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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Transcription:

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

Acromioclavicular joint separation Academic Life in EM

AC separation Grade 3

AC separation Grade 3, chronic

AC separation Grade 2, chronic

AC separation Grade 1, acute

Acromioclavicular Osteoarthritis

Radiopedia Acromion Types

Acromion, Type 2 configuration

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

Supraspinatus Tendinopathy

Infraspinatus Tendinopathy

Calcific Tendinitis

Supraspinatus Tear and Os Acromiale

Supraspinatus Tear and Os Acromiale #2

Supraspinatus, Partial Bursal Tear

Supraspinatus, Partial Bursal Tear #2

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

Supraspinatus, Partial Articular Tear

Supraspinatus, Full thickness tear

Supraspinatus, Full thickness tear

Supraspinatus, Full thickness tear #2

Supraspinatus, Full thickness tear #3

Subscapularis Partial Intersitial Tear

Massive Rotator Cuff Tear

Recurrent Supraspinatus Tear

Rotator Cuff Muscular Atrophy Research Gate

Rotator Cuff Muscles

Rotator Cuff Muscular Edema

Subscapularis Muscular Edema

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

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

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

Long Head Biceps Tendon (LHBT), Medial Subluxation

Subscapularis Tear and LHBT dislocation

Long Head Biceps Tendon (LHBT) Dislocation

Long Head Biceps Tendon (LHBT) Tear

Anterior Shoulder Dislocation

Bankart Lesion and Variants The Radiology Assistant

Bankart and Hill Sachs

Osseous Bankart

Osseous Bankart

Osseous Bankart and Hill Sachs

Reverse Bankart: Labral Tear, Posteroinferior

Labral Tear, Posteroinferior with Paralabral Cyst

Labral Tear, Posteroinferior with Paralabral Cyst

Perthes Lesion (Bankart Variant)

ALPSA (Anterior labroligamentous periosteal sleeve avulsion) lesion

GLAD (Glenolabral articular disruption) lesion

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

The Radiology Assistant Glenoid Labrum

Semantics Scholar

SLAP Tear, type 2

SLAP Tear, type 2 #2

SLAP Tear, type 2 #3

SLAP Tear, type 3

Radsource SLAP tear, type 4

The Radiology Assistant Labral Variants

Sublabral Foramen

Sublabral Recess

Buford Complex

Bennett Lesion

Test case #3 Labral Tear? Type? Type of SLAP? Involvement? Yes SLAP IV 10 12 o clock

Anatomy

Adhesive Capsulitis

Capsular Disruption

Semantics Scholar Capsular Injuries

Humeral avulsion of the glenohumeral ligament (HAGL lesion) Radiopedia

Bony humeral avulsion of the glenohumeral ligament (BHAGL lesion)

Glenoid avulsion of the glenohumeral ligament (GAGL lesion)

Rotator Cuff Interval Edema

Glenohumeral Osteoarthritis

Glenohumeral Osteoarthritis #2

Glenohumeral Osteoarthritis #3

Glenohumeral Osteoarthritis on CT

Greater Tuberosity Fracture

Rotator Cuff Repair

Biceps tenodesis

Labral Repair

Clavicular Repair

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

Enchondroma

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