference bilaterally

Question 28

What condition is likely the cause of these findings?

Answer 28

Question 29

CT is the modality of choice to evaluate \_\_\_\_

Answer 29

SC joint injuries

Question 30

What condition is likely the cause of these findings?

Answer 30

Question 31

What condition is likely the cause of these findings?

Answer 31

Anterior inferior GH dislocation

Question 32

Inferior glenoid labrum tear with possible adjacent fracture of glenoid; associated with anterior GH dislocation =

Answer 32

Bankart lesion

Question 33

Impaction fracture of lateral aspect of anatomic neck/greater tubercle, from repetitive or one time injury; associated with anterior GH dislocation =

Answer 33

Hill-Sach's deformity

Question 34

Avulsion or shear fracture of greater tubercle; associated with anterior GH dislocation =

Answer 34

Flap fracture

Question 35

What feature associated with anterior GH dislocation is seen here?

Answer 35

Question 36

What feature associated with anterior GH dislocation is seen here?

Answer 36

Question 37

Characteristics of ____ include: - Fixed internal rotationo - Widened GH joint with greater than 6mm between the humeral head and the anterior glenoid rim **(Rim sign)** - An impaction fracture can occur on medial aspect of humeral head **(trough sign or trough line)** - May have fracture of posterior superior glenoid rim (reverse bankart lesion)

Answer 37

Posterior GH dislocation

Question 38

What feature associated with posterior GH dislocation is seen here?

Answer 38

Trough & Rim signs

Question 39

Luxatio erecta aka fixed abduction is associated with what shoulder condition

Answer 39

Inferior GH dislocation

Question 40

What condition is likely the cause of these findings?

Answer 40

Acute comminuted fx of surgical neck of humerus

Question 41

What condition is likely the cause of these findings?

Answer 41

Surgical neck fx

Question 42

What condition is likely the cause of these findings?

Answer 42

Post traumatic heterotopic ossification

Question 43

What condition is likely the cause of these findings?

Answer 43

Question 44

What condition is likely the cause of these findings?

Answer 44

Question 45

What condition is likely the cause of these findings?

Answer 45

Question 46

Monoarticular inflammatory arthritis is likely \_\_\_\_

Answer 46

Septic arthritis

Question 47

What condition is likely the cause of these findings?

Answer 47

- Uniform loss of GH joint - Osteopenia of subchondral bone

Question 48

What condition is likely the cause of these findings?

Answer 48

- Lucent lesion in the proximal metaphysis of the humerus abutting the physis. - An oblique disruption of the cortex is noted through the distal portion of the lesion with medial displacement of the distal fragment. - The remaining cortex within the region of the lesion is intact but thinned. DX: simple bone cyst with associated pathological fx DDX: enchondroma, aneurysmalbone cyst and fibrous dysplasia

Question 49

What condition is likely the cause of these findings?

Answer 49

Question 50

What condition is likely the cause of these findings?

Answer 50

Question 51

What condition is likely the cause of these findings?

Answer 51

Question 52

Subperiosteal resorption of bone is the hallmark for the condition demonstrated here - Subchonral bone resorption - Osteopenia

Answer 52

Hyperparathyroidism

Question 53

Idiopathic avascular necrosis of humeral head =

Answer 53

Hass disease

Question 54

\_\_\_\_ is best modality for evaluation of osteonecrosis

Answer 54

MRI

Question 55

What condition is likely the cause of these findings?

Answer 55

Question 56

What condition is likely the cause of these findings?

Answer 56

DDX: bone infarct, enchondroma, low grade chondrosarcoma