Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Magnetic Resonance Imaging of the Shoulder*† by RICHARD J. HERZOG J Bone.

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Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Magnetic Resonance Imaging of the Shoulder*† by RICHARD J. HERZOG J Bone Joint Surg Am Volume 79(6): June 1, 1997 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1 Proton-density-weighted oblique sagittal image showing an osseous proliferation projecting off the inferior margin of the acromioclavicular joint (arrow) and impinging on the anterosuperior margin of the supraspinatus myotendinous junction. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Figs. 2-A through 2-D: Proton-density-weighted oblique sagittal images. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-B A type-II acromion (arrowheads) and a mildly thickened coracoacromial ligament (arrow) associated with moderate narrowing of the supraspinatus outlet. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-C A type-III acromion with a hook of the anteroinferior margin (arrow). RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-D A large osseous ridge (arrow) projecting off the anteroinferior margin of a type-I acromion. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-A: A proton-density-weighted axial image made through the acromioclavicular joint, showing an os acromiale (arrow). RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-B: The os acromiale (curved arrow) is also delineated on the proton-density-weighted oblique sagittal image, where a mildly thickened coracoacromial ligament (straight arrow) inserts into it. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-A: A proton-density-weighted oblique coronal image showing increased signal intensity within a thickened supraspinatus segment of the cuff (arrow). RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-B: A T2-weighted oblique coronal image showing persistently increased signal intensity within the substance of the supraspinatus tendon (arrow) but no tear extending to the bursal or articular surface of the cuff. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-A: A T2-weighted oblique coronal image showing a small, deep partial-thickness tear (arrow) involving the articular surface of the cuff. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-B: A T2-weighted oblique coronal image of a different shoulder, showing an irregular oblique tear (arrow) involving the bursal side of the cuff. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Figs. 6-A, 6-B, and 6-C: A small full-thickness tear (arrow) at the insertion site of the rotator cuff, posterior to the rotator interval. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-B: T2-weighted oblique sagittal image. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-C T2-weighted axial image. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-A: A proton-density-weighted oblique coronal image showing a tapered, completely torn supraspinatus tendon (curved arrow) and tissue demonstrating intermediate signal intensity (straight arrow) in the region of the gap in the tendon. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-B: A T2-weighted oblique coronal image showing high-signal-intensity fluid within the glenohumeral joint but no fluid extending through the defect in the cuff. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 8 A proton-density-weighted oblique sagittal image of a large, chronic full-thickness tear involving the supraspinatus and infraspinatus segments of the cuff, showing moderate-to- severe atrophy of the supraspinatus (curved arrow) and infraspinatus (str... RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 9 A proton-density-weighted axial image showing a completely detached subscapularis tendon (curved arrow). RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 10 A T2-weighted axial image showing the biceps tendon (straight arrow) to be medially subluxated and resting on the medial wall of the bicipital groove. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 11 A fat-saturated T2-weighted axial image showing edematous changes in the lateral segment of the teres minor muscle (arrow) due to an acute stretch-induced injury. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 12 A T2-weighted oblique sagittal image showing a ganglion cyst (curved arrow) located within the supraspinous fossa and extending through the spinoglenoid notch. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 13-A: A proton-density-weighted axial image made after a recent anterior dislocation of the shoulder. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 13-B: The extent of the labral tear (arrows) is defined on the proton-density-weighted oblique sagittal image. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 14 A proton-density-weighted oblique coronal image showing an avulsion of the inferior aspect of the capsule from the neck of the humerus (arrow). RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 15 A T2-weighted axial image showing a tear through the base of the posterior aspect of the glenoid labrum (arrow) along with posterior capsular stripping. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 16-A: A proton-density-weighted oblique coronal image showing a type-III tear of the superior aspect of the labrum extending anteriorly and posteriorly (SLAP lesion) (arrow). RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 16-B: A gradient-echo axial image also showing a type-III tear of the superior aspect of the labrum extending anteriorly and posteriorly (arrows). RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 17 A T2-weighted oblique coronal image showing a minimally displaced fracture of the greater tuberosity (arrow), which was the result of a skiing injury. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 18 A proton-density-weighted oblique coronal image showing a large osteonecrotic focus in the superomedial segment of the humeral head, without collapse of the subchondral bone plate, associated with chronic use of steroids. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 19 A proton-density-weighted oblique sagittal image showing subchondral cysts (arrow) within the posteroinferior margin of the glenoid. RICHARD J. HERZOG J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.