Normal Shoulder MRI and MR Arthrography: Anatomy and Technique

Abstract

The use of MR for the diagnosis of shoulder lesions is well established, as well as MR arthrography for the diagnosis for shoulder instability and microinstability. For an accurate evaluation is essential to know the normal anatomy and variants to avoid the misdiagnosis of a pitfall as pathological condition. In addition we will discuss which variants might be clinically relevant. We will review the classical frequent variants such as intraarticular structures, especially glenohumeral ligaments and labrum but also bone, cartilage and rotator cuff variants and pitfalls. Both static and dynamic structures play an important role providing stability at different positions and with different range of motion.

Keywords

shoulder - anatomy - MR arthrography - CT arthrography - abduction and external rotation

• References

• 1 Tischer T, Vogt S, Kreuz PC, Imhoff AB. Arthroscopic anatomy, variants, and pathologic findings in shoulder instability. Arthroscopy 2011; 27 (10) 1434-1443
• 2 Lugo R, Kung P, Ma CB. Shoulder biomechanics. Eur J Radiol 2008; 68 (1) 16-24
• 3 Chen Q, Miller TT, Padron M, Beltran J, In: Pope T, Bloem JL, Beltran J, Morrison W, Wilson D. , eds. Imaging of the Musculoskeletal System. Philadelphia, PA: WB Saunders; 2008: 101-125
• 4 Shortt CP, Morrison WB, Roberts CC, Deely DM, Gopez AG, Zoga AC. Shoulder, hip, and knee arthrography needle placement using fluoroscopic guidance: practice patterns of musculoskeletal radiologists in North America. Skeletal Radiol 2009; 38 (4) 377-385
• 5 Hodler J. Technical errors in MR arthrography. Skeletal Radiol 2008; 37 (1) 9-18
• 6 Jacobson JA, Lin J, Jamadar DA, Hayes CW. Aids to successful shoulder arthrography performed with a fluoroscopically guided anterior approach. Radiographics 2003; 23 (2) 373-378 ; discussion 379
• 7 Rhee RB, Chan KK, Lieu JG, Kim BS, Steinbach LS. MR and CT arthrography of the shoulder. Semin Musculoskelet Radiol 2012; 16 (1) 3-14
• 8 Farmer KD, Hughes PM. MR arthrography of the shoulder: fluoroscopically guided technique using a posterior approach. AJR Am J Roentgenol 2002; 178 (2) 433-434
• 9 Catalano OA, Manfredi R, Vanzulli A , et al. MR arthrography of the glenohumeral joint: modified posterior approach without imaging guidance. Radiology 2007; 242 (2) 550-554
• 10 Llopis E, Fernandez E, Cerezal L. MR and CT arthrography of the hip. Semin Musculoskelet Radiol 2012; 16 (1) 42-56
• 11 Saleem AM, Lee JK, Novak LM. Usefulness of the abduction and external rotation views in shoulder MR arthrography. AJR Am J Roentgenol 2008; 191 (4) 1024-1030
• 12 Guedez M, Llopis E, Hernandez E, Cruz A, Higueras V, Cerezal L. External rotation improves diagnostic yield of MR arthrography when added to conventional internal positioning in patients clinically suspected of having SLAP lesions. Poster presented at: Radiological Society of North America conference; November 20, 2008; Chicago, IL. Available at: http://archive.rsna.org/2008/6010842.html . Accessed January 28, 2015
• 13 Rudez J, Zanetti M. Normal anatomy, variants and pitfalls on shoulder MRI. Eur J Radiol 2008; 68 (1) 25-35
• 14 Cook TS, Stein JM, Simonson S, Kim W. Normal and variant anatomy of the shoulder on MRI. Magn Reson Imaging Clin N Am 2011; 19 (3) 581-594
• 15 Prescher A. Anatomical basics, variations, and degenerative changes of the shoulder joint and shoulder girdle. Eur J Radiol 2000; 35 (2) 88-102
