Difference between revisions of "X-ray of shoulder impingement"
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==Planning== | ==Planning== | ||
| + | ===Indication=== | ||
| + | Impingement syndrome can be diagnosed by a targeted medical history and physical examination,<ref>{{cite web|url=https://radiopaedia.org/articles/subacromial-impingement?lang=us|title=Subacromial impingement|author=Craig Hacking and Frank Gaillard|date=2019-03-06|website=[[Radiopaedia]]}}</ref><ref>{{cite web|url=https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/shoulder-impingement-syndrome.html|title=Shoulder Impingement Syndrome|website=[[Stanford University Medical Center]]|date=2019-03-06}}</ref> but it has also been argued that medical imaging, primarily [[projectional radiography]] ("X-ray") is a necessary part of the workup.<ref name="GarvingJakob2017">{{cite journal|last1=Garving|first1=Christina|last2=Jakob|first2=Sascha|last3=Bauer|first3=Isabel|last4=Nadjar|first4=Rudolph|last5=Brunner|first5=Ulrich H.|title=Impingement Syndrome of the Shoulder|journal=Deutsches Aerzteblatt Online|year=2017|issn=1866-0452|doi=10.3238/arztebl.2017.0765}}</ref> | ||
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| + | ===Method=== | ||
[[X-ray of the shoulder]] that should include: | [[X-ray of the shoulder]] that should include: | ||
* Frontal with and without external rotation of the shoulder | * Frontal with and without external rotation of the shoulder | ||
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* '''Shape''' of the acromion, at least for the presence of any '''acromial spur''' | * '''Shape''' of the acromion, at least for the presence of any '''acromial spur''' | ||
<gallery> | <gallery> | ||
| − | File:Flat acromion.jpg|Flat | + | File:Flat acromion.jpg|Flat (type 1)<ref name=types group=notes>Generally, report the shape of the acromion in the form of type 1, 2 or 3 only if responding to an orthopedic clinic where this is the customary classification.</ref> |
| − | File:Curved acromion.jpg|Curved | + | File:Curved acromion.jpg|Curved (type 2)<ref name=types group=notes/> |
| − | File:Hooked acromion.jpg|Hooked | + | File:Hooked acromion.jpg|Hooked (type 3)<ref name=types group=notes/> |
</gallery> | </gallery> | ||
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==Report== | ==Report== | ||
| − | *Either normal subacromial space, or a decrease thereof, with measurement of the space. | + | *Either normal subacromial space, or a decrease thereof, with measurement of the space in the latter case. |
*Presence or absence of an acromial spur. | *Presence or absence of an acromial spur. | ||
A more comprehensive report also mentions: | A more comprehensive report also mentions: | ||
| − | *The acromial shape regardless | + | *The acromial shape regardless<ref name=types group=notes/> |
*Even the absence of osteoarthritis. | *Even the absence of osteoarthritis. | ||
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{{Reporting}} | {{Reporting}} | ||
{{Bottom}} | {{Bottom}} | ||
Latest revision as of 17:14, 21 May 2019
Author:
Mikael Häggström [notes 1]
Planning
Indication
Impingement syndrome can be diagnosed by a targeted medical history and physical examination,[1][2] but it has also been argued that medical imaging, primarily projectional radiography ("X-ray") is a necessary part of the workup.[3]
Method
X-ray of the shoulder that should include:
- Frontal with and without external rotation of the shoulder
- Scapular outlet view
Evaluation
File:Subacromial space on outlet view X-ray.jpg
Supraspinatus outlet view X-ray, showing subacromial space measurement, and an acromial spur (above the arrow).
- Measurement of the subacromial space. This is normally 9–10 mm in shoulder radiographs.[4] It is significantly greater in men, with a slight reduction with age.[4] In middle age, a subacromial space less than 6 mm is pathological.[4]
- In case of decreased subacromial space, also measure the position of the humerus as described at X-ray of rotator cuff tear
- Shape of the acromion, at least for the presence of any acromial spur
- Flat acromion.jpg
Flat (type 1)[notes 2]
- Curved acromion.jpg
Curved (type 2)[notes 2]
- Hooked acromion.jpg
Hooked (type 3)[notes 2]
Also look for common differential diagnoses or worsening factors of shoulder impingement:
- Osteoarthritis. For severity grading, see X-ray of osteoarthritis of the shoulder
- Presence of any calcifications in the supraspinatus tendon, which indicates a differential diagnosis of calcific tendonitis.
- X-ray of supraspinatus calcified tendinopathy, labeled.jpg
Calcifications in the supraspinatus tendon.
Report
- Either normal subacromial space, or a decrease thereof, with measurement of the space in the latter case.
- Presence or absence of an acromial spur.
A more comprehensive report also mentions:
- The acromial shape regardless[notes 2]
- Even the absence of osteoarthritis.
- See also: General notes on reporting
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
- ↑ 2.0 2.1 2.2 2.3 Generally, report the shape of the acromion in the form of type 1, 2 or 3 only if responding to an orthopedic clinic where this is the customary classification.
References
- ↑ Craig Hacking and Frank Gaillard (2019-03-06). Subacromial impingement. Radiopaedia.
- ↑ . Shoulder Impingement Syndrome. Stanford University Medical Center (2019-03-06).
- ↑ Garving, Christina; Jakob, Sascha; Bauer, Isabel; Nadjar, Rudolph; Brunner, Ulrich H. (2017). "Impingement Syndrome of the Shoulder ". Deutsches Aerzteblatt Online. doi:. ISSN 1866-0452.
- ↑ 4.0 4.1 4.2 Claes J. Petersson & lnga Redlund- Johnell (1984). "The subacromial space in normal shoulder radiographs ". Acta Orthop Scanda 55 (1): 57–8. PMID 6702430.
