**4. Investigations**

Plain X-ray of the shoulder in anteroposterior, axillary lateral, Stryker notch, and 30° caudal view is usually sufficient to diagnose most of the shoulder girdle pathologies like shoulder dislocation, A–C joint injuries, clavicle fracture, Hill-Sachs lesion, acromial spur, etc. (**Figure 9**) [5].

MRI and ultrasound are other valuable diagnostic tools because they provide images of the

Introductory Chapter: Shoulder Joint http://dx.doi.org/10.5772/intechopen.76187 9

Ultrasonography—It is one of the cheapest and most easily done tests for shoulder pathologies like rotator cuff tear, calcific tendinitis, and biceps tear. But it is very less frequently used

MRI—It is the investigation of choice in shoulder joint injuries. It excellently depicts the labral tear, rotator cuff tear, biceps tear/displacement, and other soft tissue pathologies. The MRI has

a picture that both the clinician and the patient can understand (**Figure 13**).

soft tissues without using radiation.

**Figure 10.** Glenoid bone loss measurement.

**Figure 9.** X-ray AP view and GT avulsion.

(**Figure 12**) [6, 9, 10].

CT scan—It is very useful to diagnose bony pathologies of the shoulder. It gives excellent three-dimensional imaging of the bony shoulder girdle. Humeral and glenoid bone loss can be accurately calculated. But in case of musculoskeletal injuries, MRI is the investigation of choice (**Figures 10** and **11**).

**Figure 9.** X-ray AP view and GT avulsion.

The O'Brien test—The patient is in sitting position, and the patient's shoulder is in 90° forward flexion, adduction, and internal rotation; the examiner applies downward force. Positive result is when patient will have pain to the anterosuperior or posterosuperior part of the

Biceps load II test—This test is considered positive if the patient complains of pain during the resisted elbow flexion. The patient is in standing position, and the examiner forward flexes the arm to 90°, abducting 15–20° with elbow straight with full internal rotation so the thumb is pointing down, and applies downward force on the arm which the patient resists. Then, the patient externally rotates the arm so that the thumb is pointing up; the examiner applies downward force on the arm, and the patient resists it. The test is positive if pain or painful clicking will be elicited with the thumb down and decreased or eliminated with the thumb up (**Figure 8**).

Plain X-ray of the shoulder in anteroposterior, axillary lateral, Stryker notch, and 30° caudal view is usually sufficient to diagnose most of the shoulder girdle pathologies like shoulder dislocation, A–C joint injuries, clavicle fracture, Hill-Sachs lesion, acromial spur, etc. (**Figure 9**) [5]. CT scan—It is very useful to diagnose bony pathologies of the shoulder. It gives excellent three-dimensional imaging of the bony shoulder girdle. Humeral and glenoid bone loss can be accurately calculated. But in case of musculoskeletal injuries, MRI is the investigation of

shoulder indicating superior labral tear.

**Figure 8.** Yergason's test for Biceps.

8 Advances in Shoulder Surgery

**4. Investigations**

choice (**Figures 10** and **11**).

**Figure 10.** Glenoid bone loss measurement.

MRI and ultrasound are other valuable diagnostic tools because they provide images of the soft tissues without using radiation.

Ultrasonography—It is one of the cheapest and most easily done tests for shoulder pathologies like rotator cuff tear, calcific tendinitis, and biceps tear. But it is very less frequently used (**Figure 12**) [6, 9, 10].

MRI—It is the investigation of choice in shoulder joint injuries. It excellently depicts the labral tear, rotator cuff tear, biceps tear/displacement, and other soft tissue pathologies. The MRI has a picture that both the clinician and the patient can understand (**Figure 13**).

Arthroscopy—Though it is mainly a therapeutic and invasive key hole surgery, it can help in accurate diagnosis of many pathologies which are not shown even in MRI. Subscapularis tears, capsular rents, avulsions from the humerus, SLAP tears, etc. can be well diagnosed and

Introductory Chapter: Shoulder Joint http://dx.doi.org/10.5772/intechopen.76187 11

treated by shoulder arthroscopy (**Figures 14** and **15**) [11, 12].

**Author details**

**Figure 15.** Arthroscopy labral repair.

**Figure 14.** Arthroscopy biceps tendon.

Satish B. Sonar\* and Omkar P. Kulkarni

Dr. PDM Medical College, Amravati, India

\*Address all correspondence to: stshsonar@gmail.com

**Figure 11.** 3D CT Scan showing Bony Bankart lesion.

**Figure 12.** USG Shoulder showing spinoglenoid cyst.

**Figure 13.** MRI Showing Anterior labral tear.

Arthroscopy—Though it is mainly a therapeutic and invasive key hole surgery, it can help in accurate diagnosis of many pathologies which are not shown even in MRI. Subscapularis tears, capsular rents, avulsions from the humerus, SLAP tears, etc. can be well diagnosed and treated by shoulder arthroscopy (**Figures 14** and **15**) [11, 12].

**Figure 14.** Arthroscopy biceps tendon.

**Figure 15.** Arthroscopy labral repair.
