2nd edition. Variant appearances of the middle glenohumeral ligament include absence of the middle glenohumeral ligament, a conjoint origin with either the superior glenohumeral ligament or inferior glenohumeral ligament, and a cord-like thickening of the middle glenohumeral ligament in combination with an absent anterosuperior labrum (Buford complex) [7]. Laterally, it fuses with the posterior part of the rotator cable and fibers of the infraspinatus before these three structures jointly insert on the posterior facet of the greater tuberosity. However, the cystic changes often identified are located in the epiphysis or metaphysis near the joint spaces, and these commonly result from articular diseases. At the superior aspect of the glenoid, the long head of the biceps attaches to the supraglenoid tubercle [4, 6]. Redundancy or type III is commonly observed for the posterior capsule. DOI: https://doi.org/10.1016/j.ejrad.2008.02.028, https://doi.org/10.1016/j.mric.2011.05.005, https://doi.org/10.1016/j.rcl.2006.04.002, https://doi.org/10.1148/radiographics.20.suppl_1.g00oc03s67, https://doi.org/10.1007/s00256-017-2667-9, https://doi.org/10.1016/j.jus.2011.12.001. Pulley system. Predilection sites: proximal humerus and femur. Axial fat-saturated T1-weighted MR arthrographic section at the level of the bicipital groove shows the biceps pulley (large arrow), formed by the fusion of the coracohumeral ligament, the superior glenohumeral ligament (thin arrow) and the transverse humeral ligament. The clavicle is an S-shaped bone which articulates medially with the sternoclavicular joint and laterally with the acromioclavicular joint. (A) Axial PD-weighted and (B) Sagittal fat-suppressed T1-weighted MR arthrographic images show a cord-like middle glenohumeral ligament (white arrow) associated with an absent anterior superior labrum (black arrow) mimicking a labral tear with normal posterior labrum. New anatomical findings regarding the footprint of the rotator cuff. The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck, superior and medial to the glenoid fossa. The purpose of this study was to describe the appearance of cysts in the posterosuperior portion of the humeral head on MR arthrography and to correlate the MRI findings with the gross and histologic findings in cadavers. According to the study of Mochizuki et al., the supraspinatus insertion area is smaller and more anterior than suggested in the classic description and the supraspinatus tendon is partially covered by the infraspinatus tendon. Philadelphia, PA: Lippincott Williams & Wilkins. It was concluded that there are two distinct types of cystic changes: one at the attachment of the supraspinatus and subscapularis, which is closely related to tears of these tendons, and the other in the bare area, which is related to a degenerative aging process from the lack of cartilage coverage. The anterior (white arrow, B) and posterior (black arrow, B) bands are demonstrated on the axial section. (A) Sagittal oblique T1-weighted and (B) Coronal oblique fat-suppressed PD-weighted MR images detect areas of red marrow in the proximal humeral diaphysis with low signal intensity on T1 (arrow, A) and increased signal on fat-suppressed PD (arrow, B). Recognition of normal thinning of peripheral humeral cartilage is essential in order to not mistaken it with posttraumatic or degenerative sequels. The subacromial pseudospur is a normal variant that represents a prominence of the acromial angle at the attachment of the coracoacromial ligament. ... i had an mri on my shoulder an it shows subchondral cyst humeral head1.5 cm and rotator cuff thickining and tendonothpy . It limits the space available to the rotator cuff tendons, the subacromial subdeltoid bursa, and the long head of the biceps (Figure 7, additional material). Case 1 involved a 77-year-old woman with right shoulder pain. It should not be mistaken with a type II SLAP lesion or Superior Labrum Anterior Posterior tear which extends laterally or posteriorly [3, 4, 6, 12]. Case 1 involved a 77-year-old woman with right shoulder pain. The midsection of the ligament often adopts a more horizontal course. In addition, about 91% of cysts were connected to the joint cavity. Am J Roentgenol. In summary, cystic lesions are commonly visible in the posterosuperior portions of the humeral heads (the bare areas), just posterior to the greater tuberosity on shoulder MR images. The articular surfaces of the acromioclavicular joint are covered with