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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Lesson
MRI Mastery Series: Shoulder - Pre-course Activities
1 topic, 5 min.
Lesson
Sample Lesson - 53 Year Old Female, Injured While Playing Softball
1 topic, 4 min.
Lesson
Shoulder MRI: Assessing Instability - Anatomy
10 topics, 50 min.
Introduction to Shoulder Instability
6 m.Axial Anatomy on MRI
5 m.Axial Anatomy: The Biceps Pulley
5 m.Axial Instability Search Pattern
9 m.Axial Shoulder: The Structures that Give Radiologists Fits
6 m.Introduction to the Buford Complex
3 m.The Glenoid Cup
6 m.Dynamic and Passive Stabilizers in the Sagittal Projection
6 m.Dynamic and Passive Stabilizers in the Coronal Projection
7 m.Return of the Buford Complex
3 m.Lesson
Shoulder MRI: Assessing Instability - Protocols
7 topics, 53 min.
Key Pulsing Sequences for the Shoulder
6 m.Utilizing the ABER view in the Coronal Projection
9 m.The Value of the T2 Sequence in Shoulder Imaging
7 m.Arthrographic Analysis of the Axial Projection
11 m.Arthrographic Analysis in the Coronal Projection
9 m.Arthrographic Analysis in the Sagittal Projection
6 m.Shoulder Projections Summary
8 m.Lesson
Shoulder MRI: Assessing Instability - Pathology
11 topics, 50 min.
On-Track/Off-Track: ABER Summary
6 m.On-Track/Off-Track: Mid-Range Summary
3 m.On-Track/Off-Track: Assessing Glenoid Bone Loss
8 m.On-Track/Off-Track: The Nofsinger Technique
3 m.On-Track/Off-Track: Stable Hill-Sachs Lesions
3 m.On-Track/Off-Track: The Hill-Sachs Concept
4 m.On-Track/Off-Track: Dislocation Mechanics
4 m.On-Track/Off-Track: Dynamic Examination after Bankart Repair
6 m.On-Track/Off-Track: Using Measuring Tools on MRI
6 m.Posterior Macro & Micro Instability
7 m.Posterior Labral Pathology
6 m.Lesson
Shoulder MRI: Assessing Instability - Case Review
23 topics, 2 hr. 31 min.
17 Year Old Male – Known Dislocation
15 m.21 Year Old Male Pitcher; Decreased Range of Motion
9 m.21 Year Old Involved in a Collision Accident
9 m.54 Year Old Female with Complex Multidirectional Microinstability
7 m.49 Year Old Male, Weightlifter, Experiencing Instability
6 m.68 Year Old Male Golfer with Pain for a Month
6 m.15 Year Old Male – Fell On Outstretched Hand
8 m.55 Year Old Female, Pain in Shoulder Extending to Elbow After Arm Was Jerked
9 m.25 Year Old Male, Pain When Swinging Arm
8 m.53 Year Old Male, Motor Vehicle Accident 6 Weeks Ago, Now Experiencing Pain and Spasms
8 m.17 Year Old Male with a History of Dislocation
6 m.51 Year Old Female: Rule Out Rotator Cuff Tear
5 m.The GLOM Lesion
3 m.56 Year Old Patient with Axillary Nerve Dysfunction Post Dislocation
2 m.69 Year Old Male, Fell and Dislocated Shoulder
10 m.69 Year Old Male with Complex Pattern of Injury
9 m.38 Year Old Male with a Dislocation/Relocation Event
6 m.20 Year Old Male, Recurrent Dislocations and Instability
12 m.20 Year Old Male Pitcher with Recent Dislocation
4 m.17 Year Old Wrestler with Discomfort in the Shoulder
5 m.42 Year Old Male with a Violent Posterior Dislocation
6 m.40 Year Old Male in Motor Vehicle Accident, Irreducible Dislocation
5 m.40 Year Old Male, Post Motor Vehicle Accident
4 m.Lesson
Shoulder "Shark" Week -- Review of Rotator Cuff Anatomy
6 topics, 50 min.
Lesson
The Six Components of the Rotator Cuff
4 topics, 14 min.
Lesson
Identifying The Six Components of Rotator Cuff Tears in Practice
6 topics, 25 min.
0:00
There are actually two methods that you can use to
0:03
look at the glenoid track on the humerus to see what
0:09
kind of risk you have for recurrent dislocation.
0:11
So let's take a humerus.
0:13
This would be, this would be lateral,
0:16
greater tuberosity, and this would be medial.
0:19
Doesn't really look like a humerus.
0:22
And then let's draw our, our track.
0:25
So our track will use a different color.
0:28
And our track might be something like
0:31
this, from supralateral to inframedial.
0:34
Now, what does the track really consist of?
