CT scan shoulder is a method of radiation diagnostics that allows you to visualize the anatomical structures that form the shoulder joint. During its implementation, the head, neck and proximal part of the humerus, the articular cavity of the scapula, the lateral third of the clavicle, the general configuration of the joint and the relative location of the articular surfaces are determined. CT makes it possible to diagnose intra- and periarticular fractures, osteoporotic changes, complete and incomplete dislocations, accumulation of blood or pus in the joint cavity, deformation of articular surfaces, ankylosis, etc. Native ct scan shoulder does not require preparation and is performed as an independent study. If necessary, the procedure can be supplemented with intravenous administration of radiopaque substances.
Indications
CT shoulder is necessary in complex clinical situations requiring detailed visualization of the structures of the studied area. This procedure is used when more common techniques are uninformative against the background of clinical symptoms of shoulder joint damage. The latter include pain in the joint area during movements, axial load or at rest, a decrease in the amplitude of movements or their complete absence, an increase in size, swelling, deformation, redness and an increase in skin temperature over the joint, the formation of palpable neoplasms, pathological movements, crunch. The study is prescribed in case of suspicion of X-ray negative and complex near- and intra-articular fractures, hemarthrosis, abscesses, arthritis, arthrosis, benign and malignant formations, congenital malformations, etc.
Also, this study can be used to plan surgical treatment, assess the condition of tissues in the postoperative period or after completing a full course of pharmacotherapy. Enhancement of ct scan shoulder by the introduction of radiopaque substances makes it possible to visualize regional blood vessels. This is necessary for differential diagnosis between benign neoplasms and malignant tumors, detection of thromboembolism, blockage of vessels with atherosclerotic plaques, traumatic injuries of the main vessels.
Contraindications
Due to possible teratogenic effects, CT is contraindicated in pregnant women. The procedure is not prescribed to patients in critical condition with unstable hemodynamics, since computed tomography excludes the possibility of continuous monitoring of the condition of patients and immediate assistance. The technique is usually not used in the examination of preschool children, mentally ill or people with claustrophobia, since this contingent is unable to maintain a stationary state, which is necessary for a high-quality scan. Overweight also serves as a contraindication, since most tomographs have a weight limit of 120-150 kg.
Due to the risk of anaphylactic shock, CT of the joint with intravenous contrast is not performed in patients with intolerance to iodine-containing drugs or allergic reactions to radiopaque substances in the anamnesis. The procedure is not performed with severe hepatic and / or renal insufficiency, since most contrast agents are metabolized and excreted from the body by the liver and kidneys. For women during lactation, most experts recommend that they refrain from breastfeeding for 2 days after the contrast study. Intravenous contrast with iodine preparations during ct scan shoulder can cause significant metabolic disorders in patients suffering from type II diabetes mellitus, myeloma, thyrotoxicosis, etc.
Preparation
Native research does not require special training. In CT with intravenous contrast, certain preparatory measures are necessary. They include an allergy test for the injected drug, an assessment of kidney function (creatinine and blood urea, determination of GFR) and liver (AsAT, AlAT, bilirubin, etc.). You should also refrain from eating 4-6 hours before ct scan shoulder.
Methodology of conducting
Before the start of the scan, the radiologist instructs, interviews the patient, finds out the presence of previously undergone surgical interventions, metal structures present in the body and other factors that may affect the quality of the images. After that, the patient is asked to go to the locker room, take off all jewelry and metal objects, and then change into a special robe to prevent distortion of the results of the diagnostic procedure. Next, the patient moves into a room with a CT scanner. Most scanners have the appearance of a large thick-walled ring with a horizontal table. The patient lies down on the table, and the radiologist places the area of the body to be examined inside the tomograph.
Native CT takes 1-2 minutes, during which it is necessary to maintain a stationary state. The operation of a large part of the tomographs may be accompanied by clacking or clicking. Scanning without the use of intravenous contrast does not cause somatic sensations. With the introduction of contrast, the duration of the study increases to 15-20 minutes. The use of radiopaque drugs may be accompanied by general malaise, nausea or dizziness, which persist for some time after the study. With proper preparation and compliance with all precautions, ct scan shoulder does not cause adverse reactions or complications. After the procedure, it is not required to observe any restrictions of vital activity.
Interpretation of results
Registration of the results can take from 1-3 hours to a day, depending on the specific medical institution. In most cases, the patient receives a CD-ROM with the pictures recorded on it, copies of the pictures on film or paper, a written opinion of a radiologist with a detailed description of all the detected violations. Some diagnostic centers may send the results to the e-mail of the patient or his attending physician.
CT scan shoulder can detect violations of the structural integrity of the bones, corresponding to cracks or fractures, as well as displacement of the articular surfaces relative to each other, which is a sign of incomplete or complete dislocation. According to the study, osteoporosis, deformity, narrowing of the articular gap, ankylosis are symptoms of arthritis and osteoarthritis, as well as accumulation of blood or pus in the articular cavity – manifestations of hemarthrosis, abscess. With contrast enhancement, the presence of neovascularization in neoplasms can be detected, due to which the degree of malignancy of the tumor is determined. In contrast images, the deformation of the vessel or its “breakage” is visible – manifestations of thrombosis, embolism, atherosclerosis.
Advantages
CT scan shoulder is the method of choice in notoriously difficult clinical cases. Alternative techniques used during the examination of the shoulder joint include radiography, ultrasound scanning and arthroscopy. Radiography is the most common and affordable imaging method, characterized by less informative content and a higher radiation dose compared to CT. Ultrasound does not involve radiation load on the patient, allows you to study the structure of the joint in real time and in various planes. Its disadvantages are the dependence of the informative value of the procedure on the preparation of the doctor and the anatomical and physiological characteristics of the patient’s body. MRI visualizes soft tissues in more detail – ligaments, tendons, joint capsule, muscles, does not require the use of X-rays. In the diagnosis of bone pathologies, the possibilities of MRI and ultrasound are limited. Arthroscopy, unlike CT, is an invasive procedure and can be combined with surgical treatment.
