Shoulder (routine)

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Protocol Name = SHOULDER NYH 9.04
Entry = Head First
Position = Supine
Series number = 7
Series Notes Pulse Sequence Mode Imaging Options Plane FOV Thickness Spacing Frequency Phase TR TE Flip Angle
3 PLANE LOC Gradient Echo 2D Seq, Fast 3-PLANE 48.0 6.0 1.0 256 128
3 PLANE LOC Gradient Echo 2D Seq, Fast 3-PLANE 48.0 6.0 1.0 256 128
AXL PD FSE-XL 2D FC, NPW, Fast AXIAL 16.0 3.5 0.0 320 256 3500.0 34.0
COR PD OBLI FSE-XL 2D FC, NPW, Fast OBLIQUE 16.0 3.0 0.0 320 320 3600.0 34.0
COR T2 OBLI FATSAT FSE-XL 2D NPW, EDR, Fast OBLIQUE 16.0 3.0 0.0 256 224 4000.0 80.0
SAG PD FSAT OBLI FSE-XL 2D NPW, Fast OBLIQUE 16.0 4.0 0.5 256 224 4000.0 34.0
AXL PD optional FSE-XL 2D FC, NPW, Fast AXIAL 14.0 3.0 0.0 320 320 2500.0 15.0

Imaging the shoulder is optimal with a dedicated shoulder coil and careful patient positioning in external rotation with the shoulder as close as reasonably possible to the center of the magnet. Axial proton density, coronal oblique T2 fat sat and proton density, and sagittal oblique T2 provide an assessment of the rotator cuff, biceps, deltoid, acromio-clavicular joint, the gleno-humeral joint and surrounding large structures. If a labral injure is suspected, the optional fat sat gradient echo sequence (series 6) may be helpful or it may be necessary to bring the patient back for an MR shoulder arthrogram with intra-articular injection of dilute gadolinium.

see ICD9 codes below

First ask:
1. Have you recently injured the shoulder? Date of injury?
2. Did you have X-rays? Please bring your shoulder X-rays if not at New York Hospital.
3. Did you ever dislocate the shoulder?
4. Ever have surgery on the shoulder? Date of surgery?
5. Ever have cancer? Type? Date diagnosed?
6. Is there a shoulder mass?

If patient has history of cancer or if there is a mass, of if there has been prior surgery then schedule during the morning, preferably before 11am. Otherwise you may schedule anytime.

45 minute slot

Patient Preparation
Positioning: supine with arm at side and palm facing up. It is useful to tuck the hand under the hip to help keep the shoulder motionless. It is important to shift the patient to one side of the magnet so the shoulder being imaged is closer to the center, “sweet spot” of the magnet. This is especially helpful for fat saturation. Place a vitamin E capsule at the site of any mass or symptoms. A wide strap over the shoulder cinched down tight to the table can help reduce shoulder motion during breathing.

Coil: shoulder coil

Landmark: mid-coil

Billing Code
Upper extremity, 73221

ICD9 Codes
840.0-840.9 sprain-strain
840.0 acromio-clavicular
840.2 coraco-clavicular
840.3 infraspinatus
840.4 rotator cuff
840.5 subscpularis tendon
840.6 supraspinatus
840.8 subgleniod (deltoid)
840.9 shoulder

718.01 loose body, site unspecified
215.2 benign neoplasm, upper limb including shoulder
213.4 benign neoplasm, scapula and long bones of upper limb
171.2 malignant neoplasm, upper limb including shoulder
170.4 malignant neoplasm, scapula and ling bones of upper limb
196.3 secondary malignancy, lymph nodes of axilla and upper limb
03.24 salmonella osteomelitis

732.9 ostiochondropathy
733.20 bone cyst
733.40 aceptic necrosis of bone, site unspecified
793.7 non-specific abnormal radiologic findings, musculoskeletal system

Normal Dictation
Clinical Statement:

Patient was imaged at 1.5 Tesla in a dedicated shoulder coil
Axial proton density
Coronal Oblique proton density and T2 FSE with fat saturation
Sagittal Oblique T2 FSE
2D gradient echo with fat saturation for evaluation of labrum

Findings: The rotator cuff is intact with no abnormality identifed in the supraspinatus, infraspinatus or subscapularis tendons. There is no shoulder effusion and no fluid identified in the subacromial or subdeltoid bursae. The glenoid labrum appears intact although if there is suspicion of gleno-humeral instability an MR arthrogram may delineate labral and ligamentous pathology in greater detail. The long head of the biceps tendon is in the bicipital groove and has a normal appearance. The osseous structures are normal with no significant proliferative changes.

Impression: Normal shoulder MRI

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May 22, 2010  Tags: , , ,   Posted in: MRI, msk, upper extremity