Imaging of Cysts and Bursae about the Shoulder

Abstract

A variety of fluid and fluid-like containing structures can be seen on routine MR imaging of the shoulder including bursal effusions and cystic lesions often in association with rotator cuff tears and impingement. Given its high soft tissue contrast and multiplanar imaging capabilities, MR imaging is the modality of choice in quantifying size, confirming fluid composition, assessing anatomical relationship to the glenohumeral joint, and determining the presence/absence of accompanying intra-articular abnormalities in association with the bursal and juxta-articular cystic findings.

Keywords

bursa - ganglion cyst - shoulder - imaging - MRI - cyst mimics

• References

• 1 van Holsbeeck M, Strouse PJ. Sonography of the shoulder: evaluation of the subacromial-subdeltoid bursa. AJR Am J Roentgenol 1993; 160 (3) 561-564
• 2 Birnbaum K, Lierse W. Anatomy and function of the bursa subacromialis. Acta Anat (Basel) 1992; 145 (4) 354-363
• 3 White EA, Schweitzer ME, Haims AH. Range of normal and abnormal subacromial/subdeltoid bursa fluid. J Comput Assist Tomogr 2006; 30 (2) 316-320
• 4 Mitchell MJ, Causey G, Berthoty DP, Sartoris DJ, Resnick D. Peribursal fat plane of the shoulder: anatomic study and clinical experience. Radiology 1988; 168 (3) 699-704
• 5 Zlatkin MB, Iannotti JP, Roberts MC , et al. Rotator cuff tears: diagnostic performance of MR imaging. Radiology 1989; 172 (1) 223-229
• 6 Hollister MS, Mack LA, Patten RM, Winter III TC, Matsen III FA, Veith RR. Association of sonographically detected subacromial/subdeltoid bursal effusion and intraarticular fluid with rotator cuff tear. AJR Am J Roentgenol 1995; 165 (3) 605-608
• 7 Vahlensieck M, Resendes M, Lang P, Genant H. Shoulder MRI: the subacromial/subdeltoid bursa fat stripe in healthy and pathologic conditions. Eur J Radiol 1992; 14 (3) 223-227
• 8 Horowitz TM, Tocantins LM. An anatomical study of the role of the long thoracic nerve and the related scapular bursae in the pathogenesis of local paralysis of the serratus anterior muscle. Anat Rec 1938; 71: 375-386
• 9 Schraner AB, Major NM. MR imaging of the subcoracoid bursa. AJR Am J Roentgenol 1999; 172 (6) 1567-1571
• 10 Grainger AJ, Tirman PF, Elliott JM, Kingzett-Taylor A, Steinbach LS, Genant HK. MR anatomy of the subcoracoid bursa and the association of subcoracoid effusion with tears of the anterior rotator cuff and the rotator interval. AJR Am J Roentgenol 2000; 174 (5) 1377-1380
• 11 Gerber C, Terrier F, Zehnder R, Ganz R. The subcoracoid space. An anatomic study. Clin Orthop Relat Res 1987; (215) 132-138
• 12 Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. Orthopedics 1998; 21 (5) 545-548
• 13 Lo IK, Burkhart SS. The interval slide in continuity: a method of mobilizing the anterosuperior rotator cuff without disrupting the tear margins. Arthroscopy 2004; 20 (4) 435-441
• 14 Nové-Josserand L, Edwards TB, O'Connor DP, Walch G. The acromiohumeral and coracohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration. Clin Orthop Relat Res 2005; (433) 90-96
• 15 Dunham KS, Bencardino JT, Rokito AS. Anatomic variants and pitfalls of the labrum, glenoid cartilage, and glenohumeral ligaments. Magn Reson Imaging Clin N am 2012; 20: 213-228
• 16 Petersilge CA, Witte DH, Sewell BO, Bosch E, Resnick D. Normal regional anatomy of the shoulder. Magn Reson Imaging Clin N Am 1993; 1 (1) 1-18
• 17 Kaplan K, Sahajpal DT, Jazrawi L. Loose bodies in a sublabral recess: diagnosis and treatment. Bull Hosp Jt Dis 2006; 63 (3-4) 161-165
