Wk 5, Case 2, Shoulder MR - Review
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This is just a 67 or 68 year old with shoulder
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pain. The key to this case is this is just a, a nice case of, uh,
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osteoporosis, severe osteoporosis of the, uh, of the g glenohumeral joint.
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And presumably this patient's just getting teed up for, um, uh,
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a total shoulder arthroplasty. So, so what my surgeons want to know for,
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for such a case, uh, is how the rotator cuff muscle bulk is and,
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and how the tendons are because, um, if the, especially if the muscle bulk is,
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is maintained as in this case, then they can use, uh,
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a total shoulder arthroplasty. If,
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if there's rotator cuff tendon tear and disuse and, you know,
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atrophy of the muscles, the rotator cuff muscles, then we're looking more at a,
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uh, reverse total shoulder, in which case, and,
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and the reason why they would want to do the reverse total shoulder is, um,
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if the, uh, rotator cuff muscles are atrophied and,
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um, you know, of basically no use, then in that case,
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then they're gonna use the reverse total shoulder. So that's gonna basically,
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uh,
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move the fulcrum of the g glenohumeral joint more laterally,
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and that's gonna maximize or better optimize the firing of the deltoid
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for a reverse total shoulder. So with that in mind, if, if,
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assuming that the rotator cuff muscles are, uh, atrophied and, uh,
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we're moving more towards a,
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or we're planning more for a reverse total shoulder,
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then you want to evaluate properly the deltoid muscle Okay.
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For the surgeon. And then in that case, I wanna point out for the surgeon,
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if there is a couple of things, if there's atrophy of the deltoid muscle. Okay.
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And second, if there's any, um,
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tearing of the muscle and what happens with these patients,
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particularly when they get oa. But also with, uh,
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rotator cuff tendon tears and exposure of the greater tuberosity.
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As the patient ab ducks and moves, moves their shoulder,
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what happens is they can get, uh, undersurface, ulceration and, uh,
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uh, tearing of the articular side of the, uh, of the undersurface,
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of the deltoid there. And, and that deltoid muscle,
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especially the middle portion, uh, can fail,
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in which case that would be a problem, uh, for, uh,
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a reverse total shoulder. And for those that are interested,
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there's a nice article reviewing the deltoid muscle and, uh, the, uh,
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normal anatomy which can be divided into anterior, middle,
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and posterior portions. Okay. And, uh, but that article is called, um,
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the Deltoid Muscle, the Forgotten Muscle, I believe it is.
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And that was published in skeletal radiology, I believe, um,
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maybe five or six years ago now. But great article, if you guys can get that.
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If not, I'm happy to forward a, a copy of that, uh, PDF to,
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to you guys as well. But that's probably the, the take home for, for this case.
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Gitanjali Bajaj, MD
Assistant Professor
University of Arkansas for Medical Sciences
Edward Smitaman, MD
Clinical Associate Professor
University of California San Diego
Brian Y. Chan, MD
Assistant Professor of Musculoskeletal Radiology
University of Utah
Todd D. Greenberg, MD
Radiologist
ProScan
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