Role of shoulder ultrasonography in the evaluation of the painful shoulder

The purpose of this study was to determine the accuracy of ultrasonography in the detection of rotator cuff tears. In a prospective study of 41 patients, the ultrasound results could be compared with the combined results of (CT) arthrography, arthroscopy and operation. The sensitivity of sonography in detecting partial and total rotator cuff tears was 86%, the specificity 91%, the positive predictive value 96% and the negative predictive value 73%. In spite of the relatively small size of this series, our results are comparable with those of most other studies. Based on these results, sonography can provide a non-invasive, rapid and inexpensive diagnostic method for screening patients with shoulder complaints. A disadvantage of the method is its long learning curve.     

MRI of the shoulder

Shoulder imaging is one of the major applications in musculoskeletal MRI. In order to analyze the images it is important to keep informed about anatomical and pathological findings and publications. In this article MRI technique, anatomy and pathology is reviewed. Technical considerations about MR sequences and examination strategy are only shortly discussed with emphasis on turbo spin echo and short T1 inversion recovery imaging. Basic anatomy as well as recent findings, including macroscopic aspects of the supraspinatus fat pad, composition of the supraspinatus muscle belly, and variability of the glenohumeral ligaments or coracoid ligament, are presented. Basic pathological conditions are described in detail, e. g. instability particularly problems in differentiating the various subtypes of labral pathology. Rotator cuff diseases are elucidated with emphasis on some rarer entities such as subscapularis calcifying tendinitis, coracoid impingement, chronic bursitis producing the double-line sign, prominent coraco-acromial ligament and the impingement due to an inflamed os acromiale.     

MRI of the shoulder

Magnetic resonance imaging of the shoulder is routinely used, especially in the evaluation of rotator cuff disease and glenohumeral instability. More recent studies have provided a more sophisticated understanding of what represents a pathologic rotator cuff. Similarly, there has been an increased focus on the role of the glenohumeral ligaments and their labral attachment sites in maintaining glenohumeral stability. There have been technical advances as well, including the increased use of magnetic resonance arthrography. In addition, newer studies have shed light on the pathophysiology of the long bicipital tendon and compression neuropathies involving the suprascapular and axillary nerves.     

Arthroscopy of the shoulder

Arthroscopy of the shoulder has developed during the last decade to play a major role in diagnoses and treatment of a variety of shoulder disorders. In most incidences, arthroscopy is required at the time of shoulder surgery to refine the final diagnosis. In over 75% of the cases are arthroscopic methods used for surgical repair of the shoulder pathology. This article describes the indications for surgery as well as the techniques to treat rotator cuff disease label injuries, etc. with the arthroscope. The arthroscopic techniques dealing with subacromial decompression and instability is described.     

Sonography of the postoperative shoulder

Fifty-three patients with 60 symptomatic shoulders underwent shoulder sonography for recurrent postoperative symptoms after either acromioplasty (10 shoulders) or repair of a full-thickness rotator cuff tear in addition to acromioplasty (50 shoulders). Because surgery distorts landmarks, an understanding of the surgical procedures and their characteristic sonographic appearances is essential. After acromioplasty, the characteristic sharp margination or the acromion was replaced by a less distinct, irregular surface. After repair of a cuff tear, characteristic sonographic appearances included visualization of a reimplantation trough and loss of the echogenic subdeltoid bursa. When the cuff was intact after surgery, echogenicity was abnormal in all cases (17 shoulders). Sonography accurately diagnosed recurrent cuff tears in all 26 shoulders in which surgical proof was available and confirmed an intact cuff in 10 of 11 cases. In one shoulder, a cuff hematoma was incorrectly interpreted as a full-thickness tear. These findings suggest that sonography is an effective procedure for evaluating a postoperative patient with recurrent shoulder symptoms.     

Conventional radiography of the shoulder

Conventional radiography is a useful tool in the evaluation of shoulder pain whether in the setting of acute trauma or chronic pain and in most clinical situations should be the first imaging modality performed. Knowledge of the various projections and radiographic findings described above will ensure an optimal evaluation of the shoulder regardless of the suspected etiology of the shoulder pain.     

Pathomechanics of the throwing shoulder

Many anatomic, physiological, and biomechanical alterations have been observed in overhead athletes who present with painful shoulders. This is probably due to the complex kinetic chain mechanics required in the overhead throwing or serving motion. Any alteration along the kinetic chain can result in deficits in force production or increase in joint loads in other parts of the chain. The "disabled throwing shoulder" (DTS) is a general term that describes the limitations in function that exist in symptomatic overhead athletes. DTS typically results from a "cascade to injury" with alterations in the kinetic chain. Evaluation of athletes with the DTS should include examination of the local and distant anatomic injuries and screening for physiological (muscle inflexibilities, weakness, or imbalances) or biomechanical (motions, positions) alterations.     

Rehabilitation of the pitching shoulder

Shoulder pain is a common complaint among baseball pitchers. Frequently, the nature of shoulder pathology can be traced to lack of flexibility and muscular imbalance. This paper describes: the normal biomechanics of a properly functioning shoulder during a baseball pitch, pathomechanics of shoulder problems, flexibility requirements of the throwing shoulder, and the muscular balance necessary for an effective throwing shoulder. Appropriate examination procedures are described along with remedial exercises which ensure normal glenohumeral motion and integrated muscle action.     

