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Imaging the shoulder

Nuffield Orthopaedic Centre and Oxford Radcliffe Hospital, Oxford, UK

View larger version (77K): [in a new window]   Figure 1. MRI coronal scans in a patient on dialysis. (a) T1 weighted and (b) T2 weighted images. There is hypertrophy of the synovium and capsule returning low signal on the T1 and particularly the T2 weighted image typical of amyloid deposition (arrows).

View larger version (64K): [in a new window]   Figure 2. Subacromial bursa rice bodies. (a) T1 weighted and (b) short tau inversion recovery axial images showing a distended subacromial bursa (arrows) containing multiple loose bodies representing conglomerates of rice bodies.

View larger version (96K): [in a new window]   Figure 3. Chondroblastoma. There is a large destructive calcified lesion of the proximal humeral epiphysis.

View larger version (72K): [in a new window]   Figure 4. Full thickness tear of supraspinatus tendon. Ultrasound showing fluid in the gap between the distracted ends of the torn tendon (arrows). There is irregularity of the greater tuberosity indicating impingement (arrowhead).

View larger version (92K): [in a new window]   Figure 5. Full thickness tear of supraspinatus. Ultrasound images of small, medium and massive tears. (a) Small tear with focal loss of the normal convexity of the distal end of the tendon (arrow). (b) Medium sized tear. There is a defect in the distal end in the supraspintus tendon with the deltoid sagging into the defect. The normal convex surface of the tendon is lost. (c) Massive tear with no tendon seen between the deltoid and the humeral head.

View larger version (69K): [in a new window]   Figure 6. Full thickness tear of supraspinatus. (a) The tear cannot be seen on the T1 weighted image. (b) Corresponding short tau inversion recovery image showing high signal defect in the tendon (arrow). There is fluid seen in the subacromial bursa (arrowhead).

View larger version (177K): [in a new window]   Figure 7. Massive tear supraspinatus tendon. Short tau inversion recovery coronal image. The retracted free end of the tendon is seen to lie at the level of the glenoid (arrow).

View larger version (88K): [in a new window]   Figure 8. Massive tear supraspinatus tendon. (a) T1 weighted coronal and (b) T2 sagittal oblique image showing marked atrophy of the supraspinatus tendon and muscle (arrows) which is largely replaced by fat.

View larger version (66K): [in a new window]   Figure 9. Partial thickness tear of the supraspinatus tendon. (a) T2 weighted coronal image showing a focus of high signal in the distal end of the tendon extending to the inferior articular surface only (arrow). (b) Ultrasound showing a small hypoechoic focus at the articular surface of the tendon (arrow). (SS, supraspinatus tendon.)

View larger version (85K): [in a new window]   Figure 10. Degenaration of the supraspinatus tendon. MRI shows modest, ill-defined increased signal within the tendon on both (a) T1 and (b) T2 weighted images (arrows).

View larger version (77K): [in a new window]   Figure 11. Subachromial bursitis. Ultrasound image showing fluid in the subacromial bursa (arrow).

View larger version (100K): [in a new window]   Figure 12. Acromial spur. T1 weighted image showing a degenerate tendon and prominent spur arising from the undersurface of the acromium (arrow).

View larger version (57K): [in a new window]   Figure 13. Degenaration of the supraspinatus tendon. (a) T1 weighted MRI and (b) ultrasound showing diffuse swelling of the tendon (arrows).

View larger version (107K): [in a new window]   Figure 14. Dynamic ultrasound demonstrating impingement syndrome. On arm abduction bursal tissue (arrow) is seen to bunch up against the coracoacromial ligament (arrowhead).

View larger version (122K): [in a new window]   Figure 15. Acute tear of subscapularis. Axial ultrasound image showing a small remnant of the subscapularis tendon attached to the lesser tuberosity (arrow).

View larger version (57K): [in a new window]   Figure 16. Biceps tendon tear. Axial ultrasound showing atrophic echogenic of the long head of biceps muscle (arrow) and normal side for comparison. (H, humerus.)

View larger version (131K): [in a new window]   Figure 17. Dislocated biceps tendon. Axial ultrasound shows an empty bicipital groove (arrow). The biceps tendon (arrowhead) has dislocated medially.

View larger version (99K): [in a new window]   Figure 18. Effusion of the biceps tendon sheath. Ultrasound showing fluid within the sheath (arrow). The biceps tendon has a normal appearances.

View larger version (38K): [in a new window]   Figure 19. Rotator cuff repair. (a) Intact supraspinatus tendon. On coronal ultrasound tendon is seen in the surgical notch (arrow). (b) Rerupture of repaired supraspinatus tendon. The tendon is torn and cannot be identified in the notch (arrow).

View larger version (67K): [in a new window]   Figure 20. Frozen shoulder. Ultrasound showing focal soft tissue swelling in the region of the rotator cuff interval (arrows). Doppler showed some hypervascularity in this region.

View larger version (80K): [in a new window]   Figure 21. Calcific tendonitis. (a) T1 weighted MRI showing low signal lesion in the supraspinatus tendon (arrow). (b) Ultrasound shows a echogenic lesion (arrow) with acoustic enhancement (arrowheads). There is fluid in the subacromial bursa indicating bursitis (open arrows).

View larger version (153K): [in a new window]   Figure 22. Short tau inversion recovery coronal image showing synovial cyst arising from the superior aspect of the acromioclavicular joint.

View larger version (86K): [in a new window]   Figure 23. Osteoarthritis of the sternoclavicular joint. (a) T1 weighted image showing hypertrophy of the capsule (arrows) osteophyte and erosion. (b) Short tau inversion recovery coronal image shows a joint effusion and periarticular bony oedema. (c) Axial T1 weighted image demonstrating a prominent palpable mass due to bony and capsular hypertrophy. (C, clavicle.)