n Progressive Osseous changes n Scapular and Cuff weakness n Post. Soft Tissue contracture n Post-sup. Instability in ABD and EXT ROT.
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1 Imagig of the Shoulder i the Throwig Athlete Michael G. Ciccotti, MD Everett ad Maria Gordo Professor of Orthopaedic Surgery Chief, Divisio of Sports Medicie Rothma Istitute, Thomas Jefferso Uiversity Head Team Physicia, Philadelphia Phillies ad St. Joseph s Uiversity Predictable Series of Evets i Throwers Progressive Osseous chages Scapular ad Cuff weakess Post. Soft Tissue cotracture Post-sup. Istability i ABD ad EXT ROT. Peel-back mechaism occurs SLAP, Biceps & Post-Sup Cuff Ijury occur Geeral populatio is ot routiely exposed to this cascade of evets but throwers are! Shoulder Ijury i the Thrower - Evaluatio History Physical Examiatio Imagig Shoulder Ijury i the Thrower - Imagig Boy chages Humeral Head cysts Posterior Gleoid spurrig Capsular chages Posterior Capsular thickeig Labral chages Superior Labral frayig/tearig Rotator Cuff chages Supraspiatus/Ifraspiatus tearig Ko Fessa, JMI 2015 Tyler, AJSM 2010 Magee, AJR 2009 Coor, AJSM 2003 Traditioal Imagig Plai X-Rays Plai X-Rays AP i It & Ext Rot Y-View Axillary View Calcificatios Posterior Humeral cyst Posterior Gleoid Spurrig ASYMPTOMATIC ABNORMALITIES EXIST! Tyler, AJSM 2010 Myers, AJSM 2006 Coor, AJSM
2 Traditioal Imagig MR - Cartilage/Boe Humeral Cyst - Cor Humeral Cyst - Ax Plai X-Rays MRI/MRA T1, T2, ad specialized sequeces Coroal, Sagittal, Axial, ABER Itra-Articular Gadolieum Systematically evaluate: Cartilage, Boe, Ligamets, Muscles, Tedos, Neurovascular Structures MR - Labrum MR - Labrum SLAP Tear SLAP Tears: Imagig Pearls At/Post Tear Cotrast udercuttig the superior labrum at ad/or posterior to the biceps root >2mm Detachmet of superior labrum from gleoid Irregular borders of sublabral recess aterior to biceps achor Peri-labral cyst formatio MR - Muscle/Tedo MR - Muscle/Tedo High Grade Supraspiatus Tear High Grade Supraspiatus Tear ABER View 2
3 MR - Neurovascular Para-Labral Cyst MR Imagig MRI Ehaced MRI Kooima, AOSSM, 2003 Popovic, IJSM, 2001 Jobe, AAOS, 2001 ot perfect asymptomatic abormalities exist subtle ijuries may be missed Traditioal Imagig Ultrasoud - Labrum Spiogleoid Notch Gaglio From Degeerative Labral Tear Plai X-Rays MRI/MRA Ultrasoud H Multifrequecy 13-MHz liear-array trasducer Electroic calipers (.01mm resolutio) Allows fuctioal/dyamic assessmet * G Ultrasoud Musc/Tedo Ultrasoud Musc/Tedo Critical Zoe Supraspiatus Tear Partial Articular Surface Supraspiatus Tear Log axis(coroal) Short Axis(Sagittal) Log axis(coroal) 3
4 Ultrasoud Musc/Tedo Ultrasoud Musc/Tedo Subluxated Biceps Tedo Logitudial Biceps Tear at the Groove GT LT LT GT Ultrasoud - Neurovascular Spiogleoid Notch Gaglio From Degeerative Labral Tear Sesitivity of Preoperative MRI ad MRA i the Detectio of Palabral Tears of the Gleohumeral Joit H * G Eric Richetti, MD, Michael C. Ciccotti, MD, Gerald Williams, MD, Mark Lazarus, MD, Michael G. Ciccotti MD Results Materials & Methods Retrospective review of all labral repairs at our istitutio from Ja 05-Dec 09 1,624 cases idetified by CPT codig Palabral tears verified by reviewig operative reports (mi 1 achor/quadrat) 40 patiets meet iclusio criteria All patiets with preop MR of symptomatic shoulder Preoperative MR Imagig Total Cotrast Labral Tear 38/40 (95%) 18/18 (100%) 20/22 (91%) + >1 quadrat 18/40 (45%) 13/18 (72%) 5/22 (23%) + Palabral 4/40 (10%) 3/18 (17%) 1/22 (4%) MRIs Nocotrast 4
5 Discussio Preoperative MR may have a poor sesitivity i detectig palabral tears I our study, oly 10% (4/40) MRIs idetified a palabral tear History, Exam, ad EUA ca help make a more precise diagosis Surgeos should be prepared for more extesive labral pathology at time of surgery Recommedatios Begi with thorough history ad physical exam Plai X-Rays should be obtaied If symptoms ad exam suggest a structural ijury, the progress to advaced imagig MR (Arthrogram most ofte utilized) Ultrasoud (especially for cuff/biceps) Recommedatios Asymptomatic chages exist, particularly i throwers Iterpret the imagig fidigs with respect to the history ad exam ALWAYS treat the athlete, ot the imagig i isolatio! THANK YOU. 5
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