Imaging techniques for glenohumeral arthritis and glenohumeral arthroplasty.
A thorough history and physical examination can usually determine the cause of a painful shoulder. In most cases, the diagnosis and cause of glenohumeral arthritis are fairly obvious. Imaging studies such as radiographs, computed tomography (CT), arthrography, ultrasonography, and magnetic resonance (MR) imaging are used to confirm and further define the pathologic process. Early in the development of glenohumeral arthrosis, subtle radiographic findings may suggest the diagnosis when the symptoms are mild. Later in the progression of joint destruction, imaging studies are crucial to the planning of prosthetic arthroplasty. Subsequent to arthroplasty, imaging studies can identify existing or potential problems that might correlate with the clinical course. Recent advances in musculoskeletal imaging, such as CT, ultrasound, and MR imaging, enable the physician to confirm or document anatomic pathology that was previously only inferred. There has been a corresponding increase in the use of imaging modalities. Concurrently, cost has become a major concern, and its limitation or reduction a priority of current and future medical care. Consequently, the knowledge gained from further research, education, and clinical experience must promote appropriate use and enable doctors to avoid sophisticated imaging when the results will not influence the course of treatment. The radiographic evaluation of glenohumeral arthrosis the use of imaging techniques in planning prosthetic glenohumeral arthroplasty, and the role of imaging in followup evaluations of prosthetic arthroplasty are discussed. The preferred approaches to these subjects are presented and clinical cases are used to highlight the important and interesting principles.
Green
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Department of Orthopaedic Surgery, Brown University/Rhode Island Hospital, Providence 02903.
Norris
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D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000601:surgery; D001175:Arthrography; D003952:Diagnostic Imaging; D006801:Humans; D007595:Joint Prosthesis; D008279:Magnetic Resonance Imaging; D010003:Osteoarthritis / Q000175:diagnosis* / Q000601:surgery*; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012421:Rupture; D012785:Shoulder Joint / Q000473:pathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography