Tuesday, June 18, 2013

True anteroposterior x-rays and rotator cuff tears.

It is of interest that of the 600 posts on this blog, the one most often visited is that describing proper x-ray technique for the glenohumeral joint. 
This is reassuring, because so many of the patients referred to us have poorly done plain films so that the diagnosis is missed. There is this fascination with 'advanced imaging (CT or MRI)' that skips over the value of properly done plain films.

While it is recognized that plain films are not the definitive imaging modality for cuff disease, we applaud these authors for evaluating conventional radiography to evaluate patients with rotator cuff tears. Specifically, they set out to determine whether the true anteroposterior (AP) view of the glenohumeral joint (the thorax is rotated to the affected shoulder for 35°-45°) is more sensitive than the conventional shoulder AP view (the beam and cassette are perpendicular to the torso but oblique to the glenohumeral joint) in terms of detecting rotator cuff tears.

They reviewed intermixed  AP and conventional AP views of 160 consecutive shoulders that were subsequently shown to have rotator cuff tears on arthroscopy. Specifically they sought five signs of rotator cuff disease: greater tuberosity sclerosis, greater tuberosity osteophyte, subacromial osteophyte, greater tuberosity cyst, and humeral head osteophyte. 

They found that the detection of these findings was significantly greater on the true AP view than on the conventional AP view. 

The point is that if we are taking x-rays of the shoulder, we should school our x-ray techs in the technique that will reveal the most information. The biggest challenge seems to be teaching the proper technique for getting a good axillary view.

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