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Archive for the ‘X-Ray of the Week’ Category

Take a break!

Well done on making it to the end of week 2 of  the MSS!

This is the time to re-cap on your learning so far in relation to the shoulder and hand.  Take a look again at the bone of the week and  case of the  week especially for shoulder and hand stuff.

Week 3 will be focusing on back and neck pain, especially nerve root compression and mechanical   back pain but with something about  other back problems as well – enjoy!

Dundeebones

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Left Shoulder Xray

This is the Xray of the left shoulder of a 42 year man following a fall  from a height onto his outstretched hand.

He has  a painful, immobile shoulder with  loss of the normal contour of deltoid.

What do you think the Xray shows? (there are two abnormalities to  notice here).

Remembering Prof Parkin’s lecture today it would be important to test his sensation somewhere.

After emergency management his shoulder now looks like this.

Can you say how he as been treated and what might go wrong with his shoulder during the next few days or weeks?

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OA of acromioclavicular joint

This 70 year old man is complaining  of shoulder pain when he moves his arm.

There is no  history of trauma and no limitation of shoulder movement.  It’s just painful to do!

Significantly on examination there is no  weakness of rotator cuff function and no painful arc on abduction.

This pain Xray shows a normal gleno-humeral  joint.  There is some superior migration of the humerus suggesting rotator cuff thinning.

The AC  joint shows some features of osteoarthritis.  Can you say which of these features you can identify on the X-ray?

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The Rotator Cuff

Shoulder ultraswound scan

 An ultrasound scan is the investigation of choice for visualising the rotator cuff.  It is possible to  identify the rotator cuff muscles and their tendon cuff as it inserts on to the tuberosities of the humerus.

The surface of the humeral head can also be seen.

Tears, frays and inflammation in the rotator cuff can be identied by an ultrasound scan.  A MRI scan would show the same pathology but is more lengthy to  perform.

This picture is of a normal ultrasound scan of the rotator cuff.

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