Shoulder MRI Recognition Pattern

Systematic approach to interpreting shoulder MRI with anatomical landmarks, common pathologies, and protocol optimization

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1. MRI Protocol

A. Standard Sequences

• • Coronal oblique:
  - Parallel to supraspinatus tendon
  - T1 and PD/T2 fat-sat
  - Slice thickness: 3-4mm
• • Sagittal oblique:
  - Perpendicular to glenoid
  - Rotator cuff muscle evaluation
• • Axial:
  - Labrum and biceps tendon
  - AC joint assessment

B. Specialized Sequences

• • ABER position:
  - Abduction external rotation
  - Increases sensitivity for partial articular tears
• • MR Arthrography:
  - 12-15ml dilute gadolinium
  - Distends joint capsule

2. Rotator Cuff Assessment

A. Tendon Pathology

Tendon

Common Pathology

Key MRI Signs

Supraspinatus

Critical zone tears

Fluid signal discontinuity

Infraspinatus

Posterosuperior impingement

Tendon retraction

Subscapularis

Upper tendon tears

Medial dislocation biceps

B. Tear Classification

• • Partial thickness:
  - Articular > bursal
  - Ellman classification
• • Full thickness:
  - Bateman classification
  - Measure retraction (mm)

3. Labral & Capsular Pathology

A. Labral Tears

Type

Location

Associated Findings

Bankart

Anteroinferior

Hill-Sachs lesion

SLAP

Superior

Biceps anchor involvement

Posterior

Reverse Bankart

Reverse Hill-Sachs

B. Capsular Abnormalities

• • IGHL:
  - Anterior band most important
  - Thickening in instability

4. Biceps Tendon Pathology

A. Common Abnormalities

Condition

MRI Features

Tendinosis

Thickened, intermediate signal

Subluxation

Medial to lesser tuberosity

Complete tear

Empty groove, retracted muscle

5. Bone Marrow & Impingement

A. Impingement Syndromes

• • Subacromial:
  - Acromial morphology (Bigliani)
  - Spur formation
• • Internal:
  - Posterosuperior glenoid
  - Cystic changes greater tuberosity

B. Bone Lesions

• • Hill-Sachs:
  - Posterolateral humerus
  - Engagement risk assessment

6. Reporting Template

• 1. Technique: Sequences, contrast use
• 2. Rotator cuff:
  - Tendon integrity
  - Muscle atrophy (Goutallier)
• 3. Labrum:
  - Tear type/location
  - Paralabral cysts
• 4. Biceps:
  - Tendon position
  - Synovitis/tears
• 5. Bone:
  - Impingement features
  - Marrow edema

Always correlate with clinical history and physical exam. For rotator cuff tears, measure retraction and muscle quality. In instability cases, evaluate both labrum and Hill-Sachs lesions. For biceps pathology, follow the tendon into the groove. Document incidental findings (ganglion cysts, os acromiale) with appropriate clinical context. Postoperative cases require evaluation of anchor positions and tendon integrity.

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