1. Shoulder Anatomy
Dr. Mohamed Samieh

2. Shoulder Joint
Bones:
Humerus
scapula
clavicle
Shoulder Girdle

3. Bones of the shoulder joint
Scapula
Glenoid Fossa Infraspinatus fossa
Supraspinatus fossa Subscapular fossa
Spine Coracoid process
Acromion process
Clavicle
Humerus
Greater tubercle Lesser tubercle
Intertubercular goove Deltoid tuberosity
Head of Humerus

6. Joints

7. Joints
Sternoclavicular

8. Shoulder Anatomy
Joints
Sternoclavicular
Acromioclavicular

9. Shoulder Anatomy Joints Sternoclavicular Acromioclavicular
Glenohumeral

10. Shoulder Anatomy Ligaments Acromioclavicular Joint
Acromioclavicular Ligament

11. Shoulder Anatomy Ligaments Glenohumeral Joint Glenohumeral ligaments
Superior
Middle
Inferior

12. Shoulder Anatomy
Cartilage
Glenoid labrum

13. Shoulder Anatomy
Shoulder Girdle Muscles
Trapezius

14. Shoulder Anatomy
Shoulder Girdle Muscles
Trapezius
Serratus Anterior

15. Shoulder Anatomy Glenohumeral Muscles Rotator Cuff Suprispinatus
Infraspinatus
Teres Minor
Subscapularis

16. Shoulder Anatomy
Glenohumeral Muscles
Latissimus Dorsi

17. Shoulder Anatomy Glenohumeral Muscles Latissimus Dorsi
Pectoralis Major

18. Shoulder Anatomy Glenohumeral Muscles Latissimus Dorsi
Pectoralis Major
Deltoid

19. Shoulder Anatomy Glenohumeral Muscles Latissimus Dorsi
Pectoralis Major
Deltoid
Biceps

20. Shoulder Anatomy Glenohumeral Muscles Latissimus Dorsi
Pectoralis Major
Deltoid
Biceps
Triceps

29. Indications
1. unexplained shoulder pain 2. Acute shoulder trauma 3. Impingement syndrome: subacromial, subcoracoid, internal 4. Glenohumeral instability: chronic, recurrent, subacute, acute dislocation, and subluxation 5. Shoulder symptoms in the overhead or throwing athelete 6. Mechanical shoulder symptoms: catching, locking, napping, crepitus 7. Limited or painful range of motion 8. Swelling, enlargement, mass, or atrophy 9. Patients for whom diagnostic or therapeutic arthroscopy is planned 10. Patients with recurrent, residual, or new symptoms following shoulder surgery

30. Rotator cuff abnormalities: supraspinatus, infraspinatus,
Disorders of the long head of the biceps brachii: full-thickness and partial-thickness tears, tendonopathy,
tendonitis, subluxation, dislocation
Conditions affecting the supraspinatus outlet: acromial shape, osacromiale, subacromial spurs,
acromioclavicular joint disorders, subacromial bursitis
Labral abnormalities: cysts, degeneration, and tears, including superior labrum anterior posterior (SLAP)
and Bankart lesions and their variants
5. Muscle disorders affecting the shoulder girdle: atrophy, hypertrophy, denervation, masses, injuries

31. Patient Preparation
Have the patient to go to the toilet
Explain the procedure to the patient
Offer the patient ear protectors or ear plugs
Ask the patient to undress except for underwear
Ask the patient to remove anything containing metal (hearing aids, hairpins, body jewelry, necklace, etc.)

32. Positioning Supine Shoulder coil (oval surface coil, flexible coil)
Arm in neutral rotation or supination
Cushion the legs

33. Technique 1- Scout - localizer Sagittal plane Coronal plane
Axial plane

34. 2- Sequences (4)
1- axial T2-weighted
2-paracoronal T2
3- Sagittal
4- paracoronal T1

35. Sequence 1 axial 1- T2-weighted, fat-saturated
Plane:- parallel to humeral shaft. Cover from AC joint through proximal humeral diaphysis.
Slice thickness: 3mm (2-D), approx. 1mm for GRE
Slice gap: 20% of slice thickness (!0.6mm or factor 1.2)
FOV: 200–270mm
Saturation slab: no

36. MRI with Power 1.5 and 1.0 Tesla:
GRE or, to delineate the glenoid
labrum, FFE:
— TR = 600–700
— TE = 11
— Flip angle 60°
For T2-weighted - fat saturation
TSE, FS:
— TR = 2000–4500
— TE = 90–130

37. (parallel to the supraspinatus muscle on the axial slice)
Sequence 2 paracoronal
(parallel to the supraspinatus muscle on the axial slice)
1- T2-weighted, fat-saturated
Plane:- parallel to humeral shaft. Cover from AC joint through proximal humeral diaphysis.
Slice thickness: 3mm
Slice gap: 20% of slice thickness (!0.6mm or factor 1.2)
FOV: approx. 260–290mm
Matrix: 512 (256)
Saturation slab: parasagittal, oblique to the slice superior to the lung

38. For STIR
— TR = 1800–2200
— TE = 60
— TI = 100–130
— Flip angle 90° each
For T2-weighted - fat saturation
TSE, FS:
— TR = 2000–3500
— TE = 100–120

39. Sequence 3 sagittal 1- T1-– T2 weighted
Plane:- Prescribe sagittal plane off axial images withline parallel to bony glenoid. Image from bony glenoid through deltoid muscle.
Slice thickness: 3–4mm
Slice gap: 20% of slice thickness (!0.6–0.8mm or factor 1.2)
Saturation slab: sagittal across the lungs

40. T1
TR = 500–600
— TE = 10–20 T2
TR = 2000–4500
— TE = 90–130