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MR Imaging of the Rotator Cuff Timothy G. Sanders, M.D.

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Presentation on theme: "MR Imaging of the Rotator Cuff Timothy G. Sanders, M.D."— Presentation transcript:

1 MR Imaging of the Rotator Cuff Timothy G. Sanders, M.D.

2 MRI Technique -T1 and T2 FS -Oblique Coronal -T1 and T2 FS -Oblique Sagittal -T2 FS and GRE -Axial

3 Osseous Outlet and Acromion Rotator Cuff Surrounded by a Bony Arch Mechanical Impingement leads to degeneration of the cuff Anterior Acromion Most Important Structure Leading to Impingement

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6 Normal Osseous Outlet Coracoid Clavicle Acromion

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8 Acromial Types Type I

9 Acromial Types Type II

10 Acromial Types Type III

11 Acromial Types Type IV

12 Acromial Down Sloping Normal Axis of Acromion Anterior Down Sloping Anterior Down Sloping Evaluated on Sagittal Images Axis of Acromion

13 Acromial Down Sloping Lateral Down Sloping Evaluated on Coronal Images Normal Axis of AcromionLateral Down Sloping Axis of Acromion

14 Acromial Spur -Spur -Contains Marrow Signal -Deltoid Tendon (Mimics Spur) -Black (No Marrow Signal)

15 Os Acromiale

16 Ossification Center Usually Closes by y.o. Normal Appearing Anterior Acromion on Axial Image

17 Os Acromiale (Axial Images) -Can be unstable resulting in impingement of Rotator Cuff during contraction of the deltoid

18 Os Acromiale (Sagittal Images) “Double” AC Joint SignNormal AC Joint

19 Os Acromiale “Double” AC Joint AC JointOs Acromiale

20 Acromion Type (I, II, III) Anterior/ Lateral Down Sloping Inferior Spur Os Acromiale

21 Coracoacromial Ligament -Normal Ligament <3 mm -Thick Ligament can Impinge on Anterior Rotator Cuff

22 Acromioclavicular Joint -AC degenerative change, capsular hypertrophy -Cuff less rigidly confined -Does it cause mass effect on rotator cuff?

23 AC Joint Sprain/Separation Grade I -Capsular edema, effusion -No elevation Grade II -Capsular edema, effusion -Elevation distal clavicle

24 Osteolysis of Distal Clavicle Post-traumatic osteolysis -Complication of trauma (occurs within 2 months of injury, self limiting) -Repetitive stress (wt. lifters) -X-ray: loss of normal cortical line- distal clavicle

25 Coracoid Impingement -Normal Coracohumeral Distance is 11 mm -Narrowed C-H Distance can Impinge on Subscapularis

26 Osseous Outlet and Acromion Acromion –Type, Down Sloping, Spur, Os Acromiale AC Joint –Deg. Change, Hypertrophy (mass effect?) Coracoacromial Ligament (thickened?) Coracohumeral Impingement (subscap?)

27 Rotator Cuff (Sagittal) Infraspinatus;Teres Minor;SubscapularisSupraspinatus;

28 Rotator Cuff (Coronal) -Primary Plane for Evaluating the Supraspinatus Tendon -Musculotendinous Junction at 12:00 Position

29 Rotator Cuff (Axial Plane) -Supraspinatus Tendon

30 Rotator Cuff (Axial Plane) -Primary Plane for Evaluating Subscapularis -Infraspinatus Located Posteriorly

31 Rotator Cuff (Coronal) - Infraspinatus - Located Posteriorly - Slopes upward -Subscapularis - Located Anteriorly - Multi-slip tendon

32 Rotator Cuff Pathology Tendonopathy Tear –Partial Thickness, Full Thickness, Complete Musculotendinous Retraction Fatty Atrophy HADD/ Calcific Tendonitis

33 Tendonopathy -Increased T1-signal; thickened/ attritional changes (thinned) -Intermediate T2-signal (No Fluid Signal)

34 Partial Thickness Tear (Articular) -T2: Fluid Signal extending into black tendon -Partial Thickness Undersurface Tear

35 Partial Thickness Tear (Bursal) -Fluid Signal Extending into the Bursal Surface of the Supraspinatus Tendon

36 Partial Thickness Tear (Interstitial) -Fluid Signal within the Substance of the Tendon -Does Not Involve the Articular or Bursal Surface

37 Intramuscular Cyst Rotator Cuff -High Association with 1. P.T. Undersurface Tear 2. Small F.T. Tear 3. DDX: Paralabral Cyst

38 Intramuscular Cyst Rotator Cuff -Intramuscular Cyst Supraspinatus -Small Undersurface P.T. Tear

39 Delamination (retraction of deep fibers)

40 Full Thickness Tear -Fluid extends through the entire thickness of the tendon (superior to inferior) -Mild retraction of musculotendinous junction

41 Massive Tear Musculotendinous retraction -Measure in centimeters; can affect prognosis

42 Fatty Atrophy -Mild, Moderate, Severe -Streaks of high signal on T1 -Loss of muscle bulk (Sagittal)

43 Calcific Tendonitis -HADD: Dark Globular Area on all Pulse Sequences -Blooming Artifact on Gradient Echo Images

44 Subscapularis -Subscapularis: Attaches to lesser tuberosity -Extra-articular Biceps: Best Seen on Axial Image -In Bicipital Groove; Transverse Ligament

45 Avulsion of Subscapularis -Subscapularis Muscle can Avulse off of Lesser Tuberosity -Associated with Dislocation of the Biceps Tendon -Seen best in Axial Plane

46 Biceps Tendon (Anatomy) LHBT CH Ligament Coracohumeral ligament primary stabilizer of LHBT LHBT

47 Biceps Tendonitis/ Tear -Thick Tendon; Increased Signal -Intra-articular -Extra-articular

48 Biceps Tendon (Anatomy) Subscapularis/ transverse humeral ligament Secondary stabilizer

49 Biceps Subluxation: Pattern I 1.CHL: intact 2. Subscapularis tendon: complete tear - No Dislocation of LHBT

50 Pattern II: Intra-articular 1.CHL: torn 2.Subscapularis tendon: complete tear - Intra-articular dislocation of LHBT

51 Pattern III: Extra-articular 1.CHL: torn 2.Subscapularis tendon: superficial fibers torn -Extra-articular dislocation of LHBT

52 Pattern IV: Interstitial 1.CHL: torn 2. Subscapularis tendon: intact - Subluxation of LHBT into substance of subscapularis tendon and muscle: interstitial tear

53 Rotator Cuff Pathology Tendonopathy Tear –Partial Thickness, Full Thickness, Complete Musculotendinous Retraction Fatty Atrophy HADD/ Calcific Tendonitis Nerve Entrapment Syndromes


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