0:36
Because you can, you can measure
0:37
this track directly off the axial.
0:40
We've shown you how to do that in other vignettes.
0:43
Uh, it consists of a ridge right here,
0:46
where you have your defect, a bony ridge.
0:49
And what's this side of the track?
0:51
That side of the track, which is a little
0:53
counterintuitive, we'll make it purple,
0:56
is the medial margin of the rotator cuff.
0:59
So from the medial edge of the rotator cuff to
1:03
this spot right here is the width of the track.
1:08
So if you take the patient from a position of abduction,
1:12
external rotation, and then start moving the arm
1:16
forward, you could actually retrace that track.
1:20
Or, if you're doing a dynamic examination, you could
1:23
show in the abduction external rotation position,
1:28
and then in the less extreme position, the engagement
1:34
of this locus on the anterior aspect of the glenoid.
1:38
Now why is that happening here?
1:41
You've seen other vignettes where there was
1:44
a defect, but it did not engage this point.
1:49
And the reason is twofold.
1:53
This Hill-Sachs lesion is bigger and broader, number one.
1:58
And number two, this Hill-Sachs lesion is more medial.
2:04
When it's more medial, and you have the arm
2:07
in certain positions, it is more likely to
2:12
engage the anterior portion of the glenoid.
2:16
So, and if you lost this right here, if
2:18
you were missing the glenoid cup, wow.
2:21
Now, now you're engaging something that is completely flat.
2:25
And it just slides right off.
2:28
So, there may be a little pause
2:29
right here if you've got a point.
2:31
In other words, if you have a glenoid point,
2:34
there'll be a pause where you're locked, and then
2:37
all of a sudden you unlock, and then you dislocate.
2:40
Whereas if you don't have a glenoid,
2:42
it'll just slide right off the front.
2:45
So, Hill-Sachs lesions that are big and broad, not so
2:50
much depth, but big and broad, and more medially
2:53
located, are more prone to dislocation as one moves
2:59
from extremes of abduction external rotation forward.
On-Track/Off-Track: Dislocation Mechanics
HIDEInteractive Transcript
0:00
There are actually two methods that you can use to
0:03
look at the glenoid track on the humerus to see what
0:09
kind of risk you have for recurrent dislocation.
0:11
So let's take a humerus.
0:13
This would be, this would be lateral,
0:16
greater tuberosity, and this would be medial.
0:19
Doesn't really look like a humerus.
0:22
And then let's draw our, our track.
0:25
So our track will use a different color.
0:28
And our track might be something like
0:31
this, from supralateral to inframedial.
0:34
Now, what does the track really consist of?
0:36
Because you can, you can measure
0:37
this track directly off the axial.
0:40
We've shown you how to do that in other vignettes.
0:43
Uh, it consists of a ridge right here,
0:46
where you have your defect, a bony ridge.
0:49
And what's this side of the track?
0:51
That side of the track, which is a little
0:53
counterintuitive, we'll make it purple,
0:56
is the medial margin of the rotator cuff.
0:59
So from the medial edge of the rotator cuff to
1:03
this spot right here is the width of the track.
1:08
So if you take the patient from a position of abduction,
1:12
external rotation, and then start moving the arm
1:16
forward, you could actually retrace that track.
1:20
Or, if you're doing a dynamic examination, you could
1:23
show in the abduction external rotation position,
1:28
and then in the less extreme position, the engagement
1:34
of this locus on the anterior aspect of the glenoid.
1:38
Now why is that happening here?
1:41
You've seen other vignettes where there was
1:44
a defect, but it did not engage this point.
1:49
And the reason is twofold.
1:53
This Hill-Sachs lesion is bigger and broader, number one.
1:58
And number two, this Hill-Sachs lesion is more medial.
2:04
When it's more medial, and you have the arm
2:07
in certain positions, it is more likely to
2:12
engage the anterior portion of the glenoid.
2:16
So, and if you lost this right here, if
2:18
you were missing the glenoid cup, wow.
2:21
Now, now you're engaging something that is completely flat.
2:25
And it just slides right off.
2:28
So, there may be a little pause
2:29
right here if you've got a point.
2:31
In other words, if you have a glenoid point,
2:34
there'll be a pause where you're locked, and then
2:37
all of a sudden you unlock, and then you dislocate.
2:40
Whereas if you don't have a glenoid,
2:42
it'll just slide right off the front.
2:45
So, Hill-Sachs lesions that are big and broad, not so
2:50
much depth, but big and broad, and more medially
2:53
located, are more prone to dislocation as one moves
2:59
from extremes of abduction external rotation forward.
Report
Description
Faculty
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Tags
Trauma
Shoulder
Musculoskeletal (MSK)
MRI
Bone & Soft Tissues
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