Humeral head cysts: association with rotator cuff tears and age Eur J Orthop Surg Traumatol. The glenoid fossa forms a very shallow socket reinforced by muscles, ligaments and cartilage, helping to prevent dislocation. The shoulder joint space is still preserved (red arrow). All lesions were observed as round or oval high-signal-intensity lesions on T2-weighted and fat-suppressed T1-weighted MR arthrography images. “Shoulder Anatomy and Normal Variants”. The long head of biceps tendon is covered by a synovial sheath that communicates with the joint capsule. However, in the setting of a rotator cuff tear, a communication between the two spaces can develop. The coracoclavicular ligament complex, which connects the distal end of the clavicle to the coracoid process, controls vertical stability of the acromioclavicular joint. A variable deep notch or a physiological flattening in the humeral neck is located posterior to the greater tubercle and best visualized on axial images; this pitfall should not be mistaken for a Hill-Sachs impaction which is seen at or above the level of the coracoid process (Figure 4) [4, 5]. The two last posterior glenoid rim variants can be associated with varying degrees of posterior shoulder instability due to loss of concavity of the inferior glenoid margin. 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). (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. The ligament provides stabilization of the glenohumeral joint when the shoulder is abducted 45° [2, 6]. Coronal oblique PD-weighted MR image depicts the normal attachment of the tendon of the deltoid muscle visible on one single section mimicking an enthesophyte (arrow). (A) Axial and (B) Coronal oblique fat-suppressed T1-weighted MR arthrographic images show subchondral cysts at the attachment of the infraspinatus tendon (arrow). The second most common site was the attachment of the supraspinatus tendon. The rotator interval contains several important anatomical structures that contribute to the stability and normal function of the shoulder joint, including biceps tendon, coracohumeral ligament, superior glenohumeral ligament, rotator interval capsule, anterior fibers of the supraspinatus tendon, and superior fibers of the subscapularis tendon. Rapid destruction of both the humeral head and glenoid was seen within 1 month of the onset of shoulder pain. Axial fat saturated T2-weighted MR image depicts a thick cord-like middle glenohumeral ligament (arrow). Location of cystic changes, number of cysts Superior Middle facet Lesser Humeral Tear facet anterior posterior tuberosity head None - - 11 - - Partial 3 6 12 - 1 Complete 6 6 8 5 - The average size of the cysts was 4.5 (2-15) mm. The sublabral recess can coexist and communicate with the sublabral foramen [3, 4, 6, 12]. (B) Sagittal oblique PD-weighted MRA shows the anterior band of the inferior glenohumeral ligament (white arrows, B) and the posterior band of this ligament (black arrows, B). 1 doctor agrees. (A) Schematic illustration of the anterior ligaments of the shoulder. Subchondral Cyst or Geode of the Shoulder. These cysts were lined with collagen connective tissue and were connected to the joint spaces. Precise knowledge of the normal anatomy and variants is important to recognize and to identify pathologies. It extends from the edge of the acromion, anterior to the articular surface of the acromioclavicular joint, to the lateral border of the coracoid process (Figure 7, additional material). Am J Roentgenol. In its posterior insertion area, the rotator cable is a connecting structure between the teres minor, infraspinatus and supraspinatus tendons (Figure 11, additional material). The shoulder is capable of flexion-extension, abduction-adduction, circumduction and medial and lateral rotation. degenerative subchondral bone cyst must be added to the differential diagnosis. Figure 1 Glenoid ossification centers. This patient has marked degenerative joint disease (DJD) of the shoulder with joint space narrowing, sclerosis, and osteophytosis. Magn Reson Imaging Clin N Am. Journal of the Belgian Society of Radiology. Subchondral cysts of the humeral head and normal bare area. Bare area of the glenoid on CTA. The shoulder joint is functionally and structurally complex and is composed of bone, hyaline cartilage, labrum, ligaments, capsule, tendons and muscles. True cartilage defects of the humeral head are often located in the posterosuperior portion medial to the location of the bare area [3, 5, 6, 7]. (A) Coronal, (B) Axial and (C, D) Sagittal reconstructed CTA images demonstrate in the mid third of the glenoid a defect of the hyaline cartilage located centrally (arrows, A–C). The acromion is a posterior shoulder landmark; it is a posterolateral extension of the scapular spine, superior to the glenoid. 