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CT-Guided Shoulder Arthrography at the Rotator Cuff Interval

¹ Kernan CT/MR Imaging Center, 2202 Kernan Dr., Baltimore, MD 21207.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —33-year-old woman with left shoulder pain. CT scout image for left shoulder arthrography shows two paper clip markers present for localization. Using standard fluoroscopic technique, one would aim for skin entry at lateral and lower margin of lateral paper clip (arrow).

View larger version (83K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —33-year-old woman with left shoulder pain. Axial CT image shows initial needle position using aiming point determined from A. Note that needle entry position is far lateral to desired position (asterisk).

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —30-year-old man with left shoulder pain. CT scout image for left shoulder arthrography shows two paper clip markers present for localization. Using standard fluoroscopic technique, one would aim for skin entry along lateral edge of lateral paper clip (arrow).

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —30-year-old man with left shoulder pain. Axial CT image with paper clips still in place shows projected initial needle entry position (dotted line) using aiming point determined from A. Note that scout image distorts needle entry position such that it would be lateral to desired position (asterisk).

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —22-year-old man with right shoulder pain. CT scout image for right shoulder arthrography shows two paper clip markers present for localization. Using scout image as guide at level of rotator interval, one would aim for skin entry at medial edge of lateral paper clip (arrow).

View larger version (77K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —22-year-old man with right shoulder pain. Axial CT image at level of rotator interval with paper clips still in place shows that scout image distorts location of desired skin entry position determined from A. Axial CT image should be used instead of CT scout image to guide initial needle placement between limbs of medial paper clip (dotted line)—not medial edge of lateral paper clip as suggested by scout image in A.

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —22-year-old man with right shoulder pain. Axial CT image shows successful needle placement along margin of humeral head articular surface at level of rotator cuff interval with intraarticular contrast visible between humeral head and glenoid.

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