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Rotator Cuff Anatomy Dr. XXXXX Hospital XXXXX Date XXXXX
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Rotator Cuff Muscles/Tendons Individual Tendon Components
Supraspinatus Anomalies Anterior Fibers of Supraspinatus Infraspinatus Greater Tuberosity Anatomy Bare Area of GT Interdigitation Artifact 4-5 Histologic Layers Cable Crescent Component Teres Minor Subscapularis Rotator Intervals
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Rotator Cuff Muscles Supraspinatus Infraspinatus Teres Minor
Subscapularis
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Supraspinatus Muscular origin Supraspinatus Fossa
Inserts on Greater Tuberosity Innervation from Suprascapular Nerve Triple Blood Supply Two and Perhaps three main tendinous components
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Supraspinatus
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F:\Project2\anomalous supraspinatus 1\sagital Cuff layers\Sag Cuff Layers with ant RI 2.jpg
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F:\Project2\anomalous supraspinatus 1\sagital Cuff layers\Sag Cuff Layers with ant RI 2b.jpg
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F:\Project2\anomalous supraspinatus 1\sagital Cuff layers\Sag PD FS4
F:\Project2\anomalous supraspinatus 1\sagital Cuff layers\Sag PD FS4.jpg
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F:\Project2\anomalous supraspinatus 1\sagital Cuff layers\Sag PD FS5
F:\Project2\anomalous supraspinatus 1\sagital Cuff layers\Sag PD FS5.jpg
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F:\Project2\anomalous supraspinatus 1\sagital Cuff layers\Sag PD FS 2
F:\Project2\anomalous supraspinatus 1\sagital Cuff layers\Sag PD FS 2.jpg
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F:\Project2\anomalous supraspinatus 1\sagital Cuff layers\Sag PD FS 3
F:\Project2\anomalous supraspinatus 1\sagital Cuff layers\Sag PD FS 3.jpg
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F:\Project2\anomalous supraspinatus 1\sagital Cuff layers\Sag PD FS with ant RI.jpg
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Supraspinatus Anomalies
Separate Muscular origins from the Supraspinatus fossa, anterior component intramuscular tendon and posterior component lateral tendon Accessory Slip extends to Lesser Tuberosity ????
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Accessory Anterior Slip of Supra
10/37 cadaveric specimens, 1 with FT RCT
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Zonal Anatomy of Supraspinatus Tendon
Insertional fibers-Rim Rent Tears Critical Zone-Hypovascular Intramuscular/Musculotendinous
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Anterior Insertional Fibers
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Anterior Insertional Fibers/Rim Rent
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Rim Rent Tears Younger Patents anterior insertional SS tears, frequently with adjacent bone changes
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Anomalous Supraspinatus Tendon 1
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F:\Project2\anomalous supraspinatus 1\AxialPDa.jpg
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F:\Project2\anomalous supraspinatus 1\AxialPDb.jpg
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F:\Project2\anomalous supraspinatus 1\AxialPDc.jpg
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F:\Project2\anomalous supraspinatus 1\CorPDa.jpg
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F:\Project2\anomalous supraspinatus 1\CorPDb.jpg
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F:\Project2\anomalous supraspinatus 1\CorPDc.jpg
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F:\Project2\anomalous supraspinatus 1\CorT1a.jpg
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F:\Project2\anomalous supraspinatus 1\CorT1b.jpg
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F:\Project2\anomalous supraspinatus 1\CorT1c.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1a.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1b.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1c.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1d.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1e.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1f.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1g.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1h.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1i.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1j.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1k.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1l.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1m.jpg
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F:\Project2\anomalous supraspinatus 1\SagT1n.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2a.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2b.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2c.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2d.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2e.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2f.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2g.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2h.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2i.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2j.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2k.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2l.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2m.jpg
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F:\Project2\anomalous supraspinatus 1\SagT2n.jpg
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Anomalous Supraspinatus with Prominent RI Slip
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\sag a.jpg
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\sag b.jpg
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\sag c.jpg
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\sag d.jpg
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\sag e.jpg
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\sag f.jpg
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\axial a.jpg
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\axial b.jpg
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\axial c.jpg
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\axial d.jpg
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\axial e.jpg
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F:\Project2\anomalous supraspinatus 1\anomalous supraspinatus RI slip\axial f.jpg
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Intraspinatus Muscular Origin Infraspinatus Fossa Multicircumpennate
Innervated Suprascapular Nerve Inserts on Oblique Facet Greater Tuberosity
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F:\Project2\anomalous supraspinatus 1\Cor PD Infraspinatus Anatomy 2
F:\Project2\anomalous supraspinatus 1\Cor PD Infraspinatus Anatomy 2.jpg F:\Project2\anomalous supraspinatus 1\Cor Sag PD Infraspinatus Anatomy 3.jpg F:\Project2\anomalous supraspinatus 1\Cor Axial PD Infraspinatus Anatomy 5.jpg
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F:\Project2\anomalous supraspinatus 1\Cor PD Infraspinatus Anatomy 1
F:\Project2\anomalous supraspinatus 1\Cor PD Infraspinatus Anatomy 1.jpg F:\Project2\anomalous supraspinatus 1\Cor Sag PD Infraspinatus Anatomy 4.jpg F:\Project2\anomalous supraspinatus 1\Cor Axial PD Infraspinatus Anatomy 6.jpg
