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Shoulder
JL Gielen
J Veryser
Index
• Normal Anatomy
• Examination Procedure
• Pathology
US
MR
Index
• Normal Anatomy
• Examination Procedure
• Pathology
US
MR
Cuff Ultrastructure
• Layer 1: corocohumeral ligament superficial fibres
• Layer 2: thick main cuff portion: parallel bundles
• Layer 3: thick cuff portion: smaller bundles with
less uniform oriëntation
• Layer 4: rotator cable or transverse band, force
distribution through perpendicular bundle
orientation, deep fibres of coracohumeral
ligament
• Layer 5: capsule, random fibre orientation
US
MR
Rotator Cable (C) and Crescent (B)
Cable: transverse force distribution
Articular side tears at cable: greater functional impact
US
MR
Coracohumeral Ligament
Medial Lateral
US
MR
Index
• Normal Anatomy
• Examination Procedure
• Pathology
US
MR
Radiograph
US
Radiograph
Decubitus
Dorsalis
Endorotatio
US
Ultrasound
• Scanning procedure
• Minimal still image requirements
US
Infraspinatus: Muscle > Tendon Insertion
US
AC Joint
Neutral
Cross Arm Test
US
AC Joint
AC Joint
Clavicular compression
US
Superior-Posterior Labrum
US
Superior-Posterior Labrum
US
Internal Impingement Test
• Video Endo>Exorotatie
US
Crass
Infraspinatus T
Infraspin
US
Crass
Infraspinatus T
Infraspin
US
Crass
Infraspinatus T
Infraspin
US
Crass
Supraspinatus T
Supraspin
US
Crass
Infraspinatus T
Transverse IS
US
Crass
Supraspinatus T
Transverse SS
US
Crass
Supraspinatus T
Transverse SS
Interval
US
Neutral
Cuff Interval
Transverse SS
Interval
US
Exorotation
Sulcus Intertubercularis
Transverse
Biceps CL
US
Exorotation
Biceps C L
Longitudinal
Biceps CL
US
SS Crass Modified Crass
Modified Crass
SS and Biceps
Modified Crass
SS
Modified Crass
Coraco-acromial Ligament
US
Coraco-acromial Ligament, Dynamic Examination
US
Coracohumeral ligament
Superior glenohumeral lig
Distal superficial part
US
Exorotation
Coracohumeral ligament
Origin
US
Coracohumeral Ligament Test
• Video Endo>Exorotatie
US
Exorotation
Subscapular T
Supscapular
US
Exorotation
Subscapular T
Supscapular
US
Pectoralis M T
Teres Major
Latissimus Dorsi
Pect Major
US
Supraspinatus M
SS
Muscle Mass
US
Suprascapular Notch
Suprascap
Notch
US
Suprascapular Notch
Suprascap
Notch
US
Glenohumeral Capsule Axillary Aproach
US
Reference Level: Axial C6 Root
STCLM
Long Col
Jug I
A Car
C6
Scal Ant
US
Reference Level: Axial C6 Root
US
Axial Roots C 5-6-7
Scal Ant
Scal Med
Scal Post
STCLM
US
Roots Coronal-Oblique C6
US
Roots Coronal-Oblique C7
US
Roots Coronal-Oblique C5
US
Roots Coronal-Oblique C4
US
Ultrasound
• Scanning procedure
• Minimal still image requirements:
• Annotations!!, lateralisation!!