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). These cysts are generally what cause the pain that you are experiencing. 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 … (A) Axial and (B) Sagittal fat suppressed T1-weighted MR arthrogram of a sublabral foramen. Subacromial pseudospur. The inferior border of the rotator interval is formed by the middle glenohumeral ligament [6, 14]. The epiphysis shows fatty marrow, whereas the metaphysis and diaphysis show variable hematopoietic marrow, depending on the distribution of fatty to hematopoietic marrow [5]. The anterior (white arrow, B) and posterior (black arrow, B) bands are demonstrated on the axial section. This sulcus is visualized on (B) Axial T1-weighted MR arthrographic image (arrow, B) on an upper section. However, in the present study, cystic lesions in the humeral head were presumed to be subchondral cysts without histologic confirmation. They are also easily identified when an articular effusion is present [2, 12]. The suprascapular vessels project superior to this ligament. 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]. The anatomic neck forms the oblique circumference of the humeral head and separates the head from the tuberosities. [7] applied the term “geodes” to subchondral cysts from osteoarthritis, rheumatoid arthritis, calcium pyrophosphate deposition disease, and osteonecrosis. Journal of the Belgian Society of Radiology, vol. Dr. Clive Segil answered. It may originate from the anterior, posterior or both aspects of the labrum. The coracohumeral ligament is not a true ligament connecting two bones. In this issue we focus on glenohumeral and acromioclavicular joints. The glenoid labrum is a fibrocartilaginous structure attached around the margin of the glenoid cavity and covering the bony surface. The study of Guerini et al., indicates that the supraspinatus tendon may consist of two distinct strings representing the superficial and deep bundles of the tendon. New anatomical findings regarding the footprint of the rotator cuff. Although this chapter is based on MRI, we should not forget the importance of standard radiographs for the evaluation of bone and joint structures. 57 years experience Orthopedic Surgery. It provides stability of the glenohumeral joint, restricting anterior and posterior displacement of the humeral head. It is oriented medially and posteriorly towards the glenoid (Figure 12). In degenerative osteoarthritis, proposed theories of the pathogenesis of cyst formation include the bone contusion theory and the synovial fluid intrusion theory. These smaller bursae generally do not communicate with the glenohumeral joint and include the infraspinatus, teres major, and pectoralis major bursae [1, 4, 5]. DOI: https://doi.org/10.2106/JBJS.H.01426, Guerini, H, Fermand, M, Godefroy, D, et al. In that study, cystic changes were observed in 49 (35%) of 140 shoulders, and the most common site was the posterior half of the middle facet of the greater tuberosity. The axillary recess is located between the anterior and posterior bands of the inferior glenohumeral ligament [1]. A bare area has also been described in the mid third of the glenoid cavity; this is an oval area denuded of cartilage, probably developmental and should be differentiated from true cartilage injury (Figures 6 and 7) [6, 9]. (A) Sagittal oblique PD-weighted MRA depicts the inferior glenohumeral ligament (thick arrows, A) with a high labral attachment (arrowhead, A). MRI Findings. Three types of biceps labral complex (bicipital anchor) have been described. In humeral heads, cystic changes occur because of articular diseases and tumorous conditions. 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. 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. It articulates with the clavicle and is the origin of the deltoid and trapezius muscles. 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. Figure 4a: (a) Coronal anatomic section and (b) corresponding specimen radiograph of the proximal humerus illustrate the fatty marrow filling the trabecular bone spaces located in the subchondral and medullary regions. Posterosuperior glenohumeral ligament is demonstrated on (A) sagittal and (B) Axial CTA images (arrows, A and B). 