MRI SHOULDER WHAT TO SEE

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Transcription:

MRI SHOULDER WHAT TO SEE DR SHEKHAR SRIVASTAV Sr. Consultant- Knee & Shoulder Arthroscopy Sant Parmanand Hospital

Normal Anatomy

Normal Shoulder MRI Coronal Oblique Sagital Oblique Axial Cuts

Normal Coronal Oblique Parallel to plane of Supraspinatus Supraspinatus A-C Joint Sub-acromial & Sub-Deltoid bursa Labrum- Sup & Inf Biceps Tendon

Normal Coronal Oblique d

Normal Coronal Oblique Parallels the central tendon of supraspinatus

Normal Sagittal Oblique Perpendicular to the plane of Supraspinatus Medial to Lateral Coraco-acromial arch Rotator cuff Shape of Acromion

Normal Sagittal Oblique a

Normal Axial Cuts

Normal Axial Cuts Labrum- Ant & Post Gleno-humeral ligament Gleno-humeral cartilage Biceps Tendon Subscapularis & Teres Minor

Arthrogram Sequence Distension of joints, crowded structures seen separately Labrum, G-H ligaments, biceps anchors Partial articular surface RC tears SLAP tears

Pathological process Shoulder Impingement Rotator cuff pathology Instability Miscellaneous- Biceps, Infection, Adhesive Capulitis

Osseous Acromial Outlet A-C joint Acromion Humeral Head

Extrinsic Impingement A-C osteophytes Sub-acromial Enthesophytes Acromion Shape

Acromion Shape 3 types Type1 Type 2 Type 3

Rotator Cuff Pathology Tendinosis Partial thickness Cuff Tears Full thickness Cuff Tears

Tendinosis Thickened tendon with degeneration Intrasubstance degeneration Normal to intermediate SI changes

Partial Cuff Tears Three types Articular side- FP, CZ Interstitial Bursal side

Partial RC Tear Intrasubstance tear Bursal sided RC Tear Bursal Tear Intra-Substance Tear

Full thickness RC tears Tear extending from bursal to articular surface Fluid in SA-SD bursa Retraction of tendon Muscle undergoes Atrophy Degeneration Fatty Infiltration

Full Thickness RC Tears Tendons involved Size of the tear- AP & ML plain

Full Thickness RC Tears Muscle Atrophy

Instability Spectrum ranging from subtle instability to frank dislocation Anterior Instability Posterior Instability SLAP tear

Anterior Instability Bankart Lesion Bony Bankart Glenoid Erosion Hill Sach s lesion

Anterior Instability Bankart Lesion

Anterior Instability Bony Bankart Glenoid Erosion Bony Bankart Glenoid Erosion

Anterior Instability Hill Sach s Lesion- Postero-Sup aspect of Humeral Head

Anterior Instability Hill Sach s Lesion

Posterior Instability Posterior Labral Lesion Reverse Hill Sach s

SLAP Tear Superior Labrum Antero-Posterior Tear Avulsion Biceps Anchor

SLAP Tear Normal Biceps Anchor

SLAP Tear Torn labral

Biceps Pathology Tendinosis Rupture Dislocation

Miscellaneous Osteonecrosis Fractures Osteonecrosis Occult Fractures Infection

Shoulder is a complex joint with many normal variants Proper clinical examination and probable clinical diagnosis MRI very sensitive test for diagnosing shoulder problems MRI findings should corroborate clinical findings

j Thank You

Various lesions seen in Dislocation Shoulder ALSPA Perthes Lesion Chondral Defect Reverse Hillsachs & Post Labral tear

Rotator Cuff Supraspinatus Infraspinatus Teres minor Subscapularis

Partial Cuff Tears Articular sided cuff tear

Miscellaneous Infection Adhesive Capsulitis

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