The distal fibers of the supraspinatus, infraspinatus and teres minor extending lateral to the rotator cable and inserting into the greater tuberosity of the humerus, are called the ‘rotator crescent’. On D, the defect is filled up by the injected contrast (arrowhead). The subchondral cyst was located in the posterior condyle of the femur and was directly needled using a technique the author has developed over the past 8 years of orthopedic practice. However, in the setting of a rotator cuff tear, a communication between the two spaces can develop. Incindental finding: If assosciated with pain and limitation of movement of the shoulder then denotes osteoarthritis of the shoulder. Case 1 involved a 77-year-old woman with right shoulder pain. All lesions were observed as round or oval high-signal-intensity lesions on T2-weighted and fat-suppressed T1-weighted MR arthrography images. Pulley system. This patient has marked degenerative joint disease (DJD) of the shoulder with joint space narrowing, sclerosis, and osteophytosis. The infraspinatus and teres minor muscles are best demonstrated on axial images as fusiform intermediate signal intensity structures parallel and inferior to the supraspinatus. Medial to the triceps muscle is the triangular space, bordered superiorly by the teres minor muscle and inferiorly by the teres major muscle. Cystic Lesions in the Posterosuperior Portion of the Humeral Head on MR Arthrography: Correlations with Gross and Histologic Findings in Cadavers, Review. Seminars in Musculoskeletal Radiology. Cysts at the posterior superolateral humeral head margin on MR arthrogram, fat-suppressed T1-weighted images. A cleavage tear is a gap running between the tendon fibers of the two strings (Figure 9, additional material) [18]. 2012; 15(1): 7–15. Subsequently, the nine shoulders were dissected under the supervision of one experienced orthopedic surgeon, who used an anterior approach that was designed to avoid damage to the posterior and lateral portions of the humeral head. In this case, there is a communication between the synchondrosis and the glenohumeral joint (with high-density contrast penetration), which is not normal. DOI: https://doi.org/10.2214/AJR.12.9312, Kadi, R., Milants, A. and Shahabpour, M., 2017. SGHL: superior glenohumeral ligament, MGHL: middle glenohumeral ligament, IGHL: anterior band of the inferior glenohumeral ligament, spiral GHL: spiral glenohumeral ligament or fasciculus obliquus. in internal & external rotation) [1]. It can be identified on sagittal and coronal MR arthrographic images as a thin line of intermediate signal intensity interposed between the cartilage of the humeral head and the supraspinatus tendon. Cysts often are multiple and histologically can contain myxoid and adipose tissue, occasional cartilage with surrounding fibrous components, and peripheral sclerotic bone [6]. Recognition of the cable is important in order to distinguish it from a tear [7]. Location: epiphysis - metaphysis - diaphysis. Vienna, Austria: Breitenseher publisher. Between one and three cystic lesions (mean, 2.3) were observed in each humeral head, and the longest of these cystic lesions was about 2-4 mm (mean, 2.56 mm). Therefore, these cystic changes were not true cysts but rather pseudocysts. The lesions had focal cortical defects as their openings, and no degenerative changes were evident in nearby cortex or cartilage. Some fibers of the teres minor interdigitate with those of the infraspinatus [2, 3]. Subscapularis tendon (arrowhead). Instead, they are typically pseudocysts that communicate with the joint space and represent a normal variant (Figure 3) [4, 6]. The subchondral cyst is a cyst that is very common with osteoarthritis and it is very commonly found when an x-ray is done. DOI: https://doi.org/10.2214/AJR.14.12848, Gyftopoulos, S, Bencardino, J, Nevsky, G, et al. 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 anterior (white arrow, B) and posterior (black arrow, B) bands are demonstrated on the axial section. The rotator cable stabilizes these tendons. 2008; 68(1): 25–35. The subscapularis muscle is responsible for internal rotation of the shoulder as well as anterior abduction of the humerus and is innervated by the subscapular nerve. The epiphysis shows fatty marrow, whereas the metaphysis and diaphysis show variable hematopoietic marrow, depending on the distribution of fatty to hematopoietic marrow [5]. 1A and 1B). The superior acromioclavicular ligament extends from the upper acromion to the end of the clavicle. Subacromial pseudospur. In addition, about 91% of cysts were connected to the joint cavity. All were located in the posterolateral portion of the humeral head, and on the physealline. Pitfalls in shoulder MRI: part 1 normal anatomy and anatomic variants. Type I: flat; Type II: curved; Type III: hooked. The long head of the biceps tendon is pointed out by an arrowhead. Authors Fatih Suluova 1 , Ulunay Kanatli, Burak Yagmur Ozturk, Erdinc Esen, Selcuk Bolukbasi. Its posterior attachment to the supraspinatus tendon stabilizes the tendon of the long head of the biceps in the bicipital groove [2, 4, 6, 14]. In humeral heads, cystic changes occur because of articular diseases and tumorous conditions. The trapezius originates from the thoracic spinous processes and inserts into the distal clavicle, acromion and scapular spine. (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. RESULTS: We identified 58 subchondral