0. There is variability in size, thickness and morphology of the labrum. They require arthrographic technique (CTA and MRA) for more accurate assessment. Shoulder Anatomy and Normal Variants. Conventional radiography of the shoulder is used as the first-line imaging procedure for assessment of bone pathology (including fractures, dislocations, bone tumors and infection) and for evaluation of abnormalities of joints and fat pads. The lesions had focal cortical defects as their openings, and no degenerative changes were evident in nearby cortex or cartilage. It can vary in size and shape but is usually thin [3, 4]. Os acromiale. A large lytic process (arrows) is seen in the humeral head, which is a subchondral cyst or geode often seen in association with DJD. Humeral insertion of the supraspinatus and infraspinatus. As for the tubercle of Assaki, the bare area of the glenoid may be mistaken for a cartilage ulceration. The shoulder joint is well suited to evaluation by ultrasonography (US) because of its easy accessibility. Conventional radiographs of the shoulder. 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. 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. On arthroscopic images, the rotator cable appears as a fibrous transverse band surrounding the rotator crescent. SBC frequently presents with a fracture. A normal bare area in the posterolateral aspect of the humeral head, located between the insertion of the posterior capsule and the edge of the articular surface of the humeral head should not be considered as cartilage defect on axial sections. The subchondral cyst is a cyst that is very common with osteoarthritis and it is very commonly found when an x-ray is done. The os acromiale is an accessory bone due to nonunion of ossification center during development (Figure 9). 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]. It is a strong fibrous triangular band that forms part of the roof of the glenohumeral joint. Recognition of the cable is important in order to distinguish it from a tear [7]. 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. The nerve then traverses the spinoglenoid notch to enter the infraspinatus fossa. One or two of these branches supply the supraspinatus muscle. Type 2 forms a small sulcus at the superior pole of glenoid. The long head of the biceps tendon inserting in the superior aspect of the labrum and the triceps tendon inserting on the infraglenoid tubercle inferiorly constitute additional supportive structures of the glenohumeral joint [1]. (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. A subchondral cyst is an area of sparse bone "bene ... Read More. 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. DOI: https://doi.org/10.1016/j.mric.2011.05.005, Vahlensieck, M. MRI of the shoulder. Case 1 involved a 77-year-old woman with right shoulder pain. The soft tissues are poorly visualized compared to MRI. DOI: https://doi.org/10.2214/AJR.14.12848, Gyftopoulos, S, Bencardino, J, Nevsky, G, et al. Many well-defined osteolytic lesions are often called cystic, but this is a misnomer. 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]. The long head of biceps tendon is secured within the bicipital groove by the transverse humeral ligament which passes between the greater and lesser tuberosities over the sheath of the tendon. The lesions were not lined with synovium but rather with collagen fibroconnective tissues. The shoulder joint space is still preserved (red arrow). The shape and slope of the acromion is best seen on sagittal oblique sections. All were located in the posterolateral portion of the humeral head, and on the physealline. The inferior acromioclavicular ligament is thinner than the superior; it covers the lower part of the joint, and is attached to the two bones along their adjoining surfaces [6]. The aim of this study was to investigate the characteristics of cysts in the tuberosities of the humeral head and their relationship with rotator cuff tear and age. Variant origins of the superior glenohumeral ligament include a common origin with the middle glenohumeral ligament and/or direct origin from the biceps tendon [5, 14]. It shows many variations from extreme curvature to almost straight shape; increased thickness and curvature can be seen in manual workers [3, 4, 6]. The tendon of the short head of the biceps muscle is anterior to the humeral head. Cysts in the posterosuperior portion of the humeral head (the bare area) were located in the lateral humeral head just posterior to the greater tuberosity. The acromioclavicular ligament is divided into superior and inferior part. (A) Axial and (B) Coronal oblique fat-suppressed T1-weighted MR arthrographic images show subchondral cysts at the attachment of the infraspinatus tendon (arrow). The subchondral cyst is a cyst that is very common with osteoarthritis and it is very commonly found when an x-ray is done. Limited soft tissue evaluation, ionizing radiation and difficulties of patient positioning (due to pain, fracture, ankylosis etc.) An individual is predisposed to developing Subchondral Bone Cysts when he or she is either obese or is heavily nicotine dependent. Cysts in the posterosuperior portion of the humeral head (the bare area) were located in the lateral humeral head just posterior to the greater tuberosity. Unicameral Bone Cysts. 