Brady Darragh

Final Pr. ID: Poster #: EDU-044

Learning muculoskeletal ultrasound is challenging. We provide an interactive, problem based approach to learning how to ultrasound the shoulder in a pediatric patient, focusing on key anatomy, static positioning, and dynamic maneuvres, using a stepwise logical approach. Photographs with tranducer positions are provided. Cine images are provided for dynamic maneuvers. This approach may provide a framework for musculoskeletal ultraound workhops that can be adapted for the pediatric radiology trainee, or ultrasound technician. Read More

Authors:  Brady Darragh

Keywords:  ultrasound, shoulder

Allbery Sandra,  Powers Andria,  Love Terri,  Wheelock Lisa

Final Pr. ID: Poster #: CR-032

We present a case of an 18YO male high school baseball player with acute onset posterior pain in his non-throwing left shoulder, the leading shoulder in his batting swing. Pain began on a missed attempt at hitting an outside pitch. The pain only occurred when he was batting and resulted in subsequent loss of batting power and accuracy. Patient was asymptomatic when he was not batting. Prior to the acute event, patient had low grade pain in this location during intermittent at bats. Physical exam showed 1-2+ left shoulder posterior instability and mildly asymmetric left less than right shoulder strength. He had negative Neer, Whipple, Speed’s, and Hawkin’s tests. MRI left shoulder showed posterior labral tear with paralabral cyst. Patient underwent laparoscopic posterior labral repair with placement of four anchoring sutures and Bankart reconstruction. He did well post-operatively, returning to preinjury strength and range of motion in four months and returning to play in 6 months.
Batter’s shoulder is a rare condition recently recognized in the orthopedic literature and has not been reported to our knowledge in the radiologic literature. Although the adolescent/young adult spectrum of shoulder injuries in the throwing arm have been well described, injury types and mechanisms involving the non-throwing arm are not commonly known. The mechanics of hitting places considerable stress on the leading shoulder. Biomechanics studies by Welch CM et al show that as the hitter slides forward, the force applied by the front foot equals 123% of body weight and the hip segment rotates to a maximum speed of 714 degrees/second. This is followed by maximum shoulder segment velocity of 937 degrees/second and maximum linear bat velocity of 31 m/second. During a missed pitch, these forces are magnified due to lack of a counterforce against the dynamic posterior pulling force on the lead shoulder. Athletes with labral tear of the leading shoulder during batting (Batter’s shoulder) have a better prognosis than throwing arm labral tear, with approximately 90% returning to previous level of play.
This exhibit will display biomechanics, pre-operative and post-operative MRIs, and intra-operative laparoscopic images of Batter’s Shoulder. Read More

Authors:  Allbery Sandra , Powers Andria , Love Terri , Wheelock Lisa

Keywords:  Hitter's shoulder, Posterior labral tear, Posterior shoulder instability, Arthroscopy, Batter's shoulder

Malkawi Ibraheem,  Bloom David,  Hryhorczuk Anastasia

Final Pr. ID: Poster #: EDU-036

Describe the normal anatomic appearance and anatomic variants of the pediatric coracoid process with representative images.
Evaluate the radiologic fracture patterns and fracture mimics of the pediatric coracoid process with representative images.
Review additional pathology of the pediatric coracoid process that can present incidentally after trauma

Included topics :
I Coracoid process anatomy
Normal pediatric development/ossification
Developmental variations
Associated anatomic structures

II. Sequelae of coracoid process trauma
Multimodality imaging—radiography, CT, MRI
Pediatric fracture patterns
Mimics of fractures

III. Incidental findings of the coracoid process
Neoplasm
Other Read More

Authors:  Malkawi Ibraheem , Bloom David , Hryhorczuk Anastasia

Keywords:  shoulder anatomy, coracoid process, trauma

Kosaraju Sriya,  Errampalli Eric,  Illimoottil Mathew,  Priya Lakshmi,  Orscheln Emily

