His father was a pioneer Oklahoma Territory Physician and Surgeon and his grandfather was also a physician. After graduating from Dartmouth College he received his MD from the University of Pennsylvania Medical School where he also did his internship in general surgery. During his year association with The Presbyterian Hospital, Dr.
Normal alignment means bony articulation congruency at the AC and GH joints, as well as an acromiohumeral distance of greater than 9 mm. Less commonly, there is anterior or inferior humeral subluxation.
Instability is clinically tested using anterior or posterior apprehension tests for anterior and posterior instability, respectively.
Constituted by the acromion posteriorly, and the coracoid process and coracoacromial ligament anteriorly, the coracoacromial arch contains the SASD bursa, supraspinatus Rehabilitation for anterior glenohumeral subluxation and tendon, and LHBT.
It is best evaluated on coronal and sagittal images. Thickening, attenuation, or deficiency of one or both of these ligaments should be reported. A common pattern observed in weight lifters and overhead throwers includes low-set acromion, deficient or attenuated inferior AC ligament and thickened superior AC ligament.
Normal and abnormal alignment. Coronal image A and axial image in abduction and external rotation ABER B demonstrate normal anatomic relationship between the humeral head and the glenoid.
Coronal C and axial D images show superior and posterior humeral subluxation, respectively. On coronal images A, Bthe acromion arrows is parallel to but lower in position with respect to the clavicle.
Although there are no defined rules, mild bursitis refers to fluid reaching laterally to the level of the acromion, mild to moderate bursitis refers to fluid underneath the acromion and deltoid muscle belly, whereas moderate refers to significant distention of the bursa at both places Fig.
Severe bursal distention is uncommon and is usually due to long-standing inflammatory conditions, such as rheumatoid arthritis or chronic massive RC tears. In addition, one should look for internal synovial thickening indicating chronic bursitis ; adjacent fascial, muscle, or bone marrow edema may indicate infection ; calcific hypointense debris calcium hydroxyapatite deposition ; rice bodies rheumatoid arthritis ; and synovial chondromatosis uniform in size and shape, numerous rounded bodies Figs.
Finally, fascial fluid extending below the humeral metaphysis and medially under the acromion or around the RC muscles indicates recent partial bursal rupture and, in most cases, is related to recent trauma fall Fig.
Small amount of fluid is evident within the bursa, in keeping with mild bursitis. The bursa contains fluid, which extends underneath the deltoid muscle, in keeping with mild to moderate bursitis.
There is substantial fluid distention of the bursa, with fluid tracking underneath the deltoid muscle. This case is compatible with moderate bursitis. In B and Clarge fluid distention and synovial thickening short arrows indicate a chronic inflammatory process.
The GH joint normally contains minimal fluid, which does not significantly distend the capsule. It includes an anterosuperior subscapularis recess, an inferior axillary recess, and a posterior recess.
Synovial thickening and loose bodies commonly develop and lodge in these recesses, respectively. In cases of adhesive capsulitis joint contractionfluid normally and preferentially collects in the subscapularis recess and the LHBT sheath. Therefore, one should not overdiagnose biceps tenosynovitis in such cases.
In small effusion, there is mild distention of the joint, predominantly involving the inferior dependent recess, whereas in moderate effusion there is distention of all recesses Fig.
Similar to the SASD bursa, large distention occurs in inflammatory conditions such as rheumatoid arthritis, pigmented villonodular synovitis PVNSsynovial osteochondromatosis, septic arthritis, or significant trauma.
Hemarthrosis, depicted as T1 hyperintense joint effusion, may be related to recent trauma look for associated local bony or soft tissue injuryhemophilia look for associated enlargement of the humeral head and fluid—fluid levelsor vascular malformation.
Finally, capsular injuries with fascial fluid from trauma, humeral subluxation, or dislocationsynovial diverticulae, and ganglion may also be identified. Synovial diverticulae are particularly common following prior arthroscopy or surgical procedures, probably formed from pseudo-encapsulation of capsular leaks caused by fluid distention, which is required during these procedures.INFUSE Bone Graft and device is to be implanted via an anterior (ALIF) or lateral (OLIF, DLIF, XLIF or LLIF) approach.
As part of the Rothman Orthopaedic Institute’s Joint Replacement Program, one of the nation’s top programs, Gerald R. Williams, Jr., M.D.
specializes in . As part of the Rothman Orthopaedic Institute’s Joint Replacement Program, one of the nation’s top programs, Matthew L. Ramsey, M.D. specializes in . ORIGINAL ARTICLE Hemiplegic Shoulder Pain Syndrome: Frequency and Characteristics During Inpatient Stroke Rehabilitation Alexander W.
Dromerick, MD, Dorothy F. . The Shoulder Avneesh Chhabra, Sahar Jalali Farahani, and Theodoros Soldatos The shoulder is a complex ball-and-socket articulation, which involves synchronized motion among four joints, the glenohumeral (GH) joint, acromioclavicular (AC) joint, sternoclavicular joint, and the scapulothoracic joint.
Abnormalities of one joint may . Differential Diagnosis. Most dislocations are situated in the Glenohumeral joint and 90% of this dislocations are anterior which can cause concomitant pathologies such as a Hill sachs lesion or injury of the brachial plexus.; Pain in the AC joint from osteoarthritis or disc disease; Osteolysis of the distal clavicle ; Instability of the AC joint Rotator-cuff .