aDepartment of Diagnostic Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro 4th Floor, Boston, MA 02215, USA
bDepartment of Orthopaedic Surgery and Rehabilitative Medicine, Yale University School of Medicine, 800 Howard Avenue, New Haven, CT 06510, USA
cDepartment of Diagnostic Radiology and Orthopaedic Surgery and Rehabilitative Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
Pain in the postoperative shoulder is difficult for all individuals involved. The patient has already undergone a surgical procedure and is presenting now with pain possibly relating to a complication of the procedure or reinjury. In addition, the patient typically has undergone a series of maneuvers, from physical therapy to cortisone injection, without relief of the symptoms. For the orthopaedic surgeon the possibility of a complication of the procedure is disheartening. Finally, for the radiologist the postoperative shoulder usually is more difficult to interpret because of a change in the normal anatomy, not knowing exactly what was accomplished at surgery or what techniques or types of equipment were used, and, more typically, the presence of artifact.
Evaluation of the postoperative shoulder at our institution usually is accomplished with MR arthrography. Occasionally the study can be performed as a noncontrast study or possibly as a CT arthrogram of the shoulder in cases of claustrophobia or contraindications, such as a cardiac pacemaker or metal located somewhere in the body.
When imaging the postoperative shoulder, as in the nonoperated shoulder, a dedicated phase array shoulder coil should be used . The imaging parameters often do not differ from standard nonoperated shoulder protocols; however, attention should be given to sequences that can reduce metallic susceptibility artifact. At our institution we use 3- to 4-mm slice thickness for most planes, a 13- to 16-cm field of view, and a 256 to 192 matrix. The patient is imaged with the arm adducted and in external rotation. Some studies have advocated additional sequences in the abducted external rotation position (ABER) to provide tension and better demonstrate the anteroinferior capsulo-labral structures, especially following Bankart repair [2,3]. This additional
*Corresponding author. E-mail address: [email protected] (L.D. Katz).
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