Radiology Corner – Shoulder Pain: What’s Your Diagnosis?

By: Terry R. Yochum, DC, DACBR, Fellow, ACCR and Michael S. Barry, DC, DACBR

Figure 1. What’s your diagnosis?

Figure 1. What’s your diagnosis?

History

Two adult patients present with a long-standing history of shoulder pain. The diagnosis in Figures 1 and 2 is the same. What’s your diagnosis?

Diagnosis

Degenerative joint disease (osteoarthritis) of the glenohumeral articulation. In Fig. 2, there is an associated rotator cuff tear with cephalic migration of the humeral head as a result of rupture of the rotator cuff tendon.

Discussion

Degenerative changes in the acromioclavicualr joint are far more common than the glenohumeral joint. Consequently, any signs of degenerative joint disease in the glenohumeral joint should arouse suspicion for previous significant trauma or an underlying cartilage disease, such as calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, ochronosis, or acromegaly.1

Acromioclavicular joint. Loss of joint space, sclerosis, and osteophyte formation are characteristic radiographic signs. Small subchondral cysts may be observed in the distal clavicle.

Figure 2. What's your diagnosis?

Figure 2. What’s your diagnosis?

Glenohumeral joint. Articular changes consist of a nonuniform loss of joint space, sclerosis, and osteophyte formation, particularly at the inferior humeral head (as was seen in Fig. 1). Associated subchondral cysts may be seen at the articular surface, although these are usually very small.

Rotator cuff degeneration may manifest as small cyst formation in the tuberosities. Rotator cuff disruption is characterized by a superior migration of the humerus in relation to the glenoid cavity due to the unopposed action of the deltoid muscle (Fig. 2).Erosion with sclerosis of the inferior surface of the acromion usually accompanies this superior humeral displacement (Fig. 2). Diagnosis of a torn rotator cuff can be achieved primarily by magnetic resonance imaging.1

References

1. Yochum TR, Rowe LJ. Essentials of Skeletal Radiology, 2nd ed. Baltimore, MD: Williams & Wilkins, 1996.

About the Authors

Dr. Terry R. Yochum is a second generation Chiropractor and a cum laude graduate of the National College of Chiropractic, where he subsequently completed his radiology specialty. He is a Diplomate of the American Chiropractic Board of Radiology and served as its vice-president and president for seven years (1983-1990).

Dr. Michael S. Barry is a 1988 cum laude graduate of Palmer College of Chiropractic. He completed a three-year radiology residency at Logan College of Chiropractic following two years of clinical practice in Las Vegas, Nevada. He received his diplomate in radiology from the American Chiropractic Board of Radiology in 1992.