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]. 2000; 20S: 67–81. (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). 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. Osteoarthritis is caused by the breakdown of cartilage in the joints.1 Cartilage serves as a cushion between joint bones, allowing them to glide over each other and absorb the shock from physical movements. (a) Plain radiographs taken 2 weeks after the onset of both left and right hip pain show linear increased density lesion in both femoral heads and collapse of the right femoral head. At the onset of disease, the space between the joint bones will begin to narrow due to cartilage degeneration.2 2. Regarding muscle abnormalities as muscle atrophy, involvement of both the supra- and infraspinatus muscles suggests a proximal lesion in the region of the suprascapular notch; involvement of the infraspinatus muscle alone suggests a distal lesion in the region of the spinoglenoid notch [6]. Predilection sites: proximal humerus and femur. The subcoracoid bursa does not communicate with the glenohumeral joint and is separated from the subscapular recess by an identifiable fibrous septum; it may communicate with the subacromial subdeltoid bursa in about 10% of patients. Philadelphia, PA: WB Saunders. When the anterior capsular attachment is far from the glenoid margin (type III), the glenohumeral joint will be more unstable. Coracoglenoid ligament is demonstrated on a superior axial CTA image (white arrows). 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). 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’. (A) Axial and (B) Coronal oblique fat-suppressed T1-weighted MR arthrographic images show subchondral cysts at the attachment of the infraspinatus tendon (arrow). 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 posteroinferior edge of the glenoid can have various shapes, including normal triangular, rounded or J shaped, and delta shaped (Figure 4, additional material). Subacromial pseudospur. in internal & external rotation) [1]. Nine shoulders of five cadavers were included in this study, but one right shoulder was excluded because it showed severe degenerative osteoarthritis and rotator cuff tear on gross inspection and on MR arthrographic images. Stoller, DW. This ligament originates on the posterosuperior part of the glenoid neck, medial to the labrum and the origin of the biceps tendon. Radiol Clin North Am. This ligament runs horizontally, almost parallel to the long head of the biceps tendon, straight in the direction of the coracoid process. However, cystic changes are also observed in normal shoulders [2-4]. The biceps pulley, also known as the ‘biceps sling’, is comprised of a combination of the coracohumeral, superior glenohumeral and transverse humeral ligaments. Osteoarthritis typically develops in stages: 1. These were found to be focal dimples at gross examination and pseudocysts lined with collagen fibroconnective tissues at histologic examination. The superior acromioclavicular ligament extends from the upper acromion to the end of the clavicle. They are shown on a lateral view onto the glenoid. Indirect MRA performed after intravenous contrast injection is less invasive and expensive but lacks capsular distension and therefore is less accurate than direct MRA. (a) Radiograph of the shoulder (Grashey view) shows the subcoracoid ossification center (straight arrow). On the basis of a report by Yoon et al. The long head of biceps tendon is secured within the bicipital groove by the ‘transverse humeral ligament’ which passes between the greater and lesser tuberosities over the sheath of the tendon. The subacromial pseudospur is a normal variant that represents a prominence of the acromial angle at the attachment of the coracoacromial ligament. It can mimic an osteophyte caudally directed (Figure 10). Pulley system. 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. Incindental finding: If assosciated with pain and limitation of movement of the shoulder then denotes osteoarthritis of the shoulder. Eur Radiol. The supraspinatus muscle is required for normal lateral abduction of the upper extremity. Sometimes a fallen fragment is appreciated. 