• 18 Bencardino J, Fitzpatrick D, Shepard T, Hahn M, Jazrawi L. The sublabral foramen as a communicating pathway to the subscapularis recess. Skeletal Radiol 2011; 40: 485-515
• 19 O'Brien SJ, Neves MC, Arnoczky SP , et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 1990; 18 (5) 449-456
• 20 Bui-Mansfield LT, Taylor DC, Uhorchak JM, Tenuta JJ. Humeral avulsions of the glenohumeral ligament: imaging features and a review of the literature. AJR Am J Roentgenol 2002; 179 (3) 649-655
• 21 Stoller DW. MR arthrography of the glenohumeral joint. Radiol Clin North Am 1997; 35 (1) 97-116
• 22 Emig EW, Schweitzer ME, Karasick D, Lubowitz J. Adhesive capsulitis of the shoulder: MR diagnosis. AJR Am J Roentgenol 1995; 164 (6) 1457-1459
• 23 Carrillon Y, Noel E, Fantino O, Perrin-Fayolle O, Tran-Minh VA. Magnetic resonance imaging findings in idiopathic adhesive capsulitis of the shoulder. Rev Rhum Engl Ed 1999; 66 (4) 201-206
• 24 Tamai K, Yamato M. Abnormal synovium in the frozen shoulder: a preliminary report with dynamic magnetic resonance imaging. J Shoulder Elbow Surg 1997; 6 (6) 534-543
• 25 Gückel C, Nidecker A. MR arthrographic findings in tenosynovitis of the long bicipital tendon of the shoulder. Skeletal Radiol 1998; 27 (1) 7-12
• 26 Needell SD, Zlatkin MB, Sher JS, Murphy BJ, Uribe JW. MR imaging of the rotator cuff: peritendinous and bone abnormalities in an asymptomatic population. AJR Am J Roentgenol 1996; 166 (4) 863-867
• 27 Kaplan PA, Bryans KC, Davick JP, Otte M, Stinson WW, Dussault RG. MR imaging of the normal shoulder: variants and pitfalls. Radiology 1992; 184 (2) 519-524
• 28 Koplas MC, Winalski CS, Ulmer Jr WH, Recht M. Bilateral congenital absence of the long head of the biceps tendon. Skeletal Radiol 2009; 38 (7) 715-719
• 29 Sanders TG, Tirman PF, Feller JF, Genant HK. Association of intramuscular cysts of the rotator cuff with tears of the rotator cuff: magnetic resonance imaging findings and clinical significance. Arthroscopy 2000; 16 (3) 230-235
• 30 Manvar AM, Kamireddi A, Bhalani SM, Major NM. Clinical significance of intramuscular cysts in the rotator cuff and their relationship to full- and partial-thickness rotator cuff tears. AJR Am J Roentgenol 2009; 192 (3) 719-724
• 31 Kassarjian A, Torriani M, Ouellette H, Palmer WE. Intramuscular rotator cuff cysts: association with tendon tears on MRI and arthroscopy. AJR Am J Roentgenol 2005; 185 (1) 160-165
• 32 Clark JM, Harryman II DT. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am 1992; 74 (5) 713-725
• 33 Mochizuki T, Sugaya H, Uomizu M , et al. Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am 2008; 90 (5) 962-969
• 34 Kishimoto K, Akisue T, Fujimoto T , et al. Intra-tendinous ganglion in the long head of the biceps humeri. Skeletal Radiol 2008; 37 (3) 263-265
• 35 Rutten MJ, de Jong MD, van Loon T, Jager GJ. Intratendinous ganglion of the long head of the biceps tendon: US and MRI features (2010: 9b). Intratendinous ganglion. Eur Radiol 2010; 20 (12) 2997-3001
• 36 Robertson DE. Cystic degeneration of the peroneus brevis tendon. J Bone Joint Surg Br 1959; 41-B (2) 362-364
• 37 Thornburg LE. Ganglions of the hand and wrist. J Am Acad Orthop Surg 1999; 7 (4) 231-238
• 38 Chen WS. Intratendinous ganglion and carpometacarpal boss. A report of two cases. Ital J Orthop Traumatol 1992; 18 (3) 421-425
• 39 Kannus P, Józsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 1991; 73 (10) 1507-1525
• 40 Tirman PF, Feller JF, Janzen DL, Peterfy CG, Bergman AG. Association of glenoid labral cysts with labral tears and glenohumeral instability: radiologic findings and clinical significance. Radiology 1994; 190 (3) 653-658
