MRI SHOULDER JOINT HOW TO READ MRI SCAN OF SHOULDER JOINT EASY METHOD SYSTEMATIC APPROACH TO SHOULDER MRI

1. How to read a shoulder MRI
Dr ARJUN

2. T1- weighted image:
Fats and bone marrow produce high signal (white); ligaments, cartilage,
fluid produce low signal (black)
T2- weighted image:
Ligaments, cartilage and fluid produce high signal (white); bone marrow
produces a low signal (black).

3. PLANES
Coronal oblique:
slices parallel to the tendon of the supraspinatus muscle,
going from posterior to the anterior shoulder.
Sagittal oblique:
slices perpendicular to the supraspinatus muscle, going
from head of humerus to the scapula.
Axial plane:
makes cross-sections of the shoulder from top to bottom.

4. • All tendons: low SI on all MRI sequences

5. Axial

14. Coronal plane

26. Sagittal plane

33. ABER VIEW
abduction external rotation
(ABER) view

35. Images in the ABER position are obtained in an axial way 45 degrees
off the coronal plane.
In that position the 3-6 o’clock region is imaged perpendicular

36. Labral tears (ABER) view
excellent for assessing the anteroinferior labrum at the 3-6
o’clock position, where most labral tears are located.
In the aber position
inferior glenohumeral ligament is stretched
Tension on the anteroinferior labrum
Intra-articular contrast to get between the labral tear and the glenoid

38. •ABER view :useful for both partial- and full-thickness tears of
the rotator cuff.
ABER POSITION :releases tension on the cuff relative to the
normal coronal view obtained with the arm in adduction.
As a result, subtle articular-sided partial thickness tears will not
lie apposed to the adjacent intact fibers of the remaining
rotator cuff nor be effaced against the humeral head, and
•intra-articular contrast can enhance visualization of the tear

44. Glenohumeral joint
• Axial T1 or PD image at the level of the
superior portion of the glenohumeral joint.
• Space between the lesser tuberosity of the
humeral head and the coracoid process
( coracohumeral interval)
high signal area normally measures around
7-11 mm.
• Narrowing of the coracohumeral interval to
<6 mm highly associated with anterior
shoulder disorders such as rotator cuff tears.

45. • Acromion appears as an oval high
signal ,large rhomboid structure
that has an intermediate (gray)
signal.
• Anteriorly, follow the acromion to
the point where it articulates with
the lateral clavicle and forms the
acromioclavicular joint.

46. 15% of people the acromion contains unfused ossification centers
characterized by Decreased in intensity on MRI. This is a normal
variant called Os acromiale

47. Glenoid labrum
• Best seen in the axial plane
appearing on the anterior and posterior rim of the glenoid as two
triangular-shaped (low signal)
• Anterior labrum is usually larger than the posterior labrum.
• Tears or detachments, seen as a fluid signal extending between
the labrum and the bony glenoid or as a truncation of the labrum.

49. normal variants are all located in the 11-3 o’clock position.
Can mimic a SLAP tear
Usually not mimic a bankart-lesion,
since it is located at the 3-6 o’clock
position, where these normal variants
do not occur.
Labral tears may originate at the 3-6 o’clock position and subsequently
extend superiorly.

51. Differences between an sublabral recess and a SLAP-tear.
A recess more than 3-5 mm is always abnormal and should be regarded as a
SLAP-tear

52. Glenohumeral ligaments
• Superior, middle and inferior
glenohumeral ligaments are thickenings
of the glenoid capsule that attach onto
the anteroinferior margin of the
glenoid labrum
• Uniform structure on a T1 axial image,
appearing as a dark band near the
anterior labrum, that extends along the
humeral head

53. Biceps brachii –
Best seen on an axial PD image
On a slice through the center of the
glenohumeral joint.
• Tendon of the long head of biceps
brachii is located in the bicipital
groove,
• tendon of the short head is found at
the tip of the coracoid process.

54. Deltoid

55. ROTATOR CUFF TEAR

56. C P
CLAVICLE
SUPRASPINATUS FOSSA
IS
T MINOR
SC

57. SC
MULTIPINNATE
BICEPS ANTERO SUPERIOR
POSTERO INFERIOR

58. GT
ANTERIOR

59. PARTS OF TENDON
Critical zone 1- 1.5 cm from
enthesis
(hypovascular- prone for
degeneration)
myotendinous jn : traumatic
tears

60. collagen tendinosis tear

62. mild severe

64. Intra osseous cyst

65. Calcification( calcific tendinitis)

66. Articular sided

67. Articular sided

68. Bursal side

69. Interstitial tear

71. Full-thickness tear:
• high SI on T2WI
• Direct signs
• Tendon discontinuity
• Fluid signal in tendon gap
• Retraction of musculotendinous junction
• Associated findings
• Subacromial/ subdeltoid bursal fluid
• Muscle atrophy

72. Full thickness tear

74. •In centimeters
level up to which the muscle got retracted
Retraction of tendons

75. Subscapularis tear

76. Muscle atrophy

77. Fatty infiltration of muscle

78. Glenoid

83. Measuring the glenoid bone loss using best fit circle
method

86. • thankyou