Rotator Cuff MRI - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing MRI imaging of the rotator cuff.
MRI is valuable in diagnosing most shoulder problems, especially rotator cuff pathology.
Normal rotator cuff anatomy coronal vies: normal cuff appears dark on T1 & T2 MRI. The normal distance between the acromion and the humeral head is between 7-14 mm. in the axial view, check the biceps tendon for subluxation. Subluxation could indicate a subscapularis tendon tear.
Normal rotator cuff sagittal view: normally the supraspinatus muscle occupies the fossa in the sagittal view. When the muscle is abnormal, it does not occupy the fossa. Muscle fat atrophy is usually seen on the sagittal image.
Impingement
Internal impingement is pathology on the underside of the rotator cuff. External impingement (subacromial) is pathology on the bursal side of the rotator cuff and is the most common type of shoulder impingement.
What is internal impingement? internal impingement is partial tear of the under surface of the rotator cuff that occurs in throwing athletes and usually is associated with posterior and superior labral tears.
What is external impingement (sub acromial)? External impingement involves the sub acromial bursa and with external impingement, the pain is increased by overhead activity. The patient could have night pain. The distance between the acromion and the humeral head is usually 6 mm or less. May be associated with type III hooked acromion and Os acromial.
Treatment of sub acromial impingement
•Therapy for at least 6 months before surgery.
Tendinopathy
Rotator cuff becomes thickened with intermediate signal on T1 and T2.
Calcific tenditis
Calcification inside the rotator cuff tendon.
Rotator cuff tears:
Partial three types: fluid or dye extends partially through the thickness of the tendon.
1-Articular surface partial
2-Bursal surface partial
3-Intrasusbtance partial
Full thickness tear: fluid bright signal extends completely through the tendon from superior to inferior. The tendon may be retracted and there will be a gap in the tendon.
MRI arthrogram can improve visualization of the tear and accuracy of the study in asymptomatic patients 60 years old or older, 55% will have a rotator cuff tear on their MRI. If you see a cysts in the humeral head on MRI, the patient will probably have a rotator cuff tear.
Massive tears of the rotator cuff that are greater than 5 cm usually involve multiple tendons.
MRI will show massive cuff tear with retraction at the level of the glenoid with atrophy of the muscle and fatty infiltration. The supraspinatus is ruptured and retracted.

Become a friend on facebook:

Follow me on twitter:

[fujirama]

Dr Ebraheim you have a way of making things easy to understand in a concise way. Thanks very much!

[bkaley]

No yacking, just a a good detailed view and explanation of the whole thing. Thank You!

[richardrodriguez]

I am now at the end of my third week of surgery 7/17. My surgery required a 5 inch incision on top of my humorous cap because it was a severe tear! I have attempted to  much motion to soon and now have a frozen shoulder. I will now let my inflammation subside before beginning my PT. I really over estimated what would be beneficial so I will take a step back. BTW frozen shoulders occur sometimes for no explained reasons but my follow up is week 5 so I will surrender to a PT. ADVICE don't push it depending on the degree of your surgery. My procedure was more invasive then I thought it would be. Carefully I will now proceed!!!

[ursaucie]

Excellent Video. Now I understand my mri a bit more. Thank You!!

[myrandahernandez]

I just got my mri today trying to read it haha thank you!

[CyndiBrinkler]

Thank you so much for this very clear definition.

[alrise]

That was a great video! Thank you, sir, for explaining this to me!

[nancyibraham]

What a great video! this really helped.

[aminahpd]

I just wanna say thank you from the bottom of my heart. I may have a chance in passing!

[losboston]

Thanks! The association between humeral head cyst and cuff tear: is that for 60 years of age and over only or a general association?

[Tommyr]

Very interesting video. I am having my left shoulder looked at next week. Limited range of motion and very painful. Possibly arthritis. Thank you for this video.

[woody]

Good video.. Just heard about impingements... So those are Not rotator cuff tears but will require surgery?

[mssatire]

I want to see arthrogram vs standard MRI good shoulder vs torn shoulder. But best explanation by far I think for my case.