hyaline cartilage and in the central portion of the joint there is a fibrocartilaginous disc, usually incomplete. Together with the coracobrachialis muscle tendon it originates from the coracoid process and is well demonstrated on axial sections [2, 3, 4, 5, 12]. Subchondral Cyst or Geode of the Shoulder. Coronal oblique images are oriented parallel to the scapula or parallel to the course of the supraspinatus tendon (determined on axial images); sagittal oblique images are oriented perpendicular to the coronal oblique plane, covering the deltoid muscle and the scapula to include rotator cuff muscle bellies; axial images are performed from the acromioclavicular joint to below the axillary pouch. DOI: http://doi.org/10.5334/jbr-btr.1467, Kadi, R., Milants, A., & Shahabpour, M. (2017). (A) Sagittal oblique PD-weighted MRA depicts the inferior glenohumeral ligament (thick arrows, A) with a high labral attachment (arrowhead, A). There are two main recesses of the capsule, the subscapular recess and the axillary recess (Figure 23). 2017;101(S2):3. An association between prior shoulder trauma or stress and development of an os acromiale has been reported. Schematic illustration of the acromion shape as described by Bigliani. It is best seen on axial images as a circular, signal void structure in the intertubercular groove. There is a relative increase in density in the humeral head (white arrows) with a subchondral lucency seen in the medial portion of the head. The inferior glenohumeral ligament is actually a complex of anterior and posterior bands as well as an axillary pouch that is reinforced by the fasciculus obliquus on the glenoid side (Figure 16). Direct MRA uses intra-articular injection of gadolinium based contrast with the same technical approach as for CTA. The purpose of this study was to describe the appearance of cysts in the posterosuperior portion of the humeral head on MR arthrography and to correlate the MRI findings with the gross and histologic findings in cadavers. Glenohumeral joint synovitis and bone edema are nonspecific. However, ultrasonographic evaluation of the shoulder is limited to the long head of biceps tendon, the rotator cuff, the subacromial-subdeltoid bursa and the acromioclavicular joint. 2012; 95(1): 22–24. Normal red bone marrow in a young adult. Intra-articular injection of iodine contrast material allows visualization of the capsulolabral structures. The subscapularis tendon inserts here in a broad band. This variant is encountered in about 11% of individuals and best seen on fat-saturated T1-weighted coronal oblique images obtained with MRA and CTA (Figure 14) [13]. The infraspinatus inserts on approximately half of the superior facet and the entire middle facet of the greater tuberosity. The inferior glenohumeral ligament actually consists of an anterior and posterior band as well as the axillary pouch that is reinforced by the fasciculus obliquus (or spiral glenohumeral ligament) on the glenoid side (Figure 16). DOI: https://doi.org/10.5334/jbr-btr.554. Cartilage is better evaluated using CTA than MRA because of the smaller slice thickness of CT images and the clear difference in contrast between the injected high-density contrast material (appearing white) and the grey density of cartilage on CT [4]. Subacromial pseudospur. in internal & external rotation) [1]. Under normal circumstances this bursa does not communicate with the joint space and is not seen on MRI unless it is distended by fluid. The tendon passes within the joint superiorly and obliquely under the rotator cuff, between the supraspinatus tendon and the subscapularis tendon through the ‘rotator interval’. DOI: https://doi.org/10.1148/radiographics.20.suppl_1.g00oc03s67. Subchondral cysts of the humeral head and normal bare area. 2017; 46(8): 1101–1111. It is a strong fibrous triangular band that forms part of the roof of the glenohumeral joint. Axial fat-saturated PD-weighted MR image shows focal elevation of the subchondral bone (arrow) in the mid third of the glenoid with focal thinning of overlying cartilage (arrowhead). The supraspinatus muscle is best demonstrated on coronal oblique and axial sections as a thick, intermediate signal intensity structure tapering into a low signal intensity tendon that inserts into the superolateral aspect of the greater tuberosity. CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. (A) Axial and (B) Sagittal fat suppressed T1-weighted MR arthrogram of a sublabral foramen. It is lined