DOI: 10.1148/rg.264055087
MR Imaging of Rotator Cuff Injury: What the Clinician Needs to Know1
Yoav Morag, MD,
Jon A. Jacobson, MD,
Bruce Miller, MD,
Michel De Maeseneer, MD, PhD,
Gandikota Girish, MD and
David Jamadar, MD
1 From the Departments of Radiology (Y.M., J.A.J., M.D.M., G.G., D.J.) and Orthopedic Surgery (B.M.), University of Michigan Medical Center, 1500 E Medical Center Dr, TC-B1-132G, Ann Arbor, MI 48109-0326. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received April 11, 2005; revision requested June 30 and received August 19; accepted August 26. All authors have no financial relationships to disclose.
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Figure 1a. Overlap between the distal supraspinatus and infraspinatus tendons. Consecutive sagittal fat-saturated T2-weighted MR images (repetition time msec/echo time msec = 3000/60) (a obtained medial to b) show overlap between the distal supraspinatus tendon (SST) (green) and the distal infraspinatus tendon (IST) (yellow).
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Figure 1b. Overlap between the distal supraspinatus and infraspinatus tendons. Consecutive sagittal fat-saturated T2-weighted MR images (repetition time msec/echo time msec = 3000/60) (a obtained medial to b) show overlap between the distal supraspinatus tendon (SST) (green) and the distal infraspinatus tendon (IST) (yellow).
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Figure 2a. Rotator cuff arthropathy. (a) Sagittal T1-weighted MR image (620/8) shows a massive rotator cuff tear with only subscapularis tendon (SSC) fibers remaining. A = acromion, D = deltoid muscle, H = humeral head. (b) Coronal oblique T1-weighted MR image (620/8) shows superior subluxation of the humeral head (H) abutting the acromion (A). G = glenoid fossa. (c) Radiograph obtained in a different patient also shows superior subluxation of the humeral head abutting the acromion (cf b). (d) Coronal oblique T1-weighted MR image (620/8) obtained in a third patient shows subchondral bone marrow edema caused by impaction of the humeral head (H) against the acromion (arrow), a condition that may progress to collapse.
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Figure 2b. Rotator cuff arthropathy. (a) Sagittal T1-weighted MR image (620/8) shows a massive rotator cuff tear with only subscapularis tendon (SSC) fibers remaining. A = acromion, D = deltoid muscle, H = humeral head. (b) Coronal oblique T1-weighted MR image (620/8) shows superior subluxation of the humeral head (H) abutting the acromion (A). G = glenoid fossa. (c) Radiograph obtained in a different patient also shows superior subluxation of the humeral head abutting the acromion (cf b). (d) Coronal oblique T1-weighted MR image (620/8) obtained in a third patient shows subchondral bone marrow edema caused by impaction of the humeral head (H) against the acromion (arrow), a condition that may progress to collapse.
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Figure 2c. Rotator cuff arthropathy. (a) Sagittal T1-weighted MR image (620/8) shows a massive rotator cuff tear with only subscapularis tendon (SSC) fibers remaining. A = acromion, D = deltoid muscle, H = humeral head. (b) Coronal oblique T1-weighted MR image (620/8) shows superior subluxation of the humeral head (H) abutting the acromion (A). G = glenoid fossa. (c) Radiograph obtained in a different patient also shows superior subluxation of the humeral head abutting the acromion (cf b). (d) Coronal oblique T1-weighted MR image (620/8) obtained in a third patient shows subchondral bone marrow edema caused by impaction of the humeral head (H) against the acromion (arrow), a condition that may progress to collapse.
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Figure 2d. Rotator cuff arthropathy. (a) Sagittal T1-weighted MR image (620/8) shows a massive rotator cuff tear with only subscapularis tendon (SSC) fibers remaining. A = acromion, D = deltoid muscle, H = humeral head. (b) Coronal oblique T1-weighted MR image (620/8) shows superior subluxation of the humeral head (H) abutting the acromion (A). G = glenoid fossa. (c) Radiograph obtained in a different patient also shows superior subluxation of the humeral head abutting the acromion (cf b). (d) Coronal oblique T1-weighted MR image (620/8) obtained in a third patient shows subchondral bone marrow edema caused by impaction of the humeral head (H) against the acromion (arrow), a condition that may progress to collapse.
