MRI of the shoulder (an approach)

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

• coracohumeral ligament

• superior glenohumeral ligament

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

• synovia

• medial and inferior glenohumeral ligaments

  • traumatic injury (HAGL, GAGL), adhesive capsulitis

• labral pathology

  • anterior and posterior glenolabral injuries, SLAP lesion

Soft tissues

Assessment of deltoid and pectoralis muscles and the subcutaneous fat:

• pectoralis tear, lipoma

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