Department of Radiology, NYU Hospital for Joint Diseases, NYU Langone Medical Center, NYU Center for Musculoskeletal Care, NYU School of Medicine, 301 E 17th St, Sixth Floor, New York, NY 10003.
Radiology. 2013 Nov;269(2):323-37. doi: 10.1148/radiol.13121926.
In the shoulder, the advantages of range of motion are traded for the disadvantages of vulnerability to injury and the development of instability. Glenohumeral instability encompasses a broad spectrum of clinical complaints and presentations. The diagnosis can be obvious or entirely unsuspected. Imaging findings depend on numerous factors and range from gross osseous defects to equivocal labral abnormalities and undetectable capsular lesions. This review focuses on the imaging findings in three distinct clinical scenarios: acute first-time shoulder dislocation, chronic instability with repeated dislocation, and chronic instability without repeated dislocation. The biomechanics of dislocation and the pathophysiology of labral-ligamentous injury are discussed. The authors distinguish the findings that occur in the acutely traumatized shoulder from those that typify the chronic unstable joint. The roles of different imaging modalities are also distinguished, including magnetic resonance arthrography and the value of specialized imaging positions. The goal of imaging depends on the clinical scenario. Image interpretation and reporting may need to emphasize diagnosis and the identification of lesions that are associated with instability or the characterization of lesions for treatment planning.
在肩部，运动范围的优势与易受伤和不稳定发展的劣势相交换。盂肱关节不稳定包括广泛的临床症状和表现。诊断可能是明显的，也可能完全没有被怀疑。影像学表现取决于许多因素，从明显的骨缺陷到不确定的盂唇异常和无法检测到的囊病变。这篇综述集中在三种不同临床情况下的影像学表现：首次急性肩关节脱位、反复脱位的慢性不稳定和无反复脱位的慢性不稳定。讨论了脱位的生物力学和盂唇韧带损伤的病理生理学。作者区分了在急性创伤性肩部出现的表现和典型的慢性不稳定关节的表现。还区分了不同影像学方式的作用，包括磁共振关节造影术和特殊影像学体位的价值。影像学的目的取决于临床情况。图像解释和报告可能需要强调诊断和识别与不稳定相关的病变，或者对治疗计划进行病变特征描述。
