This document discusses MRI of the shoulder joint. It provides information on common MRI sequences used for the shoulder, key anatomical sections imaged, and various pathologies that can be seen. Example cases are presented to demonstrate common injuries like rotator cuff tears, labral tears, fractures, and adhesive capsulitis. The importance of correlating MRI findings with arthroscopy is emphasized given the potential for asymptomatic findings on MRI.

1. MRI OF SHOULDER JOINT
Dr Krishna Kiran MD.DNB.FRCR
Radiologist
Calicut
This presentation is intended for medical and
allied professionals.

2. What is T1,T2.. And many other
fancy names used in MRI..??
T2 T1 FAT
SUPPRESSED
STIR/PDFS
Common sequences in MRI shoulder

3. 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.

4. Key section in shoulder
coronal image in the
middle third

5. Anterior coronal section

6. Posterior coronal section shoulder

7. Sagittal section

8. Axial anatomy

9. After review of
anatomy , Let us
proceed to our
case.

10. CASE 1
?ROTATOR CUFF TEAR

13. Full thickness tear
supraspinatus tendon
except fibers in anterior
third

14.  Complete tears of supraspinatus tendon are
accompanied by muscle atrophy and fatty
infiltration.
 These are important negative prognostic
factors for tendon repair and shoulder
arthroplasty.
 Muscle thickness using Fat occupancy ratio
and fatty infiltration of muscle can be
assessed on MRI.

15. Fat occupancy ratio

16. Reduced fat occupancy Normal fat occupancy

17. Fatty infiltration
supraspinatus
Normal supraspinatus

18. Case 2
 ? Rotator cuff tear

20. Avulsion Fracture
greater tuberosity of
humerus

21. Case 3
 ?RCT

23. Rimrent or PASTA tear

24. Rimrent or PASTA tear
 A partial tear that extends to articular surface
does not extent to bursal surface.

25. Case 4
 Recurrent Dislocation shoulder

26. Anterior middle posterior
Coronal sections

27. Posterior sections of shoulder

29. Hill Sach Lesion

30. Anterior labral
tear
Normal anterior
labrum for
comparison

31. Labral clock
Clockwise approach to
labrum is the easiest way
to diagnose labral tears
and differentiate them
from normal variants.

32. ABER view
Abduction external rotation view of shoulder is utilized to detect
subtle soft tissue pathology of anteroinferior labrum and rotator
cuff.

33. Types of anteroinferior labral
tears.
Bankart
lesion
Perthe
lesion
ALPSA
lesion

34. Case 5
 Shoulder pain and limitation of movement.

36. Anterior middle
posterior

37. Anterior capsule
thickening indicative
of adhesive
capsulitis.
Normal for comparison

38. Case 6
Shoulder pain on overhead hand
movement

39. Anterior middle
posterior

40. Anterior middle
posterior

41. Supraspinatus tendonitis / tendinopathy
MRI shows tendon enlargement and mild intratendinous
hyperintense signal.

42. Case 7
 Suspected scapula fracture

44. 3D CT is done to assess
scapula and adjacent
injuries.

45. Case 8
 An athlete complains of pain on throwing and
overhead movement of arm.

46. MR Arthrogram

47. Hyperintense signal within labrum extending
posteriorly. Indicative of SLAP lesion. (Superior Labral
anteroposterior tear)

48. 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)

49. History of Trauma
CASE 1O

50. AP shoulder

51. Y view or scapula lateral

52. Internally rotated humerus giving light
bulb appearance. Y view showing
Posterior dislocation
posterior
dislocation.

53. Other views of shoulder
Outlet or Neer`s view

54. Other views
Axillary view

56. What about ultrasound..?
Useful tool in
•Rotator cuff tendinopathy or tear.
•Calcific tendonitis.
•Subacromial bursal effusion.
Limitations
•Many parts of joint can not be
assessed.
•Operator dependent

57. 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

58. What is difference between low
strength and 1.5T magnet..?
0.2T
1.5 T

59. How accurate are shoulder
MRI reports..?
 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
findings better.
 In doubtful cases it is better to mutually discuss and
proceed.
Sher et al JBJS 1995

60. What are types of
acromion..?
Type 2 and 3 are
associated with
shoulder impingement

61. QUIZ
 Shoulder , arm pain after suddenly lifting
heavy weight

63. SLAP tear
extending to
biceps anchor

64. 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 ..!!