Biceps pulley injury - Bennett type II

Case contributed by Ivan Turkalj
Diagnosis almost certain


A male, jiu jitsu athlete complaining of painful snapping shoulder after he was injured at training, was referred for MR arthrography.

Patient Data

Age: 23
Gender: Male

Direct MR arthrography of...


Direct MR arthrography of the shoulder

A tear of the coracohumeral ligament is evident.

Single void adjacent to the coracohumeral ligament tear may represent a gas bubble introduced during arthrography. 

No evidence of injuries to rotator cuff tendons. 

Glenoid labrum is intact.

Glenohumeral and acromioclavicular joint spaces are preserved.  

Annotated images


Note retracted thorn coracohumeral ligament (arrow).

Case Discussion

Findings are consistent with the biceps pulley injury type II according to Bennett's classification, which explains snapping sensation of the patient while rising his arm that is probably due to tendon instability of the long head of the biceps muscle.  

This case illustrates how subtle findings of injury of the biceps pulley could be and emphasize the importance of direct MR arthrography in its depiction.

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