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Figure 3a. Neurogenic injury to the deltoid muscle. Coronal oblique fat-saturated T2-weighted (3000/60) (a) and axial intermediate-weighted (2500/28) (b) MR images show the deltoid muscle (arrows) with abnormal high signal intensity and volume loss due to neurogenic injury.
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Figure 3b. Neurogenic injury to the deltoid muscle. Coronal oblique fat-saturated T2-weighted (3000/60) (a) and axial intermediate-weighted (2500/28) (b) MR images show the deltoid muscle (arrows) with abnormal high signal intensity and volume loss due to neurogenic injury.
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Figure 4a. Focal full-thickness supraspinatus tendon tears. Coronal oblique (a) and sagittal (b) fat-saturated T2-weighted MR images (3000/60) obtained in two different patients show focal full-thickness tears of the supraspinatus tendon (SST). Double-headed arrow indicates the greatest dimension of the tears. GT = greater tuberosity.
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Figure 4b. Focal full-thickness supraspinatus tendon tears. Coronal oblique (a) and sagittal (b) fat-saturated T2-weighted MR images (3000/60) obtained in two different patients show focal full-thickness tears of the supraspinatus tendon (SST). Double-headed arrow indicates the greatest dimension of the tears. GT = greater tuberosity.
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Figure 5a. Partial-thickness tendon tears. (a) Coronal oblique fat-saturated T1-weighted MR image (570/11) shows an articular-surface partial-thickness tear (arrow) in the distal supraspinatus tendon (SST). (b) Coronal oblique fat-saturated T2-weighted MR image (3000/60) shows a bursal-surface partial-thickness tear (arrow) in the distal supraspinatus tendon (SST). These images can be used to estimate tear depth.
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Figure 5b. Partial-thickness tendon tears. (a) Coronal oblique fat-saturated T1-weighted MR image (570/11) shows an articular-surface partial-thickness tear (arrow) in the distal supraspinatus tendon (SST). (b) Coronal oblique fat-saturated T2-weighted MR image (3000/60) shows a bursal-surface partial-thickness tear (arrow) in the distal supraspinatus tendon (SST). These images can be used to estimate tear depth.
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Figure 6. Thinning of the rotator cuff. Coronal oblique fat-saturated T2-weighted MR image (3000/ 60) shows thinning of the supraspinatus tendon (arrow).
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Figure 7a. Tendon tears. Drawings illustrate a U-shaped tear before (a) and after (b) repair, a crescentic tear before (c) and after (d) repair, and an L-shaped tear before (e) and after (f) repair.
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Figure 7b. Tendon tears. Drawings illustrate a U-shaped tear before (a) and after (b) repair, a crescentic tear before (c) and after (d) repair, and an L-shaped tear before (e) and after (f) repair.
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Figure 7c. Tendon tears. Drawings illustrate a U-shaped tear before (a) and after (b) repair, a crescentic tear before (c) and after (d) repair, and an L-shaped tear before (e) and after (f) repair.
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Figure 7d. Tendon tears. Drawings illustrate a U-shaped tear before (a) and after (b) repair, a crescentic tear before (c) and after (d) repair, and an L-shaped tear before (e) and after (f) repair.
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Figure 7e. Tendon tears. Drawings illustrate a U-shaped tear before (a) and after (b) repair, a crescentic tear before (c) and after (d) repair, and an L-shaped tear before (e) and after (f) repair.
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Figure 7f. Tendon tears. Drawings illustrate a U-shaped tear before (a) and after (b) repair, a crescentic tear before (c) and after (d) repair, and an L-shaped tear before (e) and after (f) repair.