• 16 Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elbow Surg 2014; 23 (4) 536-541
• 17 Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 2014; 30 (1) 90-98
• 18 Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. Skeletal Radiol 2000; 29 (4) 204-210
• 19 Harper KW, Helms CA, Haystead CM, Higgins LD. Glenoid dysplasia: incidence and association with posterior labral tears as evaluated on MRI. AJR Am J Roentgenol 2005; 184 (3) 984-988
• 20 Randall T. Glenoid dysplasia. J Athl Train 1995; 30 (3) 259-260
• 21 Tung GA, Hou DD. MR arthrography of the posterior labrocapsular complex: relationship with glenohumeral joint alignment and clinical posterior instability. AJR Am J Roentgenol 2003; 180 (2) 369-375
• 22 Guntern DV, Pfirrmann CW, Schmid MR , et al. Articular cartilage lesions of the glenohumeral joint: diagnostic effectiveness of MR arthrography and prevalence in patients with subacromial impingement syndrome. Radiology 2003; 226 (1) 165-170
• 23 Yeh LR, Kwak S, Kim YS , et al. Evaluation of articular cartilage thickness of the humeral head and the glenoid fossa by MR arthrography: anatomic correlation in cadavers. Skeletal Radiol 1998; 27 (9) 500-504
• 24 Kralinger F, Aigner F, Longato S, Rieger M, Wambacher M. Is the bare spot a consistent landmark for shoulder arthroscopy? A study of 20 embalmed glenoids with 3-dimensional computed tomographic reconstruction. Arthroscopy 2006; 22 (4) 428-432
• 25 Ozaki R, Nakagawa S, Mizuno N, Mae T, Yoneda M. Hill-Sachs lesions in shoulders with traumatic anterior instability: evaluation using computed tomography with 3-dimensional reconstruction. Am J Sports Med 2014; 42 (11) 2597-2605
• 26 Mascarenhas R, Rusen J, Saltzman BM , et al. Management of humeral and glenoid bone loss in recurrent glenohumeral instability. Adv Orthop 2014; 2014: 640952
• 27 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 (2) 213-228 , x
• 28 Giaroli EL, Major NM, Lemley DE, Lee J. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. AJR Am J Roentgenol 2006; 186 (1) 242-246
• 29 Alyas F, Curtis M, Speed C, Saifuddin A, Connell D. MR imaging appearances of acromioclavicular joint dislocation. Radiographics 2008; 28 (2) 463-479 ; quiz 619
• 30 De Maeseneer M, Van Roy F, Lenchik L , et al. CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. Radiographics 2000; 20 (Spec No.) S67-S81
• 31 Major NM, Browne J, Domzalski T, Cothran RL, Helms CA. Evaluation of the glenoid labrum with 3-T MRI: is intraarticular contrast necessary?. AJR Am J Roentgenol 2011; 196 (5) 1139-1144
• 32 Schaeffeler C, Waldt S, Holzapfel K , et al. Lesions of the biceps pulley: diagnostic accuracy of MR arthrography of the shoulder and evaluation of previously described and new diagnostic signs. Radiology 2012; 264 (2) 504-513
• 33 Morag Y, Jacobson JA, Shields G , et al. MR arthrography of rotator interval, long head of the biceps brachii, and biceps pulley of the shoulder. Radiology 2005; 235 (1) 21-30
• 34 Petchprapa CN, Beltran LS, Jazrawi LM, Kwon YW, Babb JS, Recht MP. The rotator interval: a review of anatomy, function, and normal and abnormal MRI appearance. AJR Am J Roentgenol 2010; 195 (3) 567-576
• 35 Massengill AD, Seeger LL, Yao L , et al. Labrocapsular ligamentous complex of the shoulder: normal anatomy, anatomic variation, and pitfalls of MR imaging and MR arthrography. Radiographics 1994; 14 (6) 1211-1223
