MRI of shoulder

Indication: Shoulder pain

Routine protocol:

• Axial: PDW/FS, T2WI/FS
• Coronal:  PDW/FS, T2WI/FS, T1W
• Sagittal: PDW/FS, T2W, T1W

Approach by section: Reference approach by section

System approach for interpretation: Details of systemic approach for sport injury of shoulder

• Osseous outlet and acromion  

acromion:

•  Undersurface shape (flat, concave, anterior hook, convex). Figure 2

• anterior down sloping (Figure 3B)
• lateral down sloping (Figure 4B)

• acromion spurs (Figure 5)
• os acromiale (Figure 6B&C)

acromioclavicular joint 

•  Osteoarthritis (Figure 7)
•  AC joint sprain
•  Osteolysis of the distal clavicle (Figure 8)

 coracoacromion ligament

• Impingement of anterior cuff ( Figure 9B)

 Coracohumeral impingement (Figure 10)

• Rotator cuff

Normal anatomy (Figure 11)

Rotator cuff abnormalities

• Tendinopathy (Figure 12 A & B) 
• Calcific tendinitis (Figure 12 C)
• Partial thickness tear (Figure 13 A, B, C, D)
• Full thickness tear (Figure 13 E)
• Complete tear (Figure 13 F)

Fatty atrophy (Figure 14)

Musculotendinous retraction (Figure 13 F)

• Capsular structures and glenoid labrum

Glenoid labrum

• Superior labrum

 Normal anatomy

• Coronal (Figure 15A) 
• Axial (Figure 15B) 

Anatomic varian can mimic labral tear

• Cartilage undermining (Figure 15 A)
• Sublabral recess (Figure 15 B)
• Sublabral foramen (Figure 15 C)
• Buford complex (Figure 15D) 

Abnormality

• SLAP tear (tear of Superior  Labrum Anterior and Posterior) (Figure 16 A-E)

•  Anterior Labrum

Normal (Figure 17 A)

Abnormalities

• Tear of anteroinferior labrum

1. Bankart lesion (Figure 17 B, C and D)
2. Osseous Bankart (Figure 17 E)
3. Perthes lesion (Figure 17 F and G)
4. ALPSA lesion (Anterior Labral Periosteal Sleeve Avulsion) (Figure 17 H)
5. GLAD lesion (Glenolabral articular disruption)
6. Hill-Sachs deformity (Figure 17 I)

•  Posterior Labrum tear (Figure 18)

Capsular structures (Capsule and Glenohumeral ligaments

• HAGL (Humeral Avulsion of the inferior Glenohumeral Ligament) (Figure 19A)
• Adhesive capsulitis
• Internal impingment (Figure 19 B and C) 

• Biceps tendon injury

• Tendinopathy (Figure 20)
• Partial thickness tear
• Complete tear
• Dislocation of long head of biceps tendon (Figure 21 A - E)

 Osseous structures and articular cartilages

• Fracture (Figure 22 A)
• Contusion (Figure 22 B)
• Hill Sachs and Bankart lesions
• Articular cartilage defect (Figure 22 C)
• Avascular necrosis of humeral head (Figure 22 D)
• Glenohumeral chondrolysis (Figure 22 E and F)

  Miscellaneous

• Paralabral cyst (Figure 23 A and B)
• Nerve entrapment syndrome (Figure 24)

DICTATION EXAMPLE:

Rotator cuff tear:

CLINICAL MANIFESTATION: Trauma with shoulder pain

TECHNIQUE:

Axial: T2W/FS, PDW/FS

Oblique Sagittal: T1W/TSE, T2W/FS, PDW/FS

Oblique Coronal: T1W/TSE, T2W/FS, PDW/FS

FINDINGS:

Subscapularis tendon is partial tear at superior insertion with minimal fluid collection near tear site. 

Supraspinatus tendon, Infraspinatous tendon and Teres minor tendon show no tear.

Deltoid muscles and Biceps tendon appear normal.

Glenoid labrum is intact. 

No joint effusion is noted. 

No bone and joint destruction is noted. 

CONCLUSION: 

Partial tear of right subscapularis tendon.