CT Shoulder

Indications

• Complex proximal humerus, scapula or glenoid fracture
• Glenoid bone loss quantification in shoulder instability (bony Bankart, Hill-Sachs)
• Shoulder arthroplasty planning (glenoid version/vault)
• Sternoclavicular or acromioclavicular joint pathology; clavicle fracture/nonunion

Patient prep

• Remove jewelry/metal from the shoulder region
• Supine; affected arm at the side, palm up (external rotation); raise the CONTRALATERAL arm overhead to reduce cross-torso artifact
• Coach a breath-hold — respiratory motion blurs the shoulder girdle

Contrast

Technique

• Coverage from above the clavicle/AC joint through the inferior scapular angle — the ENTIRE scapula for arthroplasty planning
• Acquire during suspended respiration
• DFOV ~16-18 cm centered on the joint; thin 0.5-1 mm isotropic recon, bone and soft-tissue algorithms
• Coronal/sagittal reformats aligned to the scapular plane; en-face (sagittal-oblique) glenoid reformats for bone-loss measurement
• 3D VR with humeral head subtraction to display the glenoid rim in instability

Series / Sequences

Key points

• For instability, the en-face glenoid view with best-fit circle is the measurement the surgeon wants — build it every time
• Arthroplasty planning software requires the whole scapula including the inferior angle; a clipped scapula gets the study rejected
• Breath-hold + contralateral arm up are the two easy artifact killers
• IV contrast rarely needed; if used (mass/infection), inject the contralateral arm

References