– AC joint longitudinal: with cross arm test
– RC components longitudinal with thickness
• SS, SSC, IS
– Subdeltoid space thickness
– RC interval
– Biceps long head longitudinal
– Pathology
US
Ultrasound Abduction Endorot: AC > IS > SS
US
Ultrasound Abduction Endorot: Transverse
US
Ultrasound Neutral Position: Interval - Biceps
US
Ultrasound Neutral Position: Biceps tendon
US
Ultrasound Neutral Position
US
Ultrasound Exorotation: Subscapularis
US
Index
• Normal Anatomy
• Examination Procedure
• Pathology
US
MR
Pathology
• Minor Glenohumeral Instability
• Cuff Lesions
• AC Joint
• Biceps Caput Longum
• Impingement
US
MR
Minor Glenohumeral Instability
• Purpose: Detection and Grading of
– Causes of minor shoulder instability
• Anatomical variants
• Congenital disorders
• Lesions
– Lesions due to (minor) shoulder instability
• Techniques
– Radiography
– Ultrasound
– CT-arthrography
– MRI, direct and indirect arthro-MRI
US
MR
Minor Shoulder Instability
• Static Constraints
• Dynamic Constraints
US
MR
Static Constraints
• Bony structures
– Humeral and glenoid version
– Surface area and articular conformity
– Coracoacromial arch
– (Acromioclavicular joint)
• Soft tissues
– Glenohumeral ligaments and capsule
– Glenoid labrum
– Subacromial bursa
• (Intraarticular pressure)
US
MR
Dynamic Constraints
• Rotator cuff
– Through Joint Compression
– Individual components of rotator cuff
– Rotator cuff through preloading glenohumeral ligaments
• Long head of biceps tendon
• (Supporting musculature)
• (Proprioception and reflexes)
• (Scapulothoracic motion)
US
MR
Static Constraints
• Bony structures
– Humeral and glenoid version
– Surface area and articular conformity
– Coracoacromial arch
– (Acromioclavicular joint)
• Soft tissues
– Glenohumeral ligaments and capsule
– Glenoid labrum
– Subacromial bursa
• (Intraarticular pressure)
US
MR
Subacromial Bursitis
Normal
US
MR
♀WH °620609 ed 110701
RA: Biceps Tendon Sheat, Subdeltoid Bursa
US
Dynamic Constraints
• Rotator cuff
– Through Joint Compression
– Individual components of rotator cuff
– Through preloading glenohumeral ligaments
• Long head of biceps tendon
• (Supporting musculature)
• (Proprioception and reflexes)
• (Scapulothoracic motion)
US
MR
Rotator Cuff Components
• Supraspinatus
• Infraspinatus
• Teres minor
• Subscapularis
– tendinous insertions merge with glenohumeral
joint capsule and ligaments
US
MR
Rotator Cuff Lesions
• Histologic abnormalities:  50% age > 40y
– glycosaminoglycan infiltration
– fibrocartilaginous transformation
– loss of collagen fiber organisation
– degenerative changes
• Inflammatory infiltrates not predominant !
• Clinical and functional relevance?
US
MR
Cuff Ultrastructure
• Layer 1: corocohumeral ligament superficial fibres
• Layer 2: thick main cuff portion: parallel bundles
• Layer 3: thick cuff portion: smaller bundles with
less uniform oriëntation
• Layer 4: rotator cable or transverse band, force
distribution through perpendicular bundle
orientation, deep fibres of coracohumeral
ligament
• Layer 5: capsule, random fibre orientation
US
MR
Rotator Cable (C) and Crescent (B)
Cable: transverse force distribution
Articular side tears at cable: greater functional impact
US
MR
Rotator Cuff Injury: Etiology
• Intrinsic mechanism
– Direct tendon overload
– Intrinsic degeneration
– Location: intratendinous, critical area
• Extrinsic mechanism
– Compression against surrounding structures
 impingement
– Subacromial impingement
• Painfull arc: 60 – 120° humeral elevation
