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Anterior Shoulder Dislocation:Quantification of Glenoid Bone Loss with CT

¹ Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Sha Tin, N. T., Hong Kong.
² Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong.

View larger version (81K): [in a new window]   Fig. 1A. —73-year-old woman with no history of shoulder dislocation. Double oblique reformation of CT images was used to obtain image en face to glenoid fossa. Plane parallel to midpoint of glenoid fossa (solid line) was chosen to define oblique sagittal plane (B).

View larger version (99K): [in a new window]   Fig. 1B. —73-year-old woman with no history of shoulder dislocation. Double oblique reformation of CT images was used to obtain image en face to glenoid fossa. Using supraglenoid tubercle as a reference, long axis of glenoid fossa (solid line) was defined on this oblique sagittal image, and oblique coronal image (C) was reconstructed.

View larger version (99K): [in a new window]   Fig. 1C. —73-year-old woman with no history of shoulder dislocation. Double oblique reformation of CT images was used to obtain image en face to glenoid fossa. Using supraglenoid tubercle as a reference, vertical inclination of glenoid fossa (solid line) was defined on this oblique coronal image and further oblique sagittal image (D) was reconstructed.

View larger version (98K): [in a new window]   Fig. 1D. —73-year-old woman with no history of shoulder dislocation. Double oblique reformation of CT images was used to obtain image en face to glenoid fossa. This further oblique sagittal image provided image en face to glenoid fossa.

View larger version (131K): [in a new window]   Fig. 2A. —44-year-old man with single episode of shoulder dislocation. Maximum width of glenoid fossa (solid line) on each 1-mm axial CT image was measured in millimeters.

View larger version (108K): [in a new window]   Fig. 2B. —44-year-old man with single episode of shoulder dislocation. Summation of maximum width on contiguous 1-mm axial CT images provided one measure of cross-sectional area (summated cross-sectional area). Normal anterior scapular tilt results in standard axial CT plane running anterosuperiorly to posteroinferiorly relative to long axis of glenoid.

View larger version (115K): [in a new window]   Fig. 3A. —26-year-old man with 10 episodes of anterior shoulder dislocation on one side. Oblique sagittal CT image en face to glenoid fossa of nondislocating shoulder shows maximum glenoid length as measured by drawing line from supraglenoid tubercle (defined on axial images simultaneously viewed on another window [not shown]) and most inferior aspect of glenoid fossa. Maximum glenoid width was measured by drawing line at right angles to original line across width of glenoid fossa. In this case, length was 41.8 mm and width was 28.6 mm.

View larger version (93K): [in a new window]   Fig. 3B. —26-year-old man with 10 episodes of anterior shoulder dislocation on one side. Oblique sagittal CT image en face to glenoid fossa of dislocating shoulder shows severe anterior bone loss. In this case, length was 41.1 mm and width was 21.6 mm.

View larger version (110K): [in a new window]   Fig. 4. —Normal shoulder of 23-year-old man. CT scan shows continuous tracing of outline of glenoid fossa on reformatted oblique sagittal images (reformatted cross-sectional area = 695.3 mm2).

View larger version (92K): [in a new window]   Fig. 5. —24-year-old man with normal shoulder. Oblique sagittal reformation of CT scan en face to glenoid fossa shows normal rounded anterior glenoid fossa curvature (small arrows). For descriptive purposes, glenoid notch (large arrow) was defined as 2-o'clock position, most anterior portion of anterior glenoid curvature as 3-o'clock position, and most inferior portion of glenoid fossa as 6-o'clock position.

View larger version (94K): [in a new window]   Fig. 6. —39-year-old woman with single anterior shoulder dislocation. Oblique sagittal CT scan shows minimal flattening of anterior glenoid curvature. Anterior straight line measures 6.2 mm.

View larger version (105K): [in a new window]   Fig. 7. —20-year-old man with four episodes of anterior shoulder dislocation. Oblique sagittal CT scan shows mild flattening of anterior glenoid curvature. Anterior straight line measures 9.9 mm.

View larger version (108K): [in a new window]   Fig. 8. —24-year-old man with five episodes of anterior shoulder dislocation. Oblique sagittal CT scan shows moderate flattening of anterior glenoid curvature. Anterior straight line measures 14.5 mm.

View larger version (95K): [in a new window]   Fig. 9. —21-year-old man with 10 episodes of anterior shoulder dislocation. Oblique sagittal CT scan shows moderate flattening of anterior glenoid curvature. Anterior straight line measures 16.9 mm.

View larger version (102K): [in a new window]   Fig. 10. —34-year-old man with 30 episodes of anterior shoulder dislocation. Oblique sagittal CT scan shows severe flattening of anterior glenoid curvature. Anterior straight line measures 21 mm.

View larger version (101K): [in a new window]   Fig. 11. —52-year-old man with more than 200 episodes of anterior shoulder dislocation. Oblique sagittal CT scan shows flattening and concavity of anterior glenoid curvature. Anterior straight line, transversing concavity, measures 28.9 mm.

View larger version (15K): [in a new window]   Fig. 12. —Graph shows relationship between number of dislocations sustained (x-axis) and degree of flattening of anterior glenoid curvature (i.e., anterior straight line) (y-axis). Reciprocal relationship with first few dislocations produced relatively greater effect on degree of flattening. One patient with more than 200 dislocations is not included. Solid dots represent five shoulders with concave anterior glenoid curvature.

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