• 36 Vinson EN, Wittstein J, Garrigues GE, Taylor DC. MRI of selected abnormalities at the anterior superior aspect of the shoulder: potential pitfalls and subtle diagnoses. AJR Am J Roentgenol 2012; 199 (3) 534-545
• 37 Moser TP, Cardinal É, Bureau NJ, Guillin R, Lanneville P, Grabs D. The aponeurotic expansion of the supraspinatus tendon: anatomy and prevalence in a series of 150 shoulder MRIs. Skeletal Radiol 2015; 44 (2) 223-231
• 38 Beltran J, Bencardino J, Mellado J, Rosenberg ZS, Irish RD. MR arthrography of the shoulder: variants and pitfalls. Radiographics 1997; 17 (6) 1403-1412 ; discussion 1412–1415
• 39 Beltran J, Bencardino J, Padron M, Shankman S, Beltran L, Ozkarahan G. The middle glenohumeral ligament: normal anatomy, variants and pathology. Skeletal Radiol 2002; 31 (5) 253-262
• 40 Williams MM, Snyder SJ, Buford Jr D. The Buford complex—the “cord-like” middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthroscopy 1994; 10 (3) 241-247
• 41 Lee JC, Guy S, Connell D, Saifuddin A, Lambert S. MRI of the rotator interval of the shoulder. Clin Radiol 2007; 62 (5) 416-423
• 42 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
• 43 Kolts I. A note on the anatomy of the supraspinatus muscle. Arch Orthop Trauma Surg 1992; 111 (5) 247-249
• 44 Vad VB, Southern D, Warren RF, Altchek DW, Dines D. Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy. J Shoulder Elbow Surg 2003; 12 (4) 333-336
• 45 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
• 46 Burkhart SS, Esch JC, Jolson RS. The rotator crescent and rotator cable: an anatomic description of the shoulder's “suspension bridge.”. Arthroscopy 1993; 9 (6) 611-616
• 47 Orlandi D, Sconfienza LM, Fabbro E , et al. Preliminary ultrasound evaluation of the rotator cable in asymptomatic volunteers. J Ultrasound 2012; 15 (1) 16-19
• 48 Morag Y, Jamadar DA, Boon TA, Bedi A, Caoili EM, Jacobson JA. Ultrasound of the rotator cable: prevalence and morphology in asymptomatic shoulders. AJR Am J Roentgenol 2012; 198 (1) W27-W30
• 49 Gyftopoulos S, Bencardino J, Nevsky G , et al. Rotator cable: MRI study of its appearance in the intact rotator cuff with anatomic and histologic correlation. AJR Am J Roentgenol 2013; 200 (5) 1101-1105
• 50 Sheah K, Bredella MA, Warner JJ, Halpern EF, Palmer WE. Transverse thickening along the articular surface of the rotator cuff consistent with the rotator cable: identification with MR arthrography and relevance in rotator cuff evaluation. AJR Am J Roentgenol 2009; 193 (3) 679-686
• 51 Morag Y, Jamadar DA, Miller B, Dong Q, Jacobson JA. The subscapularis: anatomy, injury, and imaging. Skeletal Radiol 2011; 40 (3) 255-269
• 52 Boon JM, de Beer MA, Botha D, Maritz NG, Fouche AA. The anatomy of the subscapularis tendon insertion as applied to rotator cuff repair. J Shoulder Elbow Surg 2004; 13 (2) 165-169
• 53 Arai R, Nimura A, Yamaguchi K , et al. The anatomy of the coracohumeral ligament and its relation to the subscapularis muscle. J Shoulder Elbow Surg 2014; 23 (10) 1575-1581
• 54 Dong Q, Jacobson JA, Jamadar DA , et al. Entrapment neuropathies in the upper and lower limbs: anatomy and MRI features. Radiol Res Pract 2012; 2012: 230679
• 55 Cothran Jr RL, Helms C. Quadrilateral space syndrome: incidence of imaging findings in a population referred for MRI of the shoulder. AJR Am J Roentgenol 2005; 184 (3) 989-992
• 56 Yanny S, Toms AP. MR patterns of denervation around the shoulder. AJR Am J Roentgenol 2010; 195 (2) W157-W63