by a synovial membrane [2]. To our knowledge, no histologically proven report has been issued about these cystic changes of the humeral head in normal shoulders without a rotator cuff disorder or articular disease. On axial images a marked retroversion is found. The infraspinatus muscle allows external rotation and posterior abduction of the upper extremity. Idiopathic glenohumeral chondrolysis with a joint effusion and loose intraarticular chondral fragments. A true tear typically propagates a greater distance superiorly into the bicipital anchor or inferiorly into the inferior glenohumeral ligament attachment site [7]. The objective of this study was to retrospectively evaluate the prevalence of the cystic changes at rotator cuff footprint on proximal humeral tuberosities and investigate their relationship with rotator cuff tears and patient age. The long head of the biceps tendon is pointed out by an arrowhead. On fat-saturated T1-weighted MRA images obtained in (A) Coronal oblique and (B) Axial planes, the ligament appears as a thin hypointense band delimited by the distended axillary pouch or recess with a U-shaped appearance (arrow, A). It is associated with a focal thinning of the overlying cartilage. The sublabral recess can coexist and communicate with the sublabral foramen [3, 4, 6, 12]. On axial sections, the coracohumeral ligament is perpendicular to the superior glenohumeral ligament and anterior to the tendon of the long head of the biceps. A subchondral cyst is an area of sparse bone "bene ... Read More. Subchondral bone cysts (SBCs) are sacs filled with fluid that form inside of joints such as knees, hips, and shoulders. The assessment of humeral cartilage remains critical due to the small cartilage thickness at this level (approximately 1mm) [3]. Some of those muscle are represented in (Figure 4) [5, 6]. This ligament is composed of two conjoined or closely adjacent bands [2]. The long head of the biceps tendon originates mostly from the supraglenoid tuberosity and partly from the superior labrum, having a common attachment with the superior glenohumeral ligament (Figures 3, 16). The shoulder joint space is still preserved (red arrow). DOI: https://doi.org/10.2106/JBJS.H.01426, Guerini, H, Fermand, M, Godefroy, D, et al. Radiol Clin North Am. It is hypothesized that the hooked acromion is in fact an acquired form and is highly associated with subacromial impingement syndrome and rotator cuff abnormalities [2, 3, 4, 6, 10]. The cysts in these locations do not represent degenerative sequels, whereas cysts located more anteriorly are associated with subscapularis tendon pathology. 2017;101(S2):3. 2012; 15(1): 7–15. Rapidly destructive arthritis (RDA) of the shoulder is a rare disease. It can be absent in 10% of healthy subjects [3]. Basic anatomy as well as recent findings are developed, including a new description of the attachment of supraspinatus and infraspinatus tendons at the superior aspect of the humerus, the rotator cable and the superior glenohumeral ligament complex. Cord-like middle glenohumeral ligament. The anatomic neck forms the oblique circumference of the humeral head and separates the head from the tuberosities. Methods:: The cyst-present group comprised 38 patients with anterior greater tubercle cyst in MRI, and age- and sex-matched 30 patients without cyst in humeral head … Several studies reported that cystic changes of the greater tuberosity and of the head of the humerus were observed in 50-80% of shoulders with rotator cuff tears [3, 4, 8]. When the anterior capsular attachment is far from the glenoid margin (type III), the glenohumeral joint will be more unstable. The scapula is a triangular bone which consists of the scapular body, the scapular spine, the scapular neck, the acromion, the glenoid fossa and the coracoid process. It is a flat, gliding joint that gives the shoulder additional flexibility which is not possible with the glenohumeral joint alone. It forms the limits of the ‘rotator interval’ together with the coracohumeral ligament and the anterosuperior aspect of the glenohumeral joint capsule [4, 14]. Solitary Bone Cyst. (A) Axial and (B) Coronal oblique fat-suppressed T1-weighted MR arthrographic images show subchondral cysts at the attachment of the infraspinatus tendon (arrow). This space contains the scapular circumflex artery (Figure 3, additional material) [1, 2]. It can mimic an osteophyte caudally directed (Figure 10). Conventional radiographs of the shoulder. As such, it