MRI of the shoulder (an approach)

At the time the article was created Joachim Feger had no recorded disclosures.

At the time the article was last revised Yoshi Yu had no financial relationships to ineligible companies to disclose.

• MRI of the shoulder reporting template

MRI of the shoulder is one of the more frequent examinations faced in daily radiological practice. This approach is an example of how to create a radiological report of an MRI shoulder with coverage of the most common anatomical sites of possible pathology.

Systematic review

A systematic review in the MRI of the shoulder is essential since shoulder anatomy itself is rather complex, and pathologies and injury patterns are manifold and only rarely lead to an abnormality of a single structure but rather show diverse findings which might need to be addressed in further patient management.

Bones

The bony structures of the shoulder, the pictured proximal humerus, the pictured scapula with the glenoid, coracoid process as well as the acromion and the distal clavicle are assessed:

• osteonecrosis of the humeral head, bone tumors, fractures, Hill Sachs defect, bony Bankart lesion

Acromioclavicular joint and coracoacromial arch

Assessment of the acromioclavicular joint, including acromial shape, downslope, variant anatomy.

• acromioclavicular injury, arthritis, hooked acromion, lateral downslope, os acromiale, acromial apophysiolysis, Geyser sign

Subacromial-subdeltoid bursa

• subacromial bursitis, fluid

Rotator cuff

Assessment of the following structures:

• supraspinatus tendon and supraspinatus muscle
• infraspinatus tendon and infraspinatus muscle
• teres minor tendon and teres minor muscle
• subscapularis tendon and subscapularis muscle

Precise assessment and description and grading of the rotator cuff pathology (e.g. tendinosis, partial-thickness, full-thickness rotator cuff tear, or calcium deposits) including the shape, extension, and tear dimensions if applicable.

Muscles are assessed with respect to atrophy, fatty degeneration, and edema as a result of a rotator cuff tear or in nerve compression syndromes.

Rotator interval and long head biceps tendon

Assessment of the following structures:

• long head biceps tendon
  • tendinosis, tear, dislocation, tenosynovitis

  The rotator interval is assessed with respect to biceps pulley injury and in cases of suspected adhesive capsulitis.

  Glenohumeral articulation

  Assessment of the following structures:

  • joint space
    • joint effusion if present and possible intra-articular fragment or intra-articular loose bodies
    • traumatic injury (HAGL, GAGL), adhesive capsulitis
    • anterior and posterior glenolabral injuries, SLAP lesion

    Soft tissues

    Assessment of deltoid and pectoralis muscles and the subcutaneous fat:

    Common pathology

    • rotator cuff tear (full-thickness, partial-thickness)
    • rotator cuff arthropathy
    • shoulder impingement
    • calcific tendinitis
    • adhesive capsulitis
    • shoulder instability
    • anterior glenolabral injuries
    • superior labral anterior-posterior (SLAP) tears
    • biceps pulley injury
    • Parsonage-Turner syndrome
    • Quadrangular space syndrome
    • pectoralis tear

    References

    • 1. Tawfik A. Rotator Cuff Disorders: How to Write a Surgically Relevant Magnetic Resonance Imaging Report? WJR. 2014;6(6):274. doi:10.4329/wjr.v6.i6.274 - Pubmed
    • 2. Morag Y, Jacobson J, Miller B, De Maeseneer M, Girish G, Jamadar D. MR Imaging of Rotator Cuff Injury: What the Clinician Needs to Know. RadioGraphics. 2006;26(4):1045-65. doi:10.1148/rg.264055087 - Pubmed
    • 3. Gassenmaier S, Armbruster M, Haasters F et al. Structured Reporting of MRI of the Shoulder – Improvement of Report Quality? Eur Radiol. 2017;27(10):4110-9. doi:10.1007/s00330-017-4778-z - Pubmed