1. The document discusses various shoulder joint diseases including rotator cuff disorders, instability, biceps disorders, tumors, arthritis, and referred pain. 2. Rotator cuff tears are classified as partial-thickness or full-thickness and can be caused by impingement or trauma. Glenoid labral tears appear on MRI as high signal intensity detachment from the glenoid rim. 3. Direct MR arthrography improves detection of chronic labral tears by distending the joint with contrast. Common labral tears include SLAP lesions, Bankart lesions, and Hill-Sachs fractures associated with instability.

2. Lecturer of radiodiagnosis

35. S H O U LD E R JO IN T
D IS E AS E S

36. 1 - Rotator cuff disease
2 – Instability and Labral lesions,
3- Biceps disorders,
4-Truma
5-Tumors
6-Arthritis.
7-Refered pain as radiculopathy, and thoracic outlet syndrome.

37. Rotator cuff disease
Tendinosis
The earliest stage of rotator cuff tendon pathology. The term
tendinosis and not tendinitis is probably appropriate to describe such a
cuff.
Partial-thickness tear
shows no communication between the glenohumeral joint and
subacromial bursa.
Bursal side tear
Articular side tear
Intratendinous tear
Full-thickness tear
It is a discontinuity in the tendon that extends from the
articular surface to the bursal surface.

38. Rotator cuff disease
Causes
1 – Impingement syndrome
2 – Degenerative
3 - Traumatic

39. Shoulder instability
shoulder instability is slipping of the humeral head out
of the glenoid socket during activities causing symptoms. It is
referred to a spectrum of disorders that includes dislocation,
subluxation and laxity.
Instability is classified according to
temporal relationship of antecedent trauma (acute first-time
versus recurrent)
degree (subluxation versus dislocation)
direction, either unidirectional (anteroinferior or posterior) or
multidirectional.

40. Shoulder instability
Causes
1 – Laxity
2 – Labral tear
SLAP lesion
Bankart lesion

41. MR imaging
Pulse sequences
MR images obtained included axial , oblique coronal
and oblique sagittal planes with different pulse sequences as
following:
Oblique Coronal T1 weighted images
Oblique Coronal T2 weighted images
Oblique Coronal T2 weighted fat suppressed images
Oblique Coronal Proton Density (PD) weighted images
Oblique Sagittal T1 weighted images
Axial Gradient weighted images

42. Direct MR arthrography
Technique
Anterior approach for intra-articular injection was done by
using a 22 G spinal needle.
Contrast agent
1- 0.5 mL of iodinated contrast agent was injected, guided under
fluoroscopy for confirmation of intra-articular position of the
needle.
2- 10 – 12 mL of a diluted solution of a paramagnetic contrast
material (( consisted of 1 mL. gadopentetate dimeglumine
( Magnevist ) diluted in 200 mL normal saline 0.9% )) was then
injected.
Pulse sequences
T1 – weighted fat suppressed images was performed in
axial , oblique coronal and oblique sagittal planes.

43. Case 1 Supraspinatus tendinosis
Ab norm al h igh s ignals e qu al le s s th an flu id

44. Case 2 ( Supraspinatus partial tear (Bursal side

45. Case 2 ( Supraspinatus partial tear (Bursal side

46. Case 3 ( Supraspinatus partial tear (Articular side

47. Case 3 ( Supraspinatus partial tear (Articular side

48. Case 4 ( Supraspinatus partial tear (Intratendinous

49. Case 4 ( Supraspinatus partial tear (Intratendinous

50. Case 5 Supraspinatus full thickness tear

51. Case 5 Supraspinatus full thickness tear

52. Case 6 Supraspinatus full thickness tear

53. Case 6 Supraspinatus full thickness tear

54. Case 7 Supraspinatus full thickness tear

55. Case 7 Supraspinatus full thickness tear

56. ROLE OF MRI IN THE
DIAGNOSIS OF GLENOID
LABRAL TEARS

57. Glenoid labrum is a ring of dense
fibrocartilagenous tissue attached to the bony
glenoid cavity, increasing its depth and
considered to be a factor for shoulder
stabilization.
Glenoid
Cavity

58. It appearse as a triangular structure at the
margin of the glenoid rim on both axial and
coronal plans. It displays low signal intensity on
all pluse sequences.
C O R O N AL T1 WI AX IAL T1 WI

59. Lab ral te ars ap p e ar in M R I as a h igh s ignal
inte ns ity with in th e s u b s tance of th e lab ru m
d e tach ing it from th e gle noid rim . Th is is ob viou s ly
s e e n in acu te s tage s wh e re as s ociate d j oint
e ffu s ion is p re s e nt allowing flu id to inte r th e s ite of
th e te ar

60. Howe ve r in ch ronic s tage s , fib ros is m ay occu r at
th e s ite of th e te ar als o with re s olving of th e joint
e ffu s ion m aking th e d e te ction of th e te ar b y
conve ntional M R I is d ifficu lt and th e lab ru m
.ap p e ars to b e norm al

61. So in th is s itu ation d ire ct M R arth rograp h y
is ind icate d

62. Intra-articu lar inje ction of ab ou t 1 0 – 1 2 m L of a
d ilu te d s olu tion of a p aram agne tic contras t m ate rial
(( cons is te d of 1 m L. gad op e nte tate d im e glu m ine
( M agne vis t ) d ilu te d in 200 m L norm al s aline 0.9%
)) b y u s ing a 22 G s p inal ne e d le .
D ire ct M R arth rograp h y C onve ntional M R I

63. Two mechanisms of truma
are encountered in the
glenoid labral tears

64. Fall on an outstretched arm

65. S u p e rior lab ral te ar
S u p e rior lab ral ante rior– to – p os te rior te ar
S LAP

66. F ou r m ain typ e s of S LAP LE S IO N S
Type I
Ju s t fraying or irre gu larity of th e lab ru m
is d e m ons trate d . Th is typ e of le s ion is
qu ite com m on in e ld e rly p e rs ons and
m ay re p re s e nt a d e ge ne rative te ar of
th e lab ru m . Th is typ e rare ly cau s e s
s ym p tom s and d o not re qu ire s u rgical
re p air.

67. ( SLAP lesion ( type II
Type II SLAP lesions consist of detachment of the superior labral-bicipital
complex from the superior glenoid rim

68. ( SLAP lesion ( type III
In type III SLAP lesions, the superior portion of the labrum is detached from
both the glenoid and the biceps tendon, and may be displaced into the joint
space.

69. ( SLAP lesion ( type IV
Type IV SLAP lesion is similar to type III lesion, with the tear extending into
the biceps tendon .

70. The biggest difficulty in diagnosing SLAP tears is differentiation of type
II tears from the normal sublabral recess, which can be seen separating
the superior labrum from the glenoid as a normal variant
D ire cte d m ore m e d ially
S m ooth ly ou tline d
At and ante riot to th e b ice p tal lab ral com p le x

71. S LAP II
Usually directed laterally
Extend posterior to the biceptal
labral complex Irregular outlines

72. SHOULDER DISLOCATION

73. Ante rior d is location
BANKART LESION
HILL SACHS FRACTURE

74. P os te rior d is location
REVERSE HILL SACHS

75. Bankart lesion

76. Bankart lesion
Hill Sachs fracture

77. Perthes lesion
A variant of Bankart le s ion

78. ALPSA lesion
A variant of Bankart le s ion

79.  MRI is an accurate modality in detection of
glenoid labral tear specially in acute stages
 Direct MR arthrography may be needed for
detection of labral tear in chronic stages,
however it converts the modality from non
invasive to an invasive method.

80. Have A Nice Day