Final Pr. ID: Poster #: EDU-071

Fractures are a common occurrence in pediatric patients with around one third of children sustaining at least one by the age of 17 years. As the pediatric osseous structures develop, secondary ossification centers will become radiographically evident and there may be several of these ossification centers in single bone. As a child approaches skeletal maturity, the physis will gradually close and the primary and secondary ossification centers fuse. These processes often occur in known and predictable patterns. However, there are numerous cartilaginous physes and secondary ossification center variants that can potentially create a diagnostic dilemma for the radiologist. Knowledge of location and expected time of secondary ossification center appearance and physeal fusion in the pediatric patient is vital to distinguish them from fractures in a trauma setting. Accurate diagnosis of fractures is necessary for facilitation of appropriate management and prevention of subsequent deformity in the growing skeleton. Upper extremity fractures are encountered significantly more frequently than lower extremity fractures in pediatrics. However, there are a number of normal structures that may serve as fracture mimics in the upper extremity, particularly at the shoulder and elbow. In this educational exhibit, we aim to describe the expected changes in visible ossification centers and physes in the osseous structures of the shoulder and elbow, highlight some common and
uncommon variations in the expected sequence, and highlight potential pitfalls related to this variation that may be mistaken for fracture or may result in an unrecognized fracture. Read More

Authors:  Kosaraju Sriya , Errampalli Eric , Illimoottil Mathew , Priya Lakshmi , Orscheln Emily

Keywords:  elbow, shoulder, fracture

Masso Maldonado Sarina,  Dragusin Iulian,  Byerly Douglas,  Clark Paul

Final Pr. ID: Poster #: CR-013

As a flat and irregular bone of the appendicular skeleton, the scapula has a zonal classification of anatomy that is both useful for surgical planning as well as for distinctive locations of common and uncommon bone neoplasms (1). The acromion and glenoid together are grouped into the S2 zone of the scapula with the remaining scapular blade and spine comprising zone S1. This unique anatomy of the scapula may present a challenge to radiologists when distinguishing between benign and malignant bone tumors that are more commonly seen in long bones. As the S2 zone is much like a metaphyseal equivalent in long bones, the more common lesions encountered there will include giant cell tumors, aneurysmal bone cysts, chondroid neoplasms, and osteomyelitis. Bone lesions of zone S1 will more commonly include tumors such as osteochondromas, Ewings sarcoma, and Lymphoma (2).
We present a case series of osteoid osteoma, chondroblastoma, osteomyelitis, T-cell Lymphoma, and Ewings sarcoma of the scapula and shoulder girdle in children aged 7 weeks to 17 years of age. The purpose of this case series is to present a variety of common and uncommon bone lesions of the scapula and shoulder girdle in children. Through the description and defining features of these lesions, radiologists may better familiarize themselves with the surgical anatomy of the scapula to develop a narrowed and accurate differential diagnosis of pediatric scapular tumors. Read More

Authors:  Masso Maldonado Sarina , Dragusin Iulian , Byerly Douglas , Clark Paul

Keywords:  Musculoskeletal, Scapula, shoulder

Wong Lincoln,  Powers Andria

Final Pr. ID: Poster #: EDU-058

MR shoulder arthrography is a frequently ordered study in the pediatric population for shoulder symptoms relating to sports injuries. The traditional technique for injecting contrast into the shoulder joint has been with fluoroscopy. Following principles of ALARA, we set out to find ways to reduce or eliminate radiation from the procedure. Ultrasound has been utilized increasingly for diagnosing musculoskeletal pathology and is a well-established technique in the adult population to guide joint injection of medication. This educational exhibit aims to discuss how we implemented this technique at our hospital, outline tips and pitfalls we learned along the way, and discuss benefits and drawbacks with the procedure. Read More

Authors:  Wong Lincoln , Powers Andria

Keywords:  ultrasound, arthrography, shoulder, radiation, MR