• Location: tendon insertion
US
MR
Rotator Cuff Lesions
• Tendinopathy-tendinosis
– Calcific tendinosis
• Partial thickness tear (PTT)
• Full thickness tear (FTT) and complete tear (CT)
• Interval tears
• Subscapularis and pectoralis major tear
• Postoperative repair
US
MR
Calcifying tendinosis
Tendinosis - swellingSA-SD bursitis
Normal
US
Rotator Cuff Calcifications
Reflective tendon bundle: stony lane
US
Calcifying Tendinopathy
1. Silent phase
2. Mechanical phase
1. elevation of bursal
floor
2. subbursal rupture
3. intrabursal rupture
US
MR
SS Calcification
US
MR
SS Calcification, Bursal Extrusion
MR
♀VDEO °500507 ed 110310
US
MR
♀VDEO °500507 ed 110310
Calciumextrusion bursa, Calcium milk at SS
US
MR
Subscapular Calcification
Anterior Impingement
US
Male WW °640416 ed 110218
Acute Shoulder Pain Started 4 Days Ago
• Calcium extrusion to subbursal floor at anterior
portion of subdeltoid bursa
US
Male BM °580608 ed110318 US
Calcium Milk at SADB
Rotator Interval widened, Tear SSC and SS
US
Pectoralis Major Tendon Calcification
Courtesy of L. Carpentier
US
SS Tendinosis
• Hypoechogenic
• Swollen
• Loss of normal fibrillar pattern
US
Cuff Tears
• Partial Thicknesstears (PTT)
– Bursal
– Articular
• Fraying, rimrent
– Intrasubstantial
• Full thicknesstears (FTT)
– Partial width
– Complete: full width
• retraction, fatty atrophy
US
MR
Supraspinatus Tear
Partial Thickness
Articular Side
Bursal Side
US
MR
Supraspinatus Tear
Fraying, Bursal Side
US
MR
Cor Intermed FS Cor T1 FS Gad Sag T1 Gad
Supraspinatus Tear, Insertion Area
Partial Thickness, Bursal Side
US
MR
Supraspinatus Tear
Partial Thickness, Bursal Side
US
Supraspinatus Tear
Intrasubstantial, delamination
US
MR
♀ DGA °460315 US MRI
Insertion Tendinosis with Delamination SS
Cor T1 FS Gad Cor Intermed FS
US
MR
Supraspinatus Tear
Small Full Thickness
Ultrasound
ArthrographyArthro-CT
US
MR
Indirect Arthro: Small Full Thickness SS Tear
US
MR
Cor Intermed FS
Cor T1
FS Gad
Female, LC °550426
SS Full Thickness Tear, Critical Area
US
MR
Supraspinatus
Full Thickness and Full Width: Complete
US
MR
Direct Arthro-MRI
Supraspinatus Tear
Full Thickness, Tendon Insertion
US
MR
Female A-CH °480701 MR US
Total Thickness Tear SS
US
Female A-CH °480701 MR US
Total Thickness Tear SS
US
End Stage
Naked Tub. Maius
Effusion AC-joint
Effusion Subdelt.
Caput Longum Bic.
Supraspinatus tear
US
Grading RC Tears
• FT: Dimensions Anteroposterior and lateral
• CT: Goutallier
– Position of retracted SS tendon relative to the
acromion
• Grade 1: lateral to the acromion
• Grade 2: subacromial
• Grade 3: medial to the acromion
MR
US
Grading Supraspinatus Muscle Atrophy: MRI and CT
• Complete or Massive Supraspinatus Tear
• Goutallier classification:
– 0 = no intramuscular fat
– 1 = some fatty streaks
– 2 = fat less extensive than muscle
– 3 = fat equal to muscle
– 4 = fat more extensive than muscle
Clin Orthop Relat Res. 1994 Jul;(304):78-83.
Fatty muscle degeneration in cuff ruptures. Pre- and
postoperative evaluation by CT scan.
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC.
US
MR
Massive Supraspinatus Tear
Supraspinatus Muscle Evaluation: CT and
MRI
• Fatty infiltration:
– Goutallier classification:
– 2 = fat less extensive
than muscle
• Muscle volume:
– Zanetti Tangent Sign
– +: muscle below
tangent line
Clin Orthop Relat Res. 1994 Jul;(304):78-83.
Fatty muscle degeneration in cuff ruptures. Pre- and
postoperative evaluation by CT scan.
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC.
