By David Stoller et al.
Диагностическая визуализация: ортопедия. Книга хорошо организованна, хорошо написана, великолепно иллюстрирована и имеет информативный текст.
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Additional info for Diagnostic Imaging Orthopaedics
Right) Coronal STIR MR demonstrates a tear (arrow) of the infraspinatus/posterior supraspinatus in a patient with posterosuperior glenoid impingement. (Left) Clinical photograph of a baseball pitcher demonstrates posterior contracture and inability to raise throwing hand - R hand (arrow) symmetrically with the left hand. Note the shoulder asymmetry. (Right) Axial PD FSE MR demonstrates synovitis (arrow) within the posterosuperior aspect of the joint. There is associated labral fraying, sclerosis of the posterosuperior glenoid and cystic changes in the posterolateral humeral head.
O Anterior-posterior,medial-lateral Morphology o Gap in thickened irregular hyperintense tendon rn +/- Thinning o Repairable tears Crescent within the distal tendon at insertion U-shaped extensive tear L-shaped tear indicates a longitudinal component o Massive tear: > 5 cm not repaired Debridement if associated with fatty atrophy of the muscle Surgical repair uncommon Radiographic Findings General Features Best diagnostic clue: Tear or gap in RTC tendon, +/joint bursal fluid, fibrosis and/or granulation tissue Location o Insertional tear within rotator crescent Rotator crescent: Lateral more avascular portion of cuff; at risk for tear o Extensive tear involving crescent and cable Rotator cable: More vascularized tissue medial to the crescent which joins anterior & posterior margins of RTC Biomechanically less stable Size o Millimeter to several centimeters DDx: Rotator Cuff Full ~hicknessTear Radiography o Acromial spurs o Type I11 (hooked) acromion o Acromioclavicular (AC) arthritis o Humeral head (HH) flattening or hypertrophy o HH greater tuberosity cysts o Superior HH migration MR Findings TlWI o Thickened indistinct tendon Tear edges not delineated on TlWI o Calcifications in the supraspinatus, infraspinatus or teres minor in cases of calcific tendinitis Hypointense calcium deposits ROTATOR CUFF FULL THICKNESS TEAR I Kev Facts I Imaging Findings I Insertional tear within rotator crescent Retraction and degeneration of tendon edges Full thickness tear associated with fatty atrophy of muscles chronic cases (fat signal on TlWI) Top Differential Diagnoses Intratendinous Cyst Partial Tear of Rotator Cuff Adhesive Capsulitis Acromioclavicular Arthritis Rheumatoid Arthritis (RA) Rotator Cuff Tendinopathy Pathology Clinical Issues Pain with impingement test Insidious onset of pain, continuously increases with time - impingement Diagnostic Checklist Assess tendons involved, status of tendon edges, status of biceps tendon and muscle atrophy Identify fluid signal intensity especially on FS PD FSE and PD and STIR sequences General path comments: Tear occurring in otherwise degenerated tendon due to chronic overuse T2WI o Hyperintense fluid signal intensity filling a gap in the tendon T2 FSE & FS PD FSE o Bald spot sign Hyperintense fluid "bald spot" within hypointense tendon "head of hair" Sagittal, axial T2WI o Fluid in subacromial bursa Increased signal intensity on T2 FSE & FS PD FSE Fluid may also be visualized in bursa without a cuff tear o Hyperintense (fluid signal intensity) bursitis Subacromial/subdeltoid fluid or bursa1 thickening Subcoracoid - esp.
B. Saunders, Philadelphia PA, 791-812, 2003 Read JW et al: Shoulder ultrasound: Diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology. J Shoulder Elbow Surg 7(3):264-71, 1998 Tirman PF et al: Posterosuperior glenoid impingement of the shoulder: Findings at MR imaging and MR arthrography with arthroscopic correlation. Radiology 193(2):431-6, 1994 ROTATOR CUFF PARTIAL THICKNESS TEAR (Lef)Coronal graphic shows a bursal surface partial tear with reactive bursal changes.