Radiologisk bildediagnostikk av akutte skulderskader

Abstract

Background: Shoulder injuries are common amongst the Norwegian population, constituting approximately 7-8 % of all injuries. In the initial evaluation of a patient with acute shoulder trauma a thorough history and clinical examination provide the fundamental background for diagnosis. Radiologic imaging evaluation gives additional information. There has been a substantial development of imaging techniques the last years. The aim of this study was to present a review of the literature concerning radiologic imaging of selected shoulder injuries. Methods: A systematic literature review was performed. The selected shoulder injuries included proximal humeral fractures and classification systems, anterior shoulder dislocations and associated fractures, and soft tissue injuries. PubMed was searched. The initial selection of articles was based on the review of titles and abstracts. The included articles were published from January 2000 to March 2017. The final selection process included full text review of chosen articles. Results: 43 relevant studies were included. 19 studies evaluated proximal humeral fractures and classification systems. 16 studies evaluated anterior shoulder dislocation and associated fractures. 8 studies evaluated soft tissue injuries. Conclusion: The studies that assessed the different classification systems of proximal humeral fractures found different results when it comes to observer agreement. Radiography seemed to be the preferred initial imaging modality when suspecting a proximal humeral fracture, with CT as a reliable complementary technique. Ultrasound and radiography seemed to be equally accurate in verification of anterior shoulder dislocation and successful reduction. CT appeared to be more accurate than radiography in quantifying glenoid bone loss. However, some radiographic projections can be used to identify significant glenoid bone loss. Hill-Sachs-lesions are less studied. Both MRI and ultrasound appear to be accurate in diagnosing full-thickness rotator cuff ruptures.