forms the roof of the rotator cuff interval and it covers the anterior aspect of the supraspinatus tendon (Figure 6, additional material). Radiographic findings of the shoulder joint have been reported in patients with rotator cuff tear, greater tuberosity changes are among the most reported. Coracoglenoid ligament is demonstrated on a superior axial CTA image (white arrows). DOI: https://doi.org/10.2214/AJR.12.9312, Kadi, R., Milants, A. and Shahabpour, M., 2017. MRA using fat-saturated T1-weighted images and CTA in the axial plane show a cord-like middle glenohumeral ligament adjacent to an absent anterosuperior labrum. J Bone Joint Surg Am. The greater tuberosity is located on the lateral aspect of the proximal humerus and is the site of insertion of the supraspinatus, infraspinatus, and teres minor tendons. All lesions were observed as round or oval high-signal-intensity lesions on T2-weighted and fat-suppressed T1-weighted MR arthrography images. The sublabral foramen should not be confused with an anterosuperior labral tear in patients with clinical symptoms. On arthroscopic images, the rotator cable appears as a fibrous transverse band surrounding the rotator crescent. Coronal oblique PD-weighted MR image displays a defect in the cartilage filling up with a moderate amount of joint fluid (arrow) without any thickening of the subchondral bone. However, the appearance of the anterior capsular insertion may vary with the arm in internal or external rotation. The radiographic signs of rotator cuff tear may include secondary degenerative changes as sclerosis, subchondral cysts, osteolysis, and notching or pitting of the greater tuberosity. It is a triangular area between the anterior border of the supraspinatus tendon and the superior border of the subscapularis tendon, ranging from the coracoid process to the biceps groove. Both the anterior and posterior bands of the inferior glenohumeral ligament insert along the inferior aspect of the surgical neck of the humerus (Figures 23 and 24) [2, 5]. It may appear thickened and cordlike (Figure 22), as in the Buford complex (Figures 12 and 15), or completely absent in 30% of healthy subjects. Prominent synovial folds of the axillary recess may stimulate loose bodies on MRI. degenerative subchondral bone cyst must be added to the differential diagnosis. (B) Axial fat saturated T2-weighted MR image obtained at the level of the coracoid process (arrowhead, B) typically shows a Hill-Sachs defect (arrow) in a patient with history of anterior shoulder dislocation. This variant is very uncommon and can be encountered in 1.5–2% of individuals [3, 6, 13]. (a) Radiograph of the shoulder (Grashey view) shows the subcoracoid ossification center (straight arrow). DOI: http://doi.org/10.5334/jbr-btr.1467, Kadi, Redouane, Annemieke Milants, and Maryam Shahabpour. it's visible in X-rays of the joints and is the result of a reactive bone response, resulting in increased bone density of the underlying articular cartilage bone (that's underneath the joint).. SBC frequently presents with a fracture. Rudez, J and Zanetti, M. Normal anatomy, variants and pitfalls on shoulder MRI. The lesser tuberosity is situated on the anterior portion of the proximal humerus, medial to the greater tuberosity. (A) Coronal oblique fat-suppressed T1-weighted MR arthrographic image shows a sublabral recess as an increased linear signal undercutting the contour of the superior glenoid labrum (arrows, A) following the contour of the glenoid cartilage without extension posterior to the biceps anchor. Also, shoulder joint spaces were filled with contrast medium of high signal intensity on fat-suppressed T1-weighted images, which established the presence of connections between joint spaces and cystic lesions of the humeral heads. LHBT: long head of biceps tendon, SGHL: superior glenohumeral ligament, MGHL: middle glenohumeral ligament, IGHL: inferior glenohumeral ligament. (Adapted and reprinted, with permission, from reference 7.) ... i had an mri on my shoulder an it shows subchondral cyst humeral head1.5 cm and rotator cuff thickining and tendonothpy . Appropriate MR imaging protocols and sequences and applied MR anatomy of the shoulder (including normal variants) are proposed to help assist management and treatment of common shoulder pathologies encountered (such as rotator cuff tears, impingement syndromes, and instability as well as less frequent causes of shoulder pain). 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