Rehabilitation of the throwing shoulder

Rehabilitation of the injured throwing arm should not be directed simply toward beginning strengthening exercises and returning the athlete to throwing as soon as possible. The total comprehensive program has been described and consists of seven phases that begin with making the proper diagnosis of a shoulder injury. Once the proper diagnosis is made, the pathophysiology of throwing injuries has to be understood by the physician, the trainer, and the athlete, and then the actual treatment begins in phase III. Initial treatment many times consists of a short period of relative rest as well as physical therapy modalities to relieve pain, and once pain is relieved phase IV begins, which is the actual techniques of range of motion, flexibility, and strengthening maneuvers. Once adequate flexibility, range of motion, and pain-free motion have been achieved, as well as adequate endurance strength, proper warm-up techniques are begun, and then a return to throwing is achieved in phase VI. The total rehabilitative cycle is concluded with phase VII, which consists of an off-season conditioning program to verify that the athlete will maintain year-round maximum condition of not only the throwing shoulder but of the entire athlete.     

Imaging of the postoperative shoulder

Imaging plays an important role in evaluation of the shoulder after surgery. In addition to being familiar with the underlying pathologic condition that leads to surgery, it is just as important to have a general understanding of the surgical procedure because it explains the expected postoperative imaging findings. Identification of postoperative complications with imaging is also improved with this information. This article reviews some of the more common surgeries of the shoulder, including rotator cuff repair, acromioplasty, labral repair, Hill-Sachs impaction fracture and glenoid bone augmentation, acromioclavicular joint repair, and shoulder arthroplasty. Each respective surgical technique is briefly reviewed, followed by discussion and examples of normal postoperative appearances and common postoperative complications. Knowledge of these common procedures and their expected postoperative imaging findings will allow an accurate assessment of complications.     

Bony injuries of the shoulder

The complex anatomy and functioning of the shoulder may challenge the radiologist. In this review the patterns of injury and radiographic findings for bony injuries of the shoulder are illustrated. The radiographic and cross-sectional imaging findings in fractures of the clavicle, scapula, and proximal humerus and in dislocations of the sternoclavicular, acromioclavicular, and glenohumeral articulations are discussed.     

Postoperative MRI of the shoulder

Magnetic resonance imaging (MRI) evaluation of the postoperative shoulder presents technical and diagnostic challenges related to imaging artifacts from hardware and micrometallic shavings, postsurgical scarring, and morphological alterations. Improved visualization of postoperative shoulder anatomy and pathology can be obtained with the use of metal artifact reduction techniques as well as MR arthrography. In this article we review the MR techniques that are designed to address these technical and diagnostic challenges, and we discuss the definitions and indications, normal MRI appearance, and complications of routine surgical procedures for treatment of injuries to the rotator cuff, labral ligamentous complex, and biceps tendon. J. Magn. Reson. Imaging 2014;40:1280–1297 . © 2014 Wiley Periodicals, Inc .     

A comparison of peak power in the shoulder press and shoulder throw

The ability to generate peak power is central for performance in many sports. Currently two distinct resistance training methods are used to develop peak power, the heavy weight/slow velocity and light weight/fast velocity regimes. When using the light weight/fast velocity power training method it was proposed that peak power would be greater in a shoulder throw exercise compared with a normal shoulder press. Nine males performed three lifts in the shoulder press and shoulder throw at 30% and 40% of their one repetition maximum (1RM). These lifts were performed identically, except for the release of the bar in the throw condition. A potentiometer attached to the bar measured displacement and duration of the lifts. The time of bar release in the shoulder throw was determined with a pressure switch. ANOVA was used to examine statistically significant differences where the level of acceptance was set at p < 0.05. Peak power was found to be significantly greater in the shoulder throw at 30% of 1 RM condition [F, (1, 23) = 2.325 p < 0.051 and at 40% of 1 RM [F, (1, 23) = 2.905 p < 0.05] compared to values recorded for the respective shoulder presses. Peak power was also greater in the 30% of 1 RM shoulder throw (510 +/- 103W) than in the 40% of 1 RM shoulder press (471 +/- 96W). Peak power was produced significantly later in the shoulder throw versus the shoulder press. This differing power reflected a greater bar velocity of the shoulder throw at both assigned weights compared with the shoulder press.     

Arthroscopic surgery of the shoulder

Arthroscopy of the shoulder is well established as a diagnostic procedure. It carries a greater degree of accuracy than conventional imaging techniques and in addition allows the assessment of instability and the degree of mechanical derangement inside the joint. Arthroscopic surgical procedures in the shoulder are in the developing stage. Arthroscopic acromioplasty for impingement syndrome has been shown to be a safe, effective procedure and probably better than conventional surgery. In the older patient, arthroscopic debridement of the rotator cuff is very effective at relieving pain. Arthroscopic surgery for removal of loose bodies and of a torn glenoid labrum would be the current recommended procedure rather than open surgery. Other rapidly developing areas of potential benefit are in the arthroscopic stabilisation of the dislocating shoulder and synovectomy of the shoulder in rheumatoid arthritis and other synovial conditions. The role of arthroscopy in the frozen shoulder is not clearly established although certainly it is the diagnostic tool of first choice in this condition.     

Ultrasound evaluation of the shoulder

This article discusses ultrasound examination of the shoulder and highlights some of its utility. The focus is on normal shoulder anatomy and pathology involving the rotator cuff, biceps tendon, and other related miscellaneous conditions.