Wednesday, November 12, 2014

The axillary - truth - view. It tells us what we need to know about arthritis.

Here is the AP view of a 47 year old vintner with shoulder pain. What is the diagnosis? Note on this view the normal joint space and the absence of osteophytes.

An axillary view taken the the functional position of elevation in the plane of the scapula (note the spinoglenoid notch showing it was taken properly) reveals bone on bone contact, however. No CT necessary!

How can this be?

The answer is that cartilage is often lost in the central aspect of the head so that the joint space loss shows when the arm is in a functional position of elevation in the plane of the scapula, but not with the arm adducted where the remaining cartilage is interposed between the head and the glenoid. It's a bit like Friar Tuck.


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