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Figure 8a. Tendon tears. (a) Axial fat-saturated T2-weighted MR image (3000/60) shows a tear (arrows) of the distal supraspinatus tendon (SST). The tear has mildly pulled away from bone, a finding that suggests a crescentic tear. (b, c) Axial (b) and coronal oblique (c) fat-saturated T2-weighted MR images (3000/60) depict a more medially displaced tear (small arrows in b) of the distal supraspinatus tendon (SST), a finding that suggests a U-shaped tear. This tear appears to extend into the rotator interval (large arrow in b). Double-headed arrow in c indicates the greatest longitudinal dimension of the tear.
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Figure 8b. Tendon tears. (a) Axial fat-saturated T2-weighted MR image (3000/60) shows a tear (arrows) of the distal supraspinatus tendon (SST). The tear has mildly pulled away from bone, a finding that suggests a crescentic tear. (b, c) Axial (b) and coronal oblique (c) fat-saturated T2-weighted MR images (3000/60) depict a more medially displaced tear (small arrows in b) of the distal supraspinatus tendon (SST), a finding that suggests a U-shaped tear. This tear appears to extend into the rotator interval (large arrow in b). Double-headed arrow in c indicates the greatest longitudinal dimension of the tear.
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Figure 8c. Tendon tears. (a) Axial fat-saturated T2-weighted MR image (3000/60) shows a tear (arrows) of the distal supraspinatus tendon (SST). The tear has mildly pulled away from bone, a finding that suggests a crescentic tear. (b, c) Axial (b) and coronal oblique (c) fat-saturated T2-weighted MR images (3000/60) depict a more medially displaced tear (small arrows in b) of the distal supraspinatus tendon (SST), a finding that suggests a U-shaped tear. This tear appears to extend into the rotator interval (large arrow in b). Double-headed arrow in c indicates the greatest longitudinal dimension of the tear.
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Figure 9a. Medial tendon retraction. Coronal oblique (a) and axial (b) fat-saturated T2-weighted MR images (3000/60) show medial retraction (arrow) of the stumps of the supraspinatus tendon (SST) and subscapularis tendon (SSC) almost to the glenoid fossa. As with medially retracted supraspinatus tendon tears, primary repair of medially retracted subscapularis tendon tears may not be feasible, and pectoralis major tendon transfer may be indicated.
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Figure 9b. Medial tendon retraction. Coronal oblique (a) and axial (b) fat-saturated T2-weighted MR images (3000/60) show medial retraction (arrow) of the stumps of the supraspinatus tendon (SST) and subscapularis tendon (SSC) almost to the glenoid fossa. As with medially retracted supraspinatus tendon tears, primary repair of medially retracted subscapularis tendon tears may not be feasible, and pectoralis major tendon transfer may be indicated.
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Figure 10. Factors affecting the medial extent of a tendon tear. On an axial fat-saturated T2-weighted MR image (3000/60), intact infraspinatus muscle and tendon fibers (arrow) are shown exerting a physiologic load on the posterior leaf of a U-shaped tear (arrowheads) of the distal supraspinatus tendon (SST), thereby increasing the distance between the tendon stump and the greater tuberosity. H = humeral head.
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Figure 11. Sagittal extent of rotator cuff tears as described by Thomazeau et al (52). Chart superimposed on a sagittal fat-saturated T2-weighted MR image (3000/60) shows the division of the rotator cuff into four segments (A–D). Supraspinatus tendon (SST) tears that extend to involve the rotator interval (B) could worsen the prognosis. IST = infraspinatus tendon, SSC = subscapularis tendon.
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Figure 12a. Involvement of the rotator interval. (a) Coronal oblique fat-saturated T2-weighted MR image (3000/ 60) shows an anterior tear (arrow) of the supraspinatus tendon (SST). (b) Coronal oblique fat-saturated T2-weighted MR image (3000/60) shows that the tear involves the ligamentous pulley of the long head of the biceps brachii tendon (black arrow) at its attachment to the lesser tuberosity (white arrow). SSC = subscapularis tendon. (c) Axial fat-saturated T2-weighted MR image (3000/60) shows that the tear (arrow) extends anteriorly to involve the lateral aspect of the coracohumeral ligament (*). C = coracoid process.