US
MR
Supraspinatus Muscle Atrophy: US grading
• Structure
– 0 = clearly visible muscle contours, fibers, and central tendon
– 1 = partially visible structures
– 2 = structures no longer visible
• Echogenicity in comparison to deltoid muscle
– 0 = iso- or hypoechoic
– 1 = slightly more echoic
– 2 = markedly more echoic
• Substantial fatty atrophy = grade 2 in at least one
of the evaluated US criteria
Strobel et al. Fatty atrophy of the supraspinatus, accuracy of US. Radiology 2005
US
Massive Supraspinatus Tear
Supraspinatus Muscle Evaluation: CT and
MRI
• Muscle volume:
• Zanetti Tangent Sign
– +: muscle below
tangent line
Invest Radiol. 1998 Mar;33(3):163-70.
Quantitative assessment of the muscles of the rotator cuff with
magnetic resonance imaging.
Zanetti M, Gerber C, Hodler J.
US
MR
Supraspinatus M
SS
Muscle Mass
US
• Fatty infiltration: Goutallier
classification:
– 0 = no intramuscular fat
– 1 = some fatty streaks
– 2 = fat less extensive than
muscle
– 3 = fat equal to muscle
– 4 = fat more extensive than
muscle
• Muscle volume: Zanetti Tangent
Sign
– +: muscle below tangent line
Invest Radiol. 1998 Mar;33(3):163-70.
Quantitative assessment of the muscles of the rotator cuff with
magnetic resonance imaging.
Zanetti M, Gerber C, Hodler J.
US
MR
Massive Supraspinatus Tear
Supraspinatus Muscle Evaluation: CT and
MRI
SS-IS CT grade 3
Grade 3 Fat Infiltration
Positive Zanetti Tangent Sign
US
MR
♀, DSE °520518 ed 100225, Postop SS
Massive Tear, Deltoid Tear
Sag T1 Cor T2 FS
US
MR
♀, DSE °520518 ed 100225, Postop SS
Massive Tear, Deltoid Tear
US
MR
Indirect Arthro
Postop SS Reinsertion
US
MR
♂, FJ °510611 ed 100526
Massive Tear SS without atrophy and IS with atrophy
US
♂, FJ °510611 ed 100526
Massive Tear SS without atrophy and IS with atrophy
US
Accuracy
Sens Spec Acc PPV Correlation (r) Tear
Measurement
Plain MRI
FTT
85% 83% 83% 99%
Plain MRI
PTT
83% 85% 39%
Plain MRI
FTT> 1cm
96% 83% 83%
Arthrography
All lesions
96% 75% 89% 0.90 (0.46 retear)
US
Tear
91% 86% 89%
US
MR
Rotator Cuff Interval
SSC
SS
Max 10 mm
Transverse SS
Interval
US
Interval Lesions
Supraspinatus Full Thickness Tear, Tickening Biceps CL
BIC
Coracohumeral
Transverse Lig
US
Dynamic Constraints
• Rotator cuff
– Through Joint Compression
– Individual components of rotator cuff
– Rotator cuff through preloading glenohumeral ligaments
• Long head of biceps tendon
• (Supporting musculature)
• (Proprioception and reflexes)
• (Scapulothoracic motion)
US
MR
Biceps Tendon (Sub)luxation
CT –Arthrography
US
MR
Subluxation Biceps Tendon
US
Axial T1 FS Gad
Biceps Dislocation,
Deep to SSC Sup to Teres Major
US
MR
♀ DDI °651002 ed1 30314
SS Complete Tear, Biceps CL superficial to SSC
Cor T1 FS Gad Cor T1 FS Gad Sag T1 Gad Sag T1 Gad
US
MR
Dynamic Constraints
• Rotator cuff
– Through Joint Compression
– Individual components of rotator cuff
– Rotator cuff through preloading glenohumeral ligaments
• Long head of biceps tendon
• Supporting musculature
• (Proprioception and reflexes)
• (Scapulothoracic motion)
