الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
The anatomical architecture of the shoulder joint entails that it is one of the most unstable synovial joints in the body. In fact such instability reflects the vulnerability of the joint in terms of a wide range of injuries to which it might be subjected. Moreover, there are various local and systemic pathological arthritic conditions that are likely to affect the joint primarily or secondary to traumatic insults.
On the other hand the radiological and imaging advance has become a corner stone in establishing and confirming the diagnosis of many clinical conditions affecting the shoulder joint. Such imaging advance, eventually paves the way for a definite and appropriate medical and surgical management accordingly.
There are main four imaging modalities represented by plain X-ray, ultrsonography, CT scan and lastly MRI that are greatly indulged in determing and clarifying any problammatic incidence affecting the joint. Both plain X-ray and CT scan are better in imaging the osseous component of the shoulder joint whereas both the ultrasonography and MRI are better in imaging the soft tissue component of the joint. They all prove to be very helpful in finely delineating the anatomical stucture of the joint under normal conditions and any major or minor derrangement affecting such anatomical structure.
These imaging devices aren’t actually used altogether at a given time, but being rather used in an ascending order under a clinical supervision. Plain radiographs along one or more projections would be orderd first so as for the clinician to gain a preliminary orientation about the joint’s condition in general in terms of articulation and outline. Then it would only be up to the clinician or the surgeon to resort to another modality among the other three modalities, not necessarily collectively but rather selectively according to the circumstances of each case independently. However, in some cases the clinician may directly resort to a definite imaging modality in reaching a precise diagnosis whenever there is a medical indication for that.
The present study shows how these imaging techniques are helpful in many of the medical conditions affecting the shoulder joint. It shows the importance of different radiographic projection in case of different types of shoulder dislocation and various arthritic conditions affecting the shoulder joint. It also shows the role of ultrasonography in imaging the soft tissue injury pertaining the shoulder joint particularily the rotator cuff injury and some arthritic condition affecting the joint especially the rheumatoid arthritis. The role of computed tomography is essential in finely imaging the bony components shoulder joint, being able to presicely delineate the displacement and dislocation of sizable or minute bony fragments commonly taking place in traumatic insults. It supports the initial plain radiography in terms of confirming what has been imaged in a prior radiograph or even detecting any minute morophological change concerning the bony criterion in case being missed on such radiograph. Three dimensional CT has recently showed efficacy in estimating the amount of glenoid bone loss seen in osteoarthritis of the shoulder joint. Moreover, conventional MRI, indirect and direct MRI arthrography showed an outstanding advance in mainly imaging the soft tissue component of the joint. It plays a prime role in detecting and following up adhesive capsulitis, rotator cuff tears and soft tissue injury that associate the shoulder dislocation.
The core issue and the main aim of relying upon such modalities eventually is to reflect the anatomical structure of the joint. So it is worthmentioning that the radiologist must be aware even before eliciting the image on how to accurately position the patient especially in case of plain X-ray relevant to the pursued anatomical constituent that needs to be clearly demonstrated on such image. Furthermore, in case of ultrasonography the operator needs to beware of the precise position on which the ultrasound probe should be applied in relation to the anatomical component needed to be illustrated. Moreover, the clinician himself must be firmly acquainted on the detailed anatomical structure and components of the shoulder joint as well as the various structures that surround it correlating such details within his/her clinical speciality accordingly.
Conclusively there won’t be a great deal of benefit in case a given radiological image pictures the joint while the clinician or the radiologist fail to translate such image into a true anatomical orientation in terms of its normal or abnormal arrangement alike, ending up in missing a provisional diagnosis being affiliated to negligence of the anatomical basis of the joint seen on the image.