MRI of the Shoulder What to look for and how to find it? Dr. Eric Handley Musculoskeletal Radiologist Cherry Creek Imaging

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1 MRI of the Shoulder What to look for and how to find it? Dr. Eric Handley Musculoskeletal Radiologist Cherry Creek Imaging

2 MRI of the Shoulder Benefits of Ultrasound: * Dynamic * Interactive real time imaging * Fluid plane of evaluation * Doppler * Cheaper (maybe)

3 MRI of the Shoulder Benefits of MRI: * Internal joint evaluation * Sensitive for edema * Cartilage evaluation * Resolution (deep structures, body habitus) * Comfortable to many radiologists and referrers

4 MRI of the Shoulder Ultrasound and MRI are complementary imaging modalities!

5 MRI of the Shoulder Role of Ultrasound * Fluid Collections (Joint effusions, bursae) * Superficial ligaments and tendons * Specific question * Muscles * Intervention

6 MRI of the Shoulder Role of MRI * Intra-articular evaluation (labrum) * Osseous pathology * Cartilage * Global symptoms

7 MRI of the Shoulder MSK Ultrasound in Radiology * Variable training * Radiologist s time * Referrals

8 MRI of the Shoulder Basic MRI Sequences * T1: fluid dark, fat bright * T2: fluid bright, fat bright * STIR (fluid sensitive): fluid bright, fat dark

9 MRI of the Shoulder MRI Sequences for Joint Evaluation * Proton Density (PD) fluid intermediate, fat bright * Proton Density Fat Saturation (PDFS) fluid bright, fat dark

10 MRI of the Shoulder Proton Density (PD) sequences are intermediate weighted with increased signal to noise. They provide excellent evaluation of fibrous and fibrocartilaginous structures, such as the labrum, ligaments, tendons and cartilage.

11 Axial Imaging What to look for: -Acromioclavicular joint -Long head biceps tendon -Subscapularis tendon -Teres minor tendon -Anterior labrum -Posterior labrum -Glenohumeral joint -Inferior Joint capsule -Muscles

12 Sagittal Imaging What to look for: -Acromioclavicular joint -Acromion shape -Long head biceps tendon -All rotator cuff tendons and muscles -Glenoid -Inferior Joint capsule -Muscles

13 Coronal Imaging What to look for: -Acromioclavicular joint -Long head biceps tendon -Supraspinatus tendon -Infraspinatus tendon -Superior labrum -Inferior labrum -Glenohumeral joint -Inferior Joint capsule -Muscles

14 Arthrogram When do we do them? 1. Postoperative 2. High level athletes 3. Preference of the Orthopedic surgeon

15 Acromioclavicular joint separation Academic Life in EM

16 AC separation Grade 3

17 AC separation Grade 3, chronic

18 AC separation Grade 2, chronic

19 AC separation Grade 1, acute

20 Acromioclavicular Osteoarthritis

21 Radiopedia Acromion Types

22 Acromion, Type 2 configuration

23 Rotator Cuff Tear? Role for MRI? * Tendons involved * Retraction of torn fibers * Muscular edema and/or atrophy

24

25 Supraspinatus Tendinopathy

26 Infraspinatus Tendinopathy

27 Calcific Tendinitis

28 Supraspinatus Tear and Os Acromiale

29 Supraspinatus Tear and Os Acromiale #2

30 Supraspinatus, Partial Bursal Tear

31 Supraspinatus, Partial Bursal Tear #2

32 PASTA * Partial articular-sided supraspinatus tendon avulsion * Rim rent tear

33 Supraspinatus, Partial Articular Tear

34 Supraspinatus, Full thickness tear

35 Supraspinatus, Full thickness tear

36 Supraspinatus, Full thickness tear #2

37 Supraspinatus, Full thickness tear #3

38 Subscapularis Partial Intersitial Tear

39 Massive Rotator Cuff Tear

40 Recurrent Supraspinatus Tear

41 Rotator Cuff Muscular Atrophy Research Gate

42 Rotator Cuff Muscles

43 Rotator Cuff Muscular Edema

44 Subscapularis Muscular Edema

45 Parsonage Turner Syndrome * Brachial neuritis * Autoimmune? * Denervation edema * Usually unilateral * Self limiting

46 Test case #1 Tear? Full or Partial? Retraction? Yes Full Yes AP involvment? Supra and Infra AC joint? Arthritis, type 2 Muscles? Atrophy

47 Test case #2 Tear? Full or Partial? Type? Yes Partial Articular AP involvment? Supra AC joint? Type 2 Muscles? Edema, no atrophy

48 Long Head Biceps Tendon (LHBT), Medial Subluxation

49 Subscapularis Tear and LHBT dislocation

50 Long Head Biceps Tendon (LHBT) Dislocation

51 Long Head Biceps Tendon (LHBT) Tear

52 Anterior Shoulder Dislocation

53 Bankart Lesion and Variants The Radiology Assistant

54 Bankart and Hill Sachs

55 Osseous Bankart

56 Osseous Bankart

57 Osseous Bankart and Hill Sachs

58 Reverse Bankart: Labral Tear, Posteroinferior

59 Labral Tear, Posteroinferior with Paralabral Cyst

60 Labral Tear, Posteroinferior with Paralabral Cyst

61 Perthes Lesion (Bankart Variant)

62 ALPSA (Anterior labroligamentous periosteal sleeve avulsion) lesion

63 GLAD (Glenolabral articular disruption) lesion

64 SLAP tear * Superior Labral Anterior Posterior tear * Typically start at 12:00 and extend posteriorly * Type 1: Fraying of superior labrum * Type 2: Tear and detachment of superior labrum * Type 3: Bucket handle tear * Type 4: Bucket handle tear with extent into biceps anchor

65 The Radiology Assistant Glenoid Labrum

66 Semantics Scholar

67 SLAP Tear, type 2

68 SLAP Tear, type 2 #2

69 SLAP Tear, type 2 #3

70 SLAP Tear, type 3

71 Radsource SLAP tear, type 4

72 The Radiology Assistant Labral Variants

73 Sublabral Foramen

74 Sublabral Recess

75 Buford Complex

76 Bennett Lesion

77 Test case #3 Labral Tear? Type? Type of SLAP? Involvement? Yes SLAP IV o clock

78 Anatomy

79 Adhesive Capsulitis

80 Capsular Disruption

81 Semantics Scholar Capsular Injuries

82 Humeral avulsion of the glenohumeral ligament (HAGL lesion) Radiopedia

83 Bony humeral avulsion of the glenohumeral ligament (BHAGL lesion)

84 Glenoid avulsion of the glenohumeral ligament (GAGL lesion)

85 Rotator Cuff Interval Edema

86 Glenohumeral Osteoarthritis

87 Glenohumeral Osteoarthritis #2

88 Glenohumeral Osteoarthritis #3

89 Glenohumeral Osteoarthritis on CT

90 Greater Tuberosity Fracture

91 Rotator Cuff Repair

92 Biceps tenodesis

93 Labral Repair

94 Clavicular Repair

95 MRI of the Shoulder What to look for and how to find it? Dr. Eric Handley Musculoskeletal Radiologist Cherry Creek Imaging

96 Enchondroma

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