US
Tear Teres Major – Lattisimus Dorsi
US
Static Constraints
• Bony structures
– Humeral and glenoid version
– Surface area and articular conformity
– Coracoacromial arch
– (Acromioclavicular joint)
• Soft tissues
– Glenohumeral ligaments and capsule
– Glenoid labrum
– Subacromial bursa
• (Intraarticular pressure)
US
MR
Dysplasia, malformations
Discongruent GH Joint
Normal joint
US
MR
Static Constraints
• Bony structures
– Humeral and glenoid version
– Surface area and articular conformity
– Coracoacromial arch
– (Acromioclavicular joint)
• Soft tissues
– Glenohumeral ligaments and capsule
– Glenoid labrum
– Subacromial bursa
• (Intraarticular pressure)
US
MR
AC Dislocation
US
Type II
Type III
Female, DRE °940929
Traction Epiphysiolysis R Proximal Humeral
Epiphysis
US
Static Constraints
• Bony structures
– Humeral and glenoid version
– Surface area and articular conformity
– Coracoacromial arch
– (Acromioclavicular joint)
• Soft tissues
– Glenohumeral ligaments and capsule
– Glenoid labrum
– Subacromial bursa
• (Intraarticular pressure)
US
MR
♂DJH °550301 ed 120715
Retractile Capsulitis, SLAP VIII
Cor T1 FS Gad Cor T1 FS Gad Ax T1 FS Gad
Sag T1 FS GadCor Intermed FSCor Intermed FS
US
MR
♂VDVL °621208 ed100422
US Retractile Capsulitis
Axillary Examination, Endorotation deficit
US
♀, EMF °710314
Retractile Capsulitis, Glenohumeral Distension US”A”
US
♀, EMF °710314
Retractile Capsulitis, Glenohumeral Distension US”A”
US
Static Constraints
• Bony structures
– Humeral and glenoid version
– Surface area and articular conformity
– Coracoacromial arch
– (Acromioclavicular joint)
• Soft tissues
– Glenohumeral ligaments and capsule
– Glenoid labrum
– Subacromial bursa
• (Intraarticular pressure)
US
MR
Coracoacromial Arch
• Acromion
• Coracoacromial ligament
• Coracoid process
Roof above supraspinatus tendon: outlet
through which tendon must pass
US
Subacromial Space
Coracoacromial arch area
Indirect MR-arthrography
SE T1 WI
US
MR
Impingement
• Subacromial
• Subcoracoidal - anterior
• Anterocranial
• Internal
US
MR
Impingement Classification
• Primary (external) impingement
– anatomy / static
• Subacromial impingement
• Anterior - Subcoracoid impingement
• Secondary (internal) impingement
– biomechanics / dynamic
• Internal or Posterior superior impingement (Walsh)
• Anterior superior impingement (Gerber)
US
MR
Impingement
• Subacromial (classical)
– Elevation, abduction
• Acromion <-
>Tuberculum major
• SA-SD bursa
• Supraspinatus
US
MR
Contusion, Mechanical Osteitis
Indirect MR-A
SE T1 FS
US
MR
Erosions,
Sclerosis
OA AC Calcifications
Radiography
Impingement
US
Subacromial Spur
Post Acromioplasty
US
Acromion Bigliani Types
1
flat
Plain radiograpy:
Scapular Y-view
2
curved
3
hooked
US
MR
Acromion Type 4
US
MR
Type 3: increased likelihood
of being associated with
full-thickness cuff tear
US
MR
Os Acromiale
US
MR
Subacromial Spur
Direct MR-arthrography
Ref.:Magnetic Resonance Imaging in
Orthopaedics and Sports medicine
David W. Stoller; 2nd ed.
