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This page is to assist in coordinating the care of patients. Most patients are investigated fully and appropriately. There are some conditions that may benefit from further or less investigations than usual.

Dislocations are common amongst the adolescent population. Radiation safety is a consideration for those with recurrence and should be managed appropriately. For referrals with shoulder instability, simple shoulder XR series, AP, scapular Y view and Axillary Outlet within the last 6 months or post latest dislocation is requested. MRI is the standard for assessing shoulder soft tissue pathology, and planning what possible soft tissue repairs can be performed to improve stability. 

Dr Drynan may request a CT scan in the recurrent dislocation setting, trauma, or bony Bankart lesion. 

Shoulder XR series, including AP, Axillary outlet and lateral views are usually required. This is to assess the Critical shoulder angle and has gravity included in the image, thus assessing the humeral position. MRI is the standard for investigating rotator cuff pathology, and is beneficial to have prior to the appointment to best manage the patient. If there are contraindications to MRI, such as pacemaker or significant Claustrophobia, then an Ultrasound would be required. The diagnostic accuracy is lower with an ultrasound. 

The history and clinical exam are the main factors in diagnosis for shoulder arthritis, and confirmation XR's are required for the referral. We do not request that you routinely perform shoulder CT scans for all arthritis. It is Dr Drynan's preference to perform a CT scan with a BluePrint Protocol for patient specific planning the patients arthroplasty. 

MRI may be required for cartilage assessment in the young or for an equivocal rotator cuff exam, but not routine practice.

The elbow is a very constrained joint and has three joints in one, radio-capitellar, radio-ulnar, ulno-humeral. Due to this complex crossing of joints, elbow XR series, including AP, Lateral and External oblique, and a CT scan to assess osteophytes. 

Trauma and injury should have an XR series with AP, Lateral and Coyles view in the adult. 

The paediatric population would benefit from AP, Lateral, internal and external AP views of the elbow. These are requested, but understand the limitations of the trauma setting and patient comfort.

Overuse and soft tissue elbow pain would benefit from MRI investigation. Ultrasound investigations may assist with diagnosis, are limited in ruling out other causes of pain, and may not yield the information for appropriate management. Medial elbow pain and any neurological pain would benefit from nerve conduction studies to assist in addressing all causes of pain.

Sports injuries are very well managed and investigated as a whole. They require knee XR series, including AP and lateral and skyline views. Assessing the cartilage, ligaments and tendons about the knee, MRI is essential. Ultrasound investigation does not achieve acceptable assessment of the intra-articular anatomy. 

Long limb alignment is a consideration in any revision ligament injury, or the early arthritic patient. These patients, usually between 30-50, may benefit from an EOS or 3 foot standing scan to assess limb alignment.

Knee arthritis is very common and well managed in a non operative fashion in the community. If the patient would like or benefit from a surgical opinion, Dr Drynan is happy to see and assist them. 

They may benefit from a knee XR series as AP, Lateral, Skyline and Rosenberg view (45 deg flexion PA) and 3 foot standing film or EOS. Dr Drynan follows Kinematic alignment philosophy and aims to restore the patients knee to the patient specific pre-arthritic alignment and balance.

If the patient would like to proceed with a surgical intervention, they may require a specific CT protocol to assist in operative planning and alignment, as per Dr Drynan's recent article in Arthroplasty Today.

Paediatric conditions involving the upper limb are common. The timely treatment of these is essential when considering growth and possible deformity. Tailoring investigations with radiation safety in mind is important. For the conditions above, in the paediatric population, the similar investigations would be useful. For any deformity or growth arrest, XR, including AP and lateral of both limbs for comparison is required, and for scapular deformity conditions, imaging of the spine is requested. Judicious use of MRI and CT for growth arrest, cartilage lesions and surgical planning is often best coordinated by Dr Drynan for the very young patient. MRI is the imaging of choice for most paediatric upper limb cartilage lesions, instability and post traumatic growth arrest, and often useful at the initial consultation.