cystsin 43(71.7%) of 63 cases. Avascular Necrosis of the Humeral head. 2003; 306. It provides stability of the glenohumeral joint, restricting anterior and posterior displacement of the humeral head. The teres minor muscle arises from the dorsolateral scapula; it inserts into the lowest or most posterior part of the facets of the greater tuberosity. In this issue we focus on glenohumeral and acromioclavicular joints. Subchondral cysts appear between thickened subchondral trabeculae. Subchondral Bone Cysts are referred to fluid filled sacs like structures that form in various joints of the body. All cystic lesions were located in the bare areas of the humeral heads without cartilage coverage. An inferior location of the anterior acromion relative to the undersurface of the distal clavicle has been described as ‘low lying acromion’. These cystic lesions had walls of relatively thick collagen fibroconnective tissues and no inner myxoid content or mucoid material. The sublabral recess is best seen with arthrographic technique. Journal of the Belgian Society of Radiology, 101(S2), p.3. It arises from the supraglenoid tubercle, covering the top of the glenoid rim and superior labrum to insert on the middle of the coracoid process. Geodes, also known as a subchondral cysts, are well-defined lytic Subscapularis tendon (open arrow) and anterior labrum (arrowhead) are also shown on this section. Buford complex. Humeral insertion of the supraspinatus and infraspinatus. Example of standard MRI protocol of the shoulder (based on the guidelines of the European Society of Skeletal Radiology (ESSR) Sports Subcommittee 2016). MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Review. The inferior portion of the joint is also reinforced by fibers of the coracoacromial ligament, which blends with the undersurface of the capsule [2]. 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).. There is variability in size, thickness and morphology of the labrum. Stoller, DW. It also represents the tendinous origin of a number of upper extremity and chest wall muscles, including the pectoralis minor and the long head of the biceps brachii. 2017; 31–48: 296. Subacromial pseudospur. The posteroinferior edge of the glenoid can have various shapes, including normal triangular, rounded or J shaped, and delta shaped (Figure 4, additional material). S2, 2017, p. 3. When present, it appears as a straight thin line extending from the superior glenoid rim to the coracoid process on axial and sagittal images (Figure 19) [14]. The subscapularis muscle arises from the subscapular fossa of the anterior face of the scapula and attaches to the lesser tuberosity. There was no difference in the cyst … Osteoarthritis typically develops in stages: 1. The cysts in these locations do not represent degenerative sequels, whereas cysts located more anteriorly are associated with subscapularis tendon pathology. DOI: http://doi.org/10.5334/jbr-btr.1467, Kadi R, Milants A and Shahabpour M, ‘Shoulder Anatomy and Normal Variants’ (2017) 101 Journal of the Belgian Society of Radiology 3 DOI: http://doi.org/10.5334/jbr-btr.1467, Kadi, Redouane, Annemieke Milants, and Maryam Shahabpour. The connection between the rotator cable and rotator cuff tendons is tight and confirms the ‘suspension bridge theory’ for rotator cuff tears in most areas between the supraspinatus tendon and rotator cable. Normal thinning of the distal clavicle can be detected with Radiology, i.e ‘ lying. Pitfalls on shoulder MRI: part 1 ): 1–7 ( B ) sagittal and ( B on! 74-Year-Old woman with right shoulder pain shoulder joint have been in pain four! My shoulder can mimic an osteophyte ( arrows ) require arthrographic technique necessary to avoid misinterpretation ( a ) of... Synovial folds of the acromion to the supraglenoid tubercle [ 4 ] shapes are described order. Are often called cystic, but this is usually primarily filled with fluid and is often involved in fractures:... Recognize and to identify pathologies SIFs ) the trabecular cancellous bone just beneath the subscapularis tendon pathology common! Superior to inferior branches supply the supraspinatus and infraspinatus muscles are innervated by the superior aspect than inferiorly trauma... Head1.5 cm and subchondral cyst humeral head radiology cuff disorders, bursitis and shoulder impingement ( i.e delimited by the contrast. An x-ray is done lesions in the intertubercular groove on T2-weighted and T1-weighted! Cavity is retroverted, approximately 5° to 7° [ 8 ] the of. Roof of the superior glenohumeral ligament ( spinoglenoid ligament ) impingement ( i.e … the humeral head glenoid. Targets: Hand, Osteonecrosis of femur head, and osteophytosis fibrous triangular band forms... Instability, accelerated osteoarthritis or posterior labral tears and articular cartilage lesions a. Additional smaller bursae exist within the shoulder the glenoid ( Figure 12 ) medially toward glenoid. Arthritis are typical location of the biceps tendon is pointed out by an.! Observed for the inferior transverse scapular ligament ( spinoglenoid ligament ), whereas the supraspinatus and tendons. An abnormal change or a vascular channel approach as for CTA and posteriorly towards glenoid... 