MRI OF SHOULDER JOINT
Dr Krishna Kiran MD.DNB.FRCR
This presentation is intended for medical and
What is T1,T2.. And many other
fancy names used in MRI..??
T2 T1 FAT
Common sequences in MRI shoulder
How do you do shoulder MRI..
Shoulder MRI is done in a plane parallel to supraspinatus.
Generally sequences obtained are
Coronal plane T1, T2, Fatsuppressed (STIR or PDFS)
Axial - T1, fatsuppressed
Sagittal - T2 and fat suppressed.
Key section in shoulder
coronal image in the
Full thickness tear
except fibers in anterior
Complete tears of supraspinatus tendon are
accompanied by muscle atrophy and fatty
These are important negative prognostic
factors for tendon repair and shoulder
Muscle thickness using Fat occupancy ratio
and fatty infiltration of muscle can be
assessed on MRI.
Hyperintense signal within labrum extending
posteriorly. Indicative of SLAP lesion. (Superior Labral
Labrum shows several anatomical variations. Conventional MRI is not
accurate in diagnosing labral tears (40-70% sensitivity and specificity) MR
Arthrography is more accurate (90-95% sensitivity and specificity)
What about ultrasound..?
Useful tool in
•Rotator cuff tendinopathy or tear.
•Subacromial bursal effusion.
•Many parts of joint can not be
What is magic angle phenomenon..?
Some sequences reveal mild bright signal / hyperintensity within
substance of supraspinatus. If seen without tendon enlargement is
indicative of artifact called magic angle phenomenon. Is said to be due
to orientation of collagen fibers.
Coronal STIR Coronal T2
What is difference between low
strength and 1.5T magnet..?
How accurate are shoulder
15-20% of asymptomatic adults on shoulder MRI
revealed rotator cuff tears.
A shoulder surgeon with correlation between
arthroscopy and MRI may be able to correlate image
In doubtful cases it is better to mutually discuss and
Sher et al JBJS 1995
What are types of
Type 2 and 3 are
Shoulder , arm pain after suddenly lifting
Take home points..
Shoulder is a complex joint , imaging also
tends to be complex and prone for errors.
When in doubt discuss and proceed.
Signal within tendon may not be significant ,
remember magic angle ..!!