Transcript
  • 1. MRI SHOULDER WHAT TO SEE DR SHEKHAR SRIVASTAV Sr. Consultant- Knee & Shoulder Arthroscopy Sant Parmanand Hospital delhiarthroscopy.com
  • 2. Normal Anatomy delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 3. Normal Shoulder MRI Coronal Oblique Sagital Oblique Axial Cuts delhiarthroscopy.com
  • 4. Normal Coronal Oblique Parallel to plane of Supraspinatus Supraspinatus A-C Joint Sub-acromial & Sub-Deltoid bursa delhiarthroscopy.com Labrum- Sup & Inf Biceps Tendon delhiarthroscopy.com
  • 5. Normal Coronal Oblique d delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 6. Normal Coronal Oblique Parallels the central tendon of supraspinatus delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 7. Normal Sagittal Oblique Perpendicular to the plane of Supraspinatus Medial to Lateral Coraco-acromial arch Rotator cuff Shape of Acromion delhiarthroscopy.com delhiarthroscopy.com
  • 8. Normal Sagittal Oblique a delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 9. Normal Axial Cuts delhiarthroscopy.com delhiarthroscopy.com
  • 10. Normal Axial Cuts Labrum- Ant & Post Gleno-humeral ligament Gleno-humeral cartilage Biceps Tendon Subscapularis & Teres delhiarthroscopy.com Minor delhiarthroscopy.com
  • 11. Arthrogram Sequence Distension of joints, crowded structures seen delhiarthroscopy.com separately Labrum, G-H ligaments, biceps anchors Partial articular surface RC tears delhiarthroscopy.com SLAP tears delhiarthroscopy.com
  • 12. Pathological process Shoulder Impingement Rotator cuff pathology Instability Miscellaneous- Biceps, Infection, Adhesive Capulitis delhiarthroscopy.com
  • 13. Osseous Acromial Outlet A-C joint Acromion Humeral Head delhiarthroscopy.com delhiarthroscopy.com
  • 14. Extrinsic Impingement A-C osteophytes Sub-acromial delhiarthroscopy.com Enthesophytes Acromion Shape delhiarthroscopy.com delhiarthroscopy.com
  • 15. Acromion Shape 3 types delhiarthroscopy.com Type1 delhiarthroscopy.com Type 2 delhiarthroscopy.com delhiarthroscopy.com Type 3
  • 16. Rotator Cuff Pathology Tendinosis Partial thickness Cuff Tears Full thickness Cuff Tears delhiarthroscopy.com
  • 17. Tendinosis Thickened tendon with degeneration delhiarthroscopy.com Intrasubstance degeneration Normal to intermediate SI changes delhiarthroscopy.com delhiarthroscopy.com
  • 18. Partial Cuff Tears Three types Articular side- FP, CZ delhiarthroscopy.com Interstitial Bursal side delhiarthroscopy.com delhiarthroscopy.com
  • 19. Partial RC Tear Intrasubstance tear Bursal sided RC Tear delhiarthroscopy.com Bursal Tear delhiarthroscopy.com Intra-Substance Tear delhiarthroscopy.com
  • 20. Full thickness RC tears Tear extending from bursal to articular surface Fluid in SA-SD bursa Retraction of tendon Muscle undergoes Atrophy Degeneration Fatty Infiltration delhiarthroscopy.com delhiarthroscopy.com
  • 21. Full Thickness RC Tears Tendons involved Size of the tear- AP & ML plain delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 22. Full Thickness RC Tears Muscle Atrophy delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 23. Instability Spectrum ranging from subtle instability to frank dislocation Anterior Instability Posterior Instability SLAP tear delhiarthroscopy.com
  • 24. Anterior Instability Bankart Lesion Bony Bankart delhiarthroscopy.com Glenoid Erosion Hill Sach s lesion delhiarthroscopy.com delhiarthroscopy.com
  • 25. Anterior Instability Bankart Lesion delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 26. Anterior Instability Bony Bankart delhiarthroscopy.com Bony Bankart Glenoid Erosion delhiarthroscopy.com Glenoid Erosion delhiarthroscopy.com
  • 27. Anterior Instability Hill Sach s LesionPostero-Sup aspect of Humeral Head delhiarthroscopy.com delhiarthroscopy.com
  • 28. Anterior Instability Hill Sach s Lesion delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 29. Posterior Instability Posterior Labral Lesion Reverse Hill Sach s delhiarthroscopy.com delhiarthroscopy.com
  • 30. SLAP Tear Superior Labrum Antero-Posterior Tear Avulsion Biceps Anchor delhiarthroscopy.com delhiarthroscopy.com
  • 31. SLAP Tear Normal Biceps Anchor delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 32. SLAP Tear Torn labral delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 33. Biceps Pathology Tendinosis Rupture Dislocation delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 34. Miscellaneous Osteonecrosis delhiarthroscopy.com Fractures Osteonecrosis delhiarthroscopy.com Infection Occult Fractures delhiarthroscopy.com delhiarthroscopy.com
  • 35. Shoulder is a complex joint with many normal variants Proper clinical examination and probable clinical diagnosis MRI very sensitive test for diagnosing shoulder problems MRI findings should corroborate clinical findings delhiarthroscopy.com
  • 36. j Thank Y ou delhiarthroscopy.com
  • 37. Various lesions seen in Dislocation Shoulder ALSPA Perthes Lesion Chondral Defect Reverse Hillsachs & Post Labral tear delhiarthroscopy.com
  • 38. Rotator Cuff Supraspinatus Infraspinatus Teres minor Subscapularis delhiarthroscopy.com
  • 39. Partial Cuff Tears Articular sided cuff tear delhiarthroscopy.com delhiarthroscopy.com delhiarthroscopy.com
  • 40. Miscellaneous delhiarthroscopy.com Infection delhiarthroscopy.com Adhesive Capsulitis delhiarthroscopy.com

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