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Figure 12b. Involvement of the rotator interval. (a) Coronal oblique fat-saturated T2-weighted MR image (3000/ 60) shows an anterior tear (arrow) of the supraspinatus tendon (SST). (b) Coronal oblique fat-saturated T2-weighted MR image (3000/60) shows that the tear involves the ligamentous pulley of the long head of the biceps brachii tendon (black arrow) at its attachment to the lesser tuberosity (white arrow). SSC = subscapularis tendon. (c) Axial fat-saturated T2-weighted MR image (3000/60) shows that the tear (arrow) extends anteriorly to involve the lateral aspect of the coracohumeral ligament (*). C = coracoid process.
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Figure 12c. Involvement of the rotator interval. (a) Coronal oblique fat-saturated T2-weighted MR image (3000/ 60) shows an anterior tear (arrow) of the supraspinatus tendon (SST). (b) Coronal oblique fat-saturated T2-weighted MR image (3000/60) shows that the tear involves the ligamentous pulley of the long head of the biceps brachii tendon (black arrow) at its attachment to the lesser tuberosity (white arrow). SSC = subscapularis tendon. (c) Axial fat-saturated T2-weighted MR image (3000/60) shows that the tear (arrow) extends anteriorly to involve the lateral aspect of the coracohumeral ligament (*). C = coracoid process.
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Figure 13. Disruption of the transverse force couple. Axial fat-saturated T2-weighted MR image (3000/60) shows anterior subluxation of the humeral head (H) relative to the glenoid fossa (G), a finding that may be related to disruption of the coupled axial forces. Fluid is noted in the glenohumeral joint and subdeltoid bursa as part of an infraspinatus tendon tear (arrow) and a large tear (not seen) of the supraspinatus tendon (SSC).
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Figure 14. Injury to the long head of the biceps brachii tendon. Sagittal fat-saturated T2-weighted MR image (3000/60) shows an extensive full-thickness tear of the supraspinatus tendon. Note the abnormal thickening and intermediate signal intensity of the long head of the biceps brachii tendon (arrow) within the rotator interval superior to the subscapularis tendon (SSC). These findings are consistent with injury to the long head of the biceps brachii tendon. IST = infraspinatus tendon.
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Figure 15a. Dislocation of the long head of the biceps brachii tendon. (a) Coronal oblique fat-saturated T2-weighted MR image (3000/60) shows an anterior tear (arrow) of the distal supraspinatus tendon (SST). (b) Axial fat-saturated T2-weighted MR image (3000/60) shows the long head of the biceps brachii tendon (arrow) dislocated medially from the bicipital groove deep to the superficial subscapularis tendon (SSC) fibers.
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Figure 15b. Dislocation of the long head of the biceps brachii tendon. (a) Coronal oblique fat-saturated T2-weighted MR image (3000/60) shows an anterior tear (arrow) of the distal supraspinatus tendon (SST). (b) Axial fat-saturated T2-weighted MR image (3000/60) shows the long head of the biceps brachii tendon (arrow) dislocated medially from the bicipital groove deep to the superficial subscapularis tendon (SSC) fibers.
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Figure 16. Drawing illustrates use of the sagittal plane (dashed line) relative to the coracoid base and acromial spine for estimating volume loss in the supraspinatus muscle.
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Figure 17. Sagittal fat-saturated T2-weighted MR image (3000/60) shows a normal occupation ratio, representing the ratio between the cross-sectional area (green) of the belly of the supraspinatus muscle (SST) and that of the scapular fossa (orange).
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Figure 18. Abnormal occupation ratio. Sagittal fat-saturated T2-weighted MR image (3000/60) shows volume loss in the supraspinatus muscle (SST), whose cross-sectional area (green) is now much smaller than that of the scapular fossa (orange).
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Figure 19a. Tangent sign. (a) Sagittal fat-saturated T2-weighted MR image (3000/60) shows the belly (green) of a normal supraspinatus muscle (SST) crossing a tangent (red line) drawn between the superior borders of the scapular spine and the superior margin of the coracoid process. (b) Sagittal fat-saturated T2-weighted MR image (3000/60) shows atrophy of the belly (green) of the supraspinatus muscle (SST), which now lies entirely below the tangent (red line).
