Sports Shoulder Injuries: What You Need to Know From MRI Reports
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Presented at the Upper Limb MSK Imaging Course In Liverpool, 20 May 2019
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Sports Shoulder Injuries: What You Need to Know From MRI Reports
- 1. Sports Shoulder Injuries: What I need to know! Lennard Funk
- 2. @theshoulderdoc ROTATOR CUFF TEAR - MRI
- 3. @theshoulderdoc MRI REPORT “Full width tear” “Advanced muscle atrophy along with Infraspinatus” “mild atrophy supraspinatus”
- 4. @theshoulderdoc What do I need to know? 1. How large is the tear? 1. Medial-lateral retraction 2. Antero-posterior extent 2. Tendons involved 3. Muscle Atrophy 4. Fatty Infiltration (% is best) 5. Humeral head position (Hamada) 6. ACJ OA (peri-articular oedema) 7. GHJ OA ROTATOR CUFF TEAR - MRI
- 9. @theshoulderdoc MRI REPORT “Full width tear” “Advanced muscle atrophy along with Infraspinatus” “mild atrophy supraspinatus”
- 10. Clinical History : Previous surgery with ? OA + loose bodies MRI Shoulder Rt : Technique: Routine shoulder MRI protocol Comparison: Right shoulder radiograph January 11, 2010. Right shoulder MRI February 13, 2010. Findings: Rotator cuff and Long head of biceps tendons: -The rotator cuff tendons demonstrate heterogeneous appearance in keeping with tendinosis but overall remain intact. No significant rotator cuff tear. There is a 9 mm cyst within the greater tuberosity at the infraspinatus tendon attachment. -The long head of biceps tendon is intact. Subacromial space, subacromial arch and AC joint: -Small volume of fluid is seen in the subacromial space. -Mild ACJ capsular oedema. -No significant subacromial spur. Glenohumeral joint: -There is evidence of previous anterior labral repair, with soft tissue anchors seen within the anterior glenoid rim. These cause susceptibility artefact. The superior labrum demonstrates degenerative changes but overall the labrum is not well assessed on this non-arthrogram examination. -There is degenerative changes of the glenohumeral joint. The humeral head demonstrates prominent osteophyte inferiorly and there is generalised thinning of the humeral head articular cartilage, which is of high grade in a few places. No subchondral changes. The glenoid demonstrates chondral thinning particularly centrally and inferiorly. The are subchondral cystic changes within the anteroinferior and inferior glenoid. -There is capsular oedema, synovitis and heterogeneity in the region of the axillary recess, particularly next to its glenoid attachment, adjacent to the above described inferior glenoid cystic changes. -No significant glenohumeral joint effusion. -I note the previous radiograph and MRI demonstrated large separate bodies within the axillary recess but these are not definitely seen on the current examination. A repeat shoulder radiograph or CT examination can further assess for intra-articular bodies. -There is a small area of susceptibility artefact within the subcoracoid recess, likely related to micro debris from previous surgery. Impression: 1: Significant glenohumeral joint degenerative changes as described with chondral loss seen on both side of the articulation, osteophyte and subchondral cystic changes within the anteroinferior and inferior glenoid. There is capsular oedema, synovitis heterogeneity and irregularity in the region of the axillary recess, particularly at its glenoid attachment, adjacent to the above described cystic changes. 2: The previously seen large intra-articular bodies are not definitely demonstrated on the current examination. A shoulder radiograph or CT examination can further assess. 3: Previous anterior labral repair. 4: Intact rotator cuff tendons. Dr Zeid Al-Ani Consultant Musculoskeletal Radiologist
- 11. @theshoulderdoc •Nine radiologists - regional & secondary care •MR diagnostic accuracy is better when surgeon and radiologist work in the same institution. •Differences between local- and non-local MRA data suggest that diagnostic accuracy is better in the local secondary referral centre. RADIOLOGIST LOCALITY N Karlson, J Geoghan, L Funk; SECEC 2011
- 12. @theshoulderdoc TEAMWORK A letter from the Riddler
- 13. @theshoulderdoc “ Don’t order a scan! It is request for a radiological opinion… … NOT an order” IMAGING REQUEST Dr Sarah Jackson
- 16. @theshoulderdoc • Goalkeepers = Cuff degeneration • Rugby = chronic ACJ changes • Rugby = Chronic labral changes • Weightlifters = posterior glenoid wear • Middle age Males = ACJ Arthritis • Gymnasts = capacious joint & small labrum AGE ___ SPORT
- 17. @theshoulderdoc
- 18. @theshoulderdoc Depends on: 1. Age of patient 2. Type of Sport 3. Mechanism of Injury 4. Time since injury 5. Clinical Findings SPORTS SCANS
- 21. @theshoulderdoc PLAIN MRI - PREFERENCES Full Sixpack Series: 1. T1 Axial - Bony 2. T1 Cor - Cuff Muscle 3. T1 Sag - extend medial to scapula ‘Y’ 4. T2 FS Cor - Cuff, ACJ, Bursa, IGHL 5. T2 FS Axial - ACJ 6. T2 FS Sag - ACJ, IGHL, Bone oedema
- 22. 1.What does surgeon want from the scans? 2. How does it affect the management? 3. Show case examples 1. Done! 2. Need to show you 3. Great idea!! RCR, Leeds, 2012
- 24. RUGBY INJURY
- 26. @theshoulderdoc Player Position Preference Previous Injuries Age SURGICAL DECISIONS Pathology Glenoid Loss Hill-Sachs HAGL Cuff Tear Profession Time of Season Career Targets Economics Social Factors
- 27. @theshoulderdoc No previous surgery = MR Arthrogram Previous surgery = CT Arthrogram No need for Ultrasound, X-Rays, etc. MR Arthrogram
- 28. MR Arthrogram
- 32. @theshoulderdoc MR ARTHROGRAM - ABER VIEWS
- 33. @theshoulderdoc POSTERO-SUPERIOR INTERNAL IMPINGEMENT 17yr old Tennis Player Peel Back Postero-superior Labrum Articular side Postero-superior Rotator Cuff
- 36. @theshoulderdoc WORDS! MRIOlder &Acute MRAYoung &Chronic ABEROverhead SUMMARY
- 39. @theshoulderdoc
- 40. @theshoulderdoc