US
MR
Coracoacromial Ligament
Thickening - Inflammation
TSE T2 FS
SE T1 FS Gad SE T1 FS Gad
US
MR
Acromioclavicular Joint OA,
Impingement, SS lesion
Indirect
arthro-MR
US
MR
Impingement
• Subcoracoid, anterior
– Endorotation
• Coracoid process <->
Tub minor
• Subscapularis tendon
• Interval: coracohumeral
ligament, Biceps tendon
US
MR
Subcoracoidal Space
US
MR
SSC FT Tear
US
MR
Indirect Arthro SS full thickness tear,
Subcoracoidal impingement
US
MR
Indirect Arthro SS full thickness tear,
Anterior impingement (2)
US
MR
♂, BH °361218 Fall on Shoulder
Complete SS tear
US
♂, BH °361218 Fall on Shoulder
Complete SS tear, Biceps CL Dislocation
US
♂, BH °361218 Fall on Shoulder
Complete SS tear, Biceps CL Dislocation, SSC tear
US
♂ BE °350123 ed20100527 US
Geiser Phenomenon, Complete SS and IS
Tear, Biceps Disclocation deep to the SSC
US
♂ BE °350123 ed20100527 US
Geiser Phenomenon, Complete SS and IS
Tear, Biceps Disclocation deep to the SSC
US
♂ BE °350123 ed20100527 US
Geiser Phenomenon, Complete SS and IS
Tear, Biceps Disclocation deep to the SSC
US
♂ MH °480129 US
Biceps CL Dislocation
US
♂ °441001 US
Longitudinal split CL Biceps, tenovaginitis
US
♂ °441001 US
CL Biceps Subluxation with Longitudinal Split
and Tenovaginitis
US
♂AK °730403 US CR
Hypertrophic Ossification SSC with
Subcoracoidal Impingement
US
♂AK °730403 US CR
Hypertrophic Ossification SSC with
Subcoracoidal Impingement
US
Impingement
• Anterosuperior
Impingement
– Follow through phase
– RC interval
• Cranial glenohumeral
ligament
• Coracohumeral
ligament
– Biceps CL tendon
– Subscapularis tendon
• Cranial portion
US
MR
6. Follow through: endorotation:
anterior
US
MR
Secondary anterosuperior impingement
• Mechanisms
• Pathology on imaging
– Subscapularis tears
– Anterosuperior labrum tear
– CL pulley lesions
– Degenerative changes anterior glenoid/
humerus
US
MR
°641216 ed 120308
Anterosuperior Impingement, Normal Cuff
Biceps Pulley Thickening
No Capsulitis
US
US
MR
Coracohumeral Ligament
US
MR
Anterosuperior Impingement
Type II acromion
Subacromial spur formation
Inflammation
–Anterior: peribursal, rotator cuff interval, coracohumeral ligament
US
MR
Rotator Cuff Interval
SSC
SS
Max 10 mm
Transverse SS
Interval
US
MR
Interval Lesions
Supraspinatus Full Thickness Tear, Tickening Biceps CL
BIC
Coracohumeral
Cranial GH Lig
US
MR
Bicepstendon (sub)luxation
Arthro-CT
US
MR
Subluxation Biceps Tendon
US
MR
Impingement
• Internal, posterior glenoid
– ABduction ExoRotation
• Glenoid <-> Tub Majus
post
• Undersurface SS post, IS
ant
• Labrum
US
MR
Secondary posterosuperior impingement
• Anatomic landmarks
– Posterosuperior humerus
– Posterosuperior glenoid
• Target
– Infraspinatus/ posterior supraspinatus
• Clinical findings
– Late-cocking position (abduction-exorotation)
– Instability related/overhead sporters ≤ 35 y
US
MR
3. late cocking phase: abduction/exorotation:
posterior RC
US
MR
♀HW °701220 ed 111006
Internal impingement with SLAP II labral
dissociation and SS undersurface tear
US
MR
♂ ST °880712 ed 110314 Javelin Thrower
Internal impingement
MR
♀ VV °800919 ed 120118 Internal Impingement,
Posterior Cranial Labral Lesion
MR
Indirect Arthro Herniation Pit
US
MR
Posterosuperior instability
• Overhead-throwing sports (dominant shoulder)
– Repeated abduction and external rotation
– Fibrosis of posterior inferior capsule
– Contact posteriorsuperior glenoid margin,labrum and
greater tuberosity
– Impingement of SS and IS
• MRI
– Cyst formation greater tuberosity
– Tear posterosuperior labrum