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Greater Tuberosity Anatomy
Superior/Horizontal Facet—Anterior and Mid Fibers of Supraspinatus Middle/Oblique Facet---Upper ½ receives overlapping fibers of Supra and Infraspinatus, Lower ½ Infraspinatus Posterior/Vertical Facet---Teres Minor
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Greater Tuberosity Anatomy
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Interdigitation Artifact
Shoulder MRI refinements: differentiation of rotator cuff tear from artifacts and tendonosis, and reassessment of normal findings. Wright T; Yoon C; Schmit BP Seminars in US, CT, MRI August 1, Volume 22, Issue 4
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Greater Tuberosity Anatomy
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Supra, Infra, Bare Area
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Cystic Changes at Bare Area
Cystic Lesions in the Posterosuperior Portion of the Humeral Head on MR Arthrography: Correlations with Gross and Histologic Findings in Cadavers Wook Jin1, Kyung Nam Ryu2, Yong Koo Park3, Weon Kyu Lee4, Sung Hye Ko2 and Dal Mo Yang1 AJR 2005; 184:
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4-5 Layers of the Rotator Cuff
Clark-5 layers CHL&Rotator Cable 1,4 Capsule 5 3 and 2 differ in orientation Fallon’s-4 layers Capsule CHL Tendons Attachment Fibrocartilage
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Rotator Cuff Cable/Crescent
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Cable/Crescent Cable component of the CHL (layer 4), thick fibrous tissue visible arthroscopically bounds thinner Crescent shaped portion of the distal cuff Extends from anterior Supra to Infra Functions as “Suspension Bridge” Shields the thinner crescent from undue stress Limits the degree of retraction of RCT Cable dominant/non dominant shoulders
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Rotator Cuff Cable/Crescent
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Rotator Cuff Cable/Crescent
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Rotator Cuff Cable/Crescent
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Rotator Cuff Cable/Crescent
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“Cable Dominant”
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\sag cable
F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\sag cable.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\Cor a.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\Cor b.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\Cor c.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\Cor d.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\Cor e.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\Cor f.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\Cor g.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\sag cable
F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\sag cable.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\example2\axial cable.jpg
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Cable Dominant PT RCT
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\Cor Pd aa.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\Cor Pd a.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\Cor Pd b.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\Cor Pd c.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\Cor Pd d.jpg
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F:\Project2\anomalous supraspinatus 1\Rotator Cable\Cor Pd e.jpg
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Cable Dominant with FT RCT
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Teres Minor Originates lower inferior edge of scapula
Inserts on Vertical Facet of Greater Tub Innervated by Axillary Nerve May show atrophy/denervation changes “Quadrilateral Space Syndrome”/Fibrous Bands Isolated Teres Minor abnormality typical---Nonspecific, d/t prior Trauma, Posterior Dislocation, Instability
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45 y/o female with Adh Capsulitis, SS PT RCT, Teres Minor Atrophy
3% of Routine Shoulder MRs
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Subscapularis Broad origin on the ventral surface of the scapula
Multicircumpennate similar to infraspinatus Inserts on lesser tuberosity Contributes to “transverse humeral” ligament Inferior muscular portion that inserts near surgical neck of humerus
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Subscapularis
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\sag MRA a.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\sag MRA b.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\sag MRA c.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\sag MRA d.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\sag MRA e.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\sag MRA f.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\axial MRA a.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\axial MRA ab.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\axial MRA b.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\axial MRA c.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\axial MRA d.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\axial MRA e.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\Cor T1a.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\Cor T1b.jpg
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History of Dislocation
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\Subscap dislocation\Cor Hill Sachs.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\Subscap dislocation\Cor a.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\Subscap dislocation\Cor b.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\Subscap dislocation\Sag a.jpg
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F:\Project2\anomalous supraspinatus 1\Subscap anatomy\Subscap dislocation\Sag b.jpg
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History of Dislocation
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F:\Project2\SUbscap dislocation with abn stretched subscap\Sag PDa.jpg
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F:\Project2\SUbscap dislocation with abn stretched subscap\Sag PDb.jpg
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F:\Project2\SUbscap dislocation with abn stretched subscap\Sag PDc.jpg
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F:\Project2\SUbscap dislocation with abn stretched subscap\Sag PDd.jpg
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Rotator Interval(s) Anterior Rotator Interval Medial and Lateral Portions Medially-Fat, RI Capsule, CHL, SGHL Lateral Apex-more complex anatomy, above components plus fibers from Supraspin and Subscapularis Focal RI tears, Site of Fibrosis in Adhesive Capsulitis
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Posterior Rotator Interval
Anatomy of the Posterior Rotator Interval: Implications for Cuff Mobilization. Miller et al.
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PRI Normal
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PRI Abnormal
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Posterior Rotator Interval Findings
Site for Arthroscopic Port Placement Normal Joint Recess Potential Space for Perilabral Cysts Adhesive Capsulitis Vessels
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Biceps Pulley Impingement
25 y/o surfer with pain during paddling and findings of bicipital tendonitis on physical exam
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