• 41 Tung GA, Entzian D, Stern JB, Green A. MR imaging and MR arthrography of paraglenoid labral cysts. AJR Am J Roentgenol 2000; 174 (6) 1707-1715
• 42 Robinson P, White LM, Lax M, Salonen D, Bell RS. Quadrilateral space syndrome caused by glenoid labral cyst. AJR Am J Roentgenol 2000; 175 (4) 1103-1105
• 43 Craig EV. The acromioclavicular joint cyst. An unusual presentation of a rotator cuff tear. Clin Orthop Relat Res 1986; (202) 189-192
• 44 Tshering Vogel DW, Steinbach LS, Hertel R, Bernhard J, Stauffer E, Anderson SE. Acromioclavicular joint cyst: nine cases of a pseudotumor of the shoulder. Skeletal Radiol 2005; 34 (5) 260-265
• 45 Craig EV. The geyser sign and torn rotator cuff: clinical significance and pathomechanics. Clin Orthop Relat Res 1984; (191) 213-215
• 46 Cooper HJ, Milillo R, Klein DA, DiFelice GS. The MRI geyser sign: acromioclavicular joint cysts in the setting of a chronic rotator cuff tear. Am J Orthop 2011; 40 (6) E118-E121
• 47 McClure JG, Raney RB. Anomalies of the scapula. Clin Orthop Relat Res 1975; (110) 22-31
• 48 Ouellette H, Thomas BJ, Kassarjian A , et al. Re-examining the association of os acromiale with supraspinatus and infraspinatus tears. Skeletal Radiol 2007; 36 (9) 835-839
• 49 Gusmer PB, Potter HG, Donovan WD, O'Brien SJ. MR Imaging of the shoulder after rotator cuff repair. AJR 1997; 168: 559-563
• 50 Spinner RJ, Atkinson JL, Tiel RL. Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg 2003; 99 (2) 330-343
• 51 Wang H, Terrill RQ, Tanaka S, Amrami KK, Spinner RJ. Adherence of intraneural ganglia of the upper extremity to the principles of the unifying articular (synovial) theory. Neurosurg Focus 2009; 26 (2) E10
• 52 Spinner RJ, Scheithauer BW, Amrami KK. The unifying articular (synovial) origin of intraneural ganglia: evolution-revelation-revolution. Neurosurgery 2009; 65 (4, Suppl): A115-A124
• 53 Murphey MD, Gibson MS, Jennings BT, Crespo-Rodríguez AM, Fanburg-Smith J, Gajewski DA. From the archives of the AFIP: Imaging of synovial sarcoma with radiologic-pathologic correlation. Radiographics 2006; 26 (5) 1543-1565
• 54 Banks KP. The target sign: extremity. Radiology 2005; 234 (3) 899-900
• 55 Lin J, Martel W. Cross-sectional imaging of peripheral nerve sheath tumors: characteristic signs on CT, MR imaging, and sonography. AJR Am J Roentgenol 2001; 176 (1) 75-82
• 56 Navarro OM, Laffan EE, Ngan BY. Pediatric soft-tissue tumors and pseudo-tumors: MR imaging features with pathologic correlation: part 1. Imaging approach, pseudotumors, vascular lesions, and adipocytic tumors. Radiographics 2009; 29 (3) 887-906
• 57 Donnelly LF, Adams DM, Bisset III GS. Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol 2000; 174 (3) 597-608
• 58 Vilanova JC, Barceló J, Smirniotopoulos JG , et al. Hemangioma from head to toe: MR imaging with pathologic correlation. Radiographics 2004; 24 (2) 367-385
• 59 Speer KP, Lohnes J, Garrett Jr WE. Radiographic imaging of muscle strain injury. Am J Sports Med 1993; 21 (1) 89-95 ; discussion 96
• 60 Slavotinek JP, Verrall GM, Fon GT. Hamstring injury in athletes: using MR imaging measurements to compare extent of muscle injury with amount of time lost from competition. AJR Am J Roentgenol 2002; 179 (6) 1621-1628
• 61 O'Connor EE, Dixon LB, Peabody T, Stacy GS. MRI of cystic and soft-tissue masses of the shoulder joint. AJR Am J Roentgenol 2004; 183 (1) 39-47
• 62 Helms CA, Major NM, Anderson MW, Kaplan PA, Dussault R. Musculoskeletal MRI. 2nd ed. Philadelphia, PA: Saunders Elsevier; 2009