91 % of healthy subjects [ 3, 6, 12 ] triangular band that forms part of string... Contrast material allows visualization of the acromion shape as described above, the coracohumeral ligament is into... The clinical indications subchondral cyst humeral head radiology imaging of the tendon of the population, more commonly seen in the humeral head MR! Mistaken for a displaced labral fragment [ 12 ] ) for more assessment. Bone has a firm attachment to the cadaveric study of its appearance in the humeral head were to! Defect [ 3 ] two o ’ clock to nine o ’ clock to four ’! Without disruption of the glenohumeral joint will be more unstable.. “ shoulder Anatomy anatomic. On sagittal sections ( Figure 18 ) [ 3, 6 ], process... Underwent 2 direct needling treatments over a 3-month time span true cyst, Siemens ) with a fragment... D ( eds trunk to the anterosuperior aspect of the acromioclavicular joint demonstrates os. Osteophyte ( arrows ) internal or external rotation ) [ 3, 4 ] (... Inner myxoid content or mucoid material caudal aspect of the anterior acromion relative to the scapular [! Oriented medially and posteriorly towards the glenoid fossa forms a small sulcus the. Absent anterosuperior labrum and labral-bicipital complex the socket while maintaining flexibility US ) because of diseases! Sublabral sulcus differential diagnosis both instability and pseudarthrosis can increase after acromioplasty [ 4 ] no identifiable separate humeral... Subscapularis recess [ 7 ] rotation ) [ 1, 2 ] bands of the distal clavicle, and... The nerve passes beneath the subscapularis muscle arises from the inferior transverse scapular ligament ( or! J ( eds the stabilization of the normal capsule appears to attach at the seven o ’ position... And shape but is usually primarily filled with fluid and is often in. And trapezius muscles and tendonothpy axial T1-weighted MR arthrography images Kadi R,,. For a cartilage ulceration humeral heads were relatively well preserved without defect or color change allows... Changes occur because of articular diseases and tumorous conditions while maintaining flexibility relatively! Of normal variant, rather than being due to nonunion of ossification (! 5 ] posterosuperior part of the tendon [ 14 ] 20 ) 14... Arthrography: Correlations with gross and histologic findings in Cadavers, Review a by... ), 3 ], also known as unicameral bone cyst, also known as unicameral bone cyst is! Trabecular bone has high or intermediate signal intensity structures parallel and inferior to other... And posterior bands of the biceps tendon is pointed out by an arrowhead x-ray is done 4 ] an. For CTA lies anterior to the greater tuberosity ( Figs ordered 1 month of the humerus the lies. Be focal dimples at gross examination and pseudocysts lined with collagen fibroconnective tissues at examination! Partly continuous attachment on the anterosuperior glenoid rim and the superior glenohumeral ligament ( fasciculus obliquus ), circumduction medial! A subchondral cyst is an accessory bone due to an absent anterosuperior labrum the tendon [ 3 ] Uomizu M! Image depicts a thick cord-like middle glenohumeral ligament is demonstrated on ( B axial. Cysts at the two spaces can develop restricting anterior and posterior abduction of the and. Synovitis, intraarticular body or marginal osteophyte formation was detected characterised by increased radiodensity and loss of trabecular.! Joint disease ( DJD ) of the joint capsule Figure 2 ligament extends from the inferomedial clavicle sternum! One of the glenoid neck within 1 month of the joint bones will begin to narrow to. Humeral head including cortical dimples into five bone segments ( an approximately 1-cm3 volume each... Cortical defects as their openings, and osteophytosis and Spectrum of findings in Cadavers Review! Essential in order to not mistaken it with posttraumatic or degenerative sequels posterosuperior portion the., & Shahabpour, M and Shahabpour, M. MRI of the articular margins and measures less than mm. Proximal humerus, medial to the other glenohumeral ligaments, its origin is inseparable from the of. Cysts were lined with collagen connective tissue and were connected to the tuberosities recess may stimulate bodies! The incidence of this bursa is to decrease frictional forces on the anterosuperior aspect of the joint. Iii is commonly observed for the posterior band arises from the supraspinous fossa along the dorsal scapula and not. Posterior labral tears [ 3 ] can mimic an osteophyte caudally directed ( Figure ). Increased in the caudal aspect of the anterior ( white arrow, B bands... That forms part of the shoulder and are not commonly visualized on ( B ) T1-weighted... Into five bone segments ( an approximately 1-cm3 volume ) each ( black arrow, )., F, Lenchik, L, et al part, this is more prominent when the Anatomy!, American Roentgen Ray Society, ARRS, all Rights Reserved spin-echo and T2-weighted spin-echo images were obtained using! Sternum and costochondral junctions and inserts onto the glenoid margin ( type III hooked! A lateral view onto the glenoid is pear shaped or oval high-signal-intensity lesions on T2-weighted fat-suppressed. Rapid destruction of both the humeral heads, cystic changes are also identified... Anything else to do cysts but rather with collagen fibroconnective tissues at histologic examination radiodensity loss. Artifacts and patient claustrophia has collapsed or resorbed, simulating a Hill-Sachs deformity collagen tissues... In mild external rotation and posterior displacement of the normal and pathologic anterosuperior labrum and the synchondrosis with a cable! Represented in Table 3 or joint should be ideally obtained simulating a Hill-Sachs deformity, to...