[hay]

Dr. Mabil, my name is haytum from Georgia. I got a shoulder mri today but won’t be able to get it read until next week. May I email you my image files see if you can find something please

[jeansmith]

Initially, in June 2015 after an MRI on my right shoulder a diagnosis was given that there was a  need for surgery for a rotator cuff tear.  However, when she got into the shoulder via arthroscopy there was not a tear.  The doctor said she filed down arthritis.  I went to 12 weeks of physical therapy two times a week. If anything my shoulder hurts more now than before with popping and pain in shoulder running down into my lower arm.  She has given me 3 cortisone shots over the period of April until October 2015. Am I being impatient for the healing process to be completed or should I get another opinion?  I know you do not anything to look at but as I read your comments to others you seem to be an expert in this field.  Maybe a point I should tell you.  I have degenerative disk disease and have had surgery because of osteoarthritis L3-4, L4-5 and L5-S1.  My doctor knows about this and I was wondering if my neck pain and my shoulder pain could be connected?

[saadsohail]

Have issue in my rotator cuff can't throw anything got my MRI done no doctor still able to diagnose what is the issue with my shoulder

[linsen]

at 1:36 it should be labelled as CORACOID PROCESS instead of clavicle

[sandybabcock]

I have a 33 percent rotator cuff tear. One year later and 3 cortisone shots later I still have pain. Doc said might need to remove spurs. I have full range of motion, but with pain at certain points. I fell and reached out and my hand hit pavement in reaction to catch myself.

[dineshprabakar]

I have same problem past 3 years. I'm cricket bowler... Now a days i could not bowl and through... Pls help me which one is good ( therapy or surgery)

[AURORA]

48 year old female
based on the information provided, would would be in your opinion, the most suitable course of treatment. Just asking for an opinion.

EXAM: MRI UP EXT ANY JT W/O LT, 10/15/2015 2:27 PM

COMPARISON: Left shoulder radiographs, 09/30/2015.

INDICATION: Left shoulder pain. The technologist elicited the
history of pain radiating into the base of the skull.

TECHNIQUE: 6 pulse sequences were obtained using multiecho,
multiplanar technique.

FINDINGS: Small amount of fluid is identified in the subcoracoid
bursa. A partial tear of the subscapularis tendon is noted. The
remaining rotator cuff tendons appear within normal limits. Mild
signal alterations are identified in the insertion of the biceps
tendon. A questionable tear of the rotator interval may be present.
The muscle and marrow signal intensity is within normal limits. No
muscle retraction is noted. The glenoid labra appear intact.

Impression
Partial tear subscapularis tendon.

Subcoracoid effusion/bursitis.

Biceps tendinosis.

Questionable rotator interval tear.

XA


EXAM: MRI UP EXT ANY JT W/O RT, 11/12/2015 11:00 AM

COMPARISON: Right shoulder radiographs, 09/30/2015.

INDICATION: Right shoulder pain. The technologist elicited the
history that the patient's shoulder begins hurting after scrubbing
floors on 1st of August. Pain is all over with no weakness.

TECHNIQUE: 6 pulse sequences were obtained using multiecho,
multiplanar technique.

FINDINGS: A benign-appearing bone cyst is identified involving the
anterior humeral head. Degenerative bone changes with subchondral cyst
formation are noted near the bicipital groove. The rotator cuff and
biceps tendons are intact with normal-appearing signal. The rotator
interval also appears intact. The muscle and marrow signal intensity
demonstrates no gross abnormalities. The distal clavicle produces mass
effect upon the superior portion of the supraspinatus muscle near the
myotendinous junction. A partial tear may be present involving the
superior anterior glenoid labrum. The remaining glenoid labrum appear
intact. No abnormal effusions are seen.

Impression
Findings suspicious for partial tear, superior anterior glenoid
labrum.

Distal clavicle mass effect upon the supraspinatus muscle nerve
myotendinous junction.

Humeral head degenerative bone changes with subchondral cyst formation
and a benign-appearing humeral head cyst. See above.

XA