– Underface tear rotator cuff
US
MR
Paralabral Cyst
US
MR
♂ ed 060312 Paralabral Cyst
Transverse Infraspinatus View Longitudinal Infraspinatus View
Infraspinatus Muscle
Paralabral Cyst
Spina Scapulae
US
MR
Courtesy FYZZIO
♂ ed 111214 Lipomatous Involution IS
Volleyball Player
Transverse Infraspinatus View Longitudinal Infraspinatus View
Teres Minor MuscleSpina Scapulae
Trapezius Muscle Trapezius Muscle
Humeral head
US
MR
Courtesy FYZZIO
Infraspinatus Denervation
MR
Supraspinatus Denervation
Nerve Compression, Idiopathic DD Parsonage Turner
TSE T2 WI FS
Parsonage Turner: Neuritis Brachial Plexus
US
MR
Conclusion
• Conventional radiography
– Scapular Y view: acromion, GH-joint
– AC-joint
• Ultrasound
– Rotator Cuff, AC-joint, Subdeltoidal bursa
• Direct arthro-MRI
– Labral lesions, including SLAP: 67% accuracy
– Capsule
• Indirect arthro-MRI
– Most complete evaluation
– Labral lesions: 100% accuracy
– Excluding capsule
Conclusion Cuff Lesions
• Ultrasound
– State of the art
– Available, economical and accurate
– Primary examination
• MRI, gadolinium enhanced
– Direct or Non-direct
– Inconsistency of clinical and ultrasound findings
– Preoperatively
• Massive tears: feasibility of primary repair
• Additional information: muscle and musculotendinous
junction
References
• Takayuki S, Teruhiko N, Masamitsu T, Masafumi I. Prediction of primary reparability of massive tears of the rotator cuff on preoperative
magnetic resonance imaging. Journal of Shoulder and Elbow Surgery 2003;12:222-225.
• Seeger LL, Gold RH, Bassett LW, Ellman H.Shoulder impingement syndrome: MR findings in 53 shoulders. American Journal Of
Roentgenology 1988;150:343-347.
• Schroder RJ, Bostanjoglo M, Kaab M, Herzog H, Hidajat N, Rottgen R, Maurer J, Felix R.
• Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2003;175:920-928.
• Nakatani T, Fujita K, Iwasaki Y, Sakai H, Kurosaka M. MRI-negative rotator cuff tears. Magn Reson Imaging. 2003;21:41-45.
• Schulte-Altedorneburg G, Gebhard M, Wohlgemuth WA, Fischer W, Zentner J, Wegener R, Balzer T, Bohndorf K. MR arthrography:
pharmacology, efficacy and safety in clinical trials. Skeletal Radiol. 2003;32:1-12.
• Motamedi AR, Urrea LH, Hancock RE, Hawkins RJ, Ho C. Accuracy of magnetic resonance imaging in determining the presence and size of
recurrent rotator cuff tears. J Shoulder Elbow Surg. 2002 Jan-Feb;11(1):6-10. Related Articles, Links
• Chang CY, Wang SF, Chiou HJ, Ma HL, Sun YC, Wu HD. Comparison of shoulder ultrasound and MR imaging in diagnosing full-thickness
rotator cuff tears. Clin Imaging. 2002;26:50-54.
• Yamakawa S, Hashizume H, Ichikawa N, Itadera E, Inoue H. Comparative studies of MRI and operative findings in rotator cuff tear. Acta Med
Okayama. 2001;55:261-268.
• Oh CH, Schweitzer ME, Spettell CM. Internal derangements of the shoulder: decision tree and cost-effectiveness analysis of conventional
arthrography, conventional MRI, and MR arthrography. Skeletal Radiol. 1999;28:670-678.
• Prickett WD, Teefey SA, Galatz LM, Calfee RP, Middleton WD, Yamaguchi K. Accuracy of ultrasound imaging of the rotator cuff in shoulders
that are painful postoperatively. J Bone Joint Surg Am. 2003;85-A:1084-1089.
US
MR
References
• Magnetic Resonance Imaging in Orthopaedics and
Sports medicine; David W. Stoller; 2nd ed.
• Internal Derangements of Joints, Emphasis on MR
Imaging; Donald Resnick and Heung Sik Kang
• MRI, Arthroscopy, and Surgical Anatomy of the
Joints; David W. Stoller
US
MR

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