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Figure 19b. Tangent sign. (a) Sagittal fat-saturated T2-weighted MR image (3000/60) shows the belly (green) of a normal supraspinatus muscle (SST) crossing a tangent (red line) drawn between the superior borders of the scapular spine and the superior margin of the coracoid process. (b) Sagittal fat-saturated T2-weighted MR image (3000/60) shows atrophy of the belly (green) of the supraspinatus muscle (SST), which now lies entirely below the tangent (red line).
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Figure 20a. Muscle fatty degeneration and volume loss in a rotator cuff muscle. (a) Coronal oblique fat-saturated T2-weighted MR image (3000/60) shows a full-thickness tear of the supraspinatus tendon (SST). The SST muscle belly appears to be markedly decreased in size. (b) Sagittal T1-weighted MR image (620/8) shows severe fatty degeneration and volume loss in the supraspinatus muscle belly (arrowhead) and infraspinatus muscle belly (arrow). The volume of the subscapularis (SSC) muscle belly appears to be unchanged. (c) Coronal oblique T1-weighted MR image (620/8) obtained in a different patient shows fatty degeneration of the infraspinatus muscle belly (IST). A = acromion.
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Figure 20b. Muscle fatty degeneration and volume loss in a rotator cuff muscle. (a) Coronal oblique fat-saturated T2-weighted MR image (3000/60) shows a full-thickness tear of the supraspinatus tendon (SST). The SST muscle belly appears to be markedly decreased in size. (b) Sagittal T1-weighted MR image (620/8) shows severe fatty degeneration and volume loss in the supraspinatus muscle belly (arrowhead) and infraspinatus muscle belly (arrow). The volume of the subscapularis (SSC) muscle belly appears to be unchanged. (c) Coronal oblique T1-weighted MR image (620/8) obtained in a different patient shows fatty degeneration of the infraspinatus muscle belly (IST). A = acromion.
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Figure 20c. Muscle fatty degeneration and volume loss in a rotator cuff muscle. (a) Coronal oblique fat-saturated T2-weighted MR image (3000/60) shows a full-thickness tear of the supraspinatus tendon (SST). The SST muscle belly appears to be markedly decreased in size. (b) Sagittal T1-weighted MR image (620/8) shows severe fatty degeneration and volume loss in the supraspinatus muscle belly (arrowhead) and infraspinatus muscle belly (arrow). The volume of the subscapularis (SSC) muscle belly appears to be unchanged. (c) Coronal oblique T1-weighted MR image (620/8) obtained in a different patient shows fatty degeneration of the infraspinatus muscle belly (IST). A = acromion.
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Figure 21a. Types of acromia. Sagittal fat-saturated T2-weighted MR images (3000/60) show type 1 (a), type 2 (b), type 3 (c), and type 4 (d) acromia (*).
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Figure 21b. Types of acromia. Sagittal fat-saturated T2-weighted MR images (3000/60) show type 1 (a), type 2 (b), type 3 (c), and type 4 (d) acromia (*).
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Figure 21c. Types of acromia. Sagittal fat-saturated T2-weighted MR images (3000/60) show type 1 (a), type 2 (b), type 3 (c), and type 4 (d) acromia (*).
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Figure 21d. Types of acromia. Sagittal fat-saturated T2-weighted MR images (3000/60) show type 1 (a), type 2 (b), type 3 (c), and type 4 (d) acromia (*).
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Figure 22. Lateral acromial angle. Coronal oblique T1-weighted MR image (620/8) shows a downsloping acromion (A).
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Figure 23a. Os acromiale. Axial (a) and coronal oblique (b) fat-saturated T2-weighted MR images (3000/60) show an os acromiale (arrow). SST = subscapularis tendon.
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Figure 23b. Os acromiale. Axial (a) and coronal oblique (b) fat-saturated T2-weighted MR images (3000/60) show an os acromiale (arrow). SST = subscapularis tendon.
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Copyright © 2006 by the Radiological Society of North America.
