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Shoulder girdle trauma is one of the most common injuries encountered in emergency centers. These injuries can be easily overlooked due to the complex osteology of the shoulder. Although radiographs are usually sufficient for assessing traumatic shoulder injuries, cross-sectional imaging is sometimes indicated to assess portions of the shoulder not well visualized by radiographs. In this article, the authors review the spectrum of shoulder girdle injuries: sternoclavicular dislocations, clavicle fractures, acromioclavicular separations, shoulder dislocations, scapula fractures, and scapulothoracic dissociation. They also discuss the presentation, imaging evaluation, and classification of these injuries with emphasis on pitfalls in imaging diagnosis and indications for computed tomography/magnetic resonance.

Injuries to the cervical and thoracolumbar spine are commonly encountered in trauma patients presenting for treatment. Cervical spine injuries occur in 3% to 4% and thoracolumbar fractures in 4% to 7% of blunt trauma patients presenting to the emergency department. Clear, validated criteria exist for screening the cervical spine in blunt trauma. Screening criteria for cervical vascular injury and thoracolumbar spine injury have less validation and widespread acceptance compared with cervical spine screening. No validated criteria exist for screening of neurologic injuries in the setting of spine trauma. CT is preferred to radiographs for initial assessment of spine trauma. CT angiography and MR angiography are both acceptable in assessment for cervical vascular injury. MRI is preferred to CT myelography for assessing neurologic injury in the setting of spine trauma. MRI is usually appropriate when there is concern for ligament injury or in screening obtunded patients for cervical spine instability. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Shoulder pain is one of the most common reasons for musculoskeletal-related physician visits. Imaging plays an important role in identifying the specific cause of atraumatic shoulder pain. This review is divided into two parts. The first part provides a general discussion of various imaging modalities (radiographs, arthrography, nuclear medicine, ultrasound, CT, and MRI) and their usefulness in evaluating atraumatic shoulder pain. The second part focuses on the most appropriate imaging algorithms for specific shoulder conditions including: rotator cuff disorders, labral tear/instability, bursitis, adhesive capsulitis, biceps tendon abnormalities, postoperative rotator cuff tears, and neurogenic pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Neonatal Salter-Harris I fractures of the distal humerus are a rare injury. This injury can be easily mistaken for a posterior elbow dislocation, creating a delay in diagnosis. We present a case of a neonate with a distal humerus Salter-Harris I fracture secondary to trauma during delivery. The patient presented with pseudoparesis of the left arm following birth. Posterior displacement of the elbow was identified on radiographs. Ultrasound of the elbow was performed after a gentle closed reduction of the left elbow was unsuccessful. A transphyseal supracondylar distal humerus fracture was identified on ultrasound. The patient subsequently had an intraoperative left elbow arthrogram to assist in visualization of the supracondylar fracture during closed reduction and percutaneous pinning. At 2-month follow-up, the patient was neurologically intact with full passive range of motion and had normal alignment of the capitellar ossification center and distal humerus on follow-up radiographs.

Acanthamoeba spp. are pathogenic protozoa that are uncommonly encountered. They tend to infect immunocompromised patients, most often causing cutaneous lesions and in some instances granulomatous amebic encephalitis, as well as rare instances of dissemination to other organs. We present a case of amebic osteomyelitis of the fibula in a patient with rejection of a transplanted kidney who was chronically immune-suppressed.