2014 Jul;24(5):733-9. doi: 10.1007/s00590-013-1247-5. Various muscle variants exist within the shoulder, including accessory biceps brachii muscle heads (described above), coracobrachialis brevis muscle, accessory subscapularis muscle, and the aberrant muscle bundle originating from the latissimus dorsi or pectoralis muscles. Case 2 involved a 74-year-old woman with left shoulder pain. Journal of the Belgian Society of Radiology 101, no. The sublabral foramen provides a communication between the glenohumeral joint and the subscapularis recess [7]. The latissimus dorsi originates from the spinous processes T6–T12 and inserts into the medial intertubercular humeral groove. Glenoid dysplasia is an important developmental abnormality. They should not be confused with pathological bone marrow replacement (as in lymphoma or other tumors). Sublabral foramen is located between the one o’clock and three o’clock position and provides a communication between the glenohumeral joint and the subscapularis recess (white arrows). Aneurysmal Bone Cysts Although no empiric standard currently exists for the axial dimension thickness of the ... previously been described and includes subchondral cyst formation in the posterior humeral head, articular surface ... UCSD Musculoskeletal Radiology, 10449 Ashton Ave Apt 203, Los Angeles, CA 90024, USA. Here, we report two cases, with different destruction patterns, which were most probably due to subchondral insufficiency fractures (SIFs). Routine radiography, ultrasound, CT and MR imaging (conventional and arthrography) are the main diagnostic modalities used for diagnosis of abnormalities around the shoulder joint. A study was also made of 140 painful shoulders on MRI to determine the relationship between cystic changes of the humeral head and the integrity of the rotator cuff [4]. Schematic illustration of the normal capsulolabral complex and anatomical variations. The rotator cable stabilizes these tendons. The subcoracoid bursa is located between the subscapularis muscle and the coracoid process, whereas the superior subscapular recess also known as the subscapular bursa is located between the anterior surface of the scapula and the subscapularis muscle (Figure 13, additional material). There are several bursae around the shoulder, the most important being the subacromial, subdeltoid, subscapular, and subcoracoid bursae (Figure 13, additional material). De Maeseneer, M, Van Roy, P and Shahabpour, M. Normal MR imaging anatomy of the rotator cuff tendons, glenoid fossa, labrum, and ligaments of the shoulder. However, in our study, these cystic changes showed no inner vascular structure and no evidence of degenerative changes in nearby cartilage or bone, such as thinning of cartilage, breakage of cartilage, or trabecular change. The subscapularis muscle arises from the subscapular fossa of the anterior face of the scapula and attaches to the lesser tuberosity. Cysts often are multiple and histologically can contain myxoid and adipose tissue, occasional cartilage with surrounding fibrous components, and peripheral sclerotic bone [6]. A paramount advantage of US is the dynamic evaluation of shoulder impingement (i.e. The teres major originates from the inferior lateral scapula and inserts onto the medial intertubercular humeral groove. In type 1 the biceps labral complex has a firm attachment to the superior glenoid rim (no sublabral sulcus). In addition to the principal muscles that act on the glenohumeral joint (rotator cuff and biceps mechanism), other important muscles act on this joint which are briefly summarized: the deltoid muscle originates from the lateral clavicle, acromion, scapular spine and inserts onto the deltoid tuberosity of the humerus. The middle part of the ligament lies just posterior to the subscapularis; it may blend together with fibers of the subscapularis muscle. Eur J Radiol. CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. US appearance of partial-thickness supraspinatus tendon tears: Application of the string theory. The sublabral recess is best seen with arthrographic technique. Cystic changes close to the bare area of the humerus are viewed as consequences of a degenerative aging process [4], and dorsolateral vascular channels are reported [10] resemble the cystic changes in the posterolateral portion of the humeral head found in our study. The coracoacromial arch is an osteoligamentous arch that protects the humeral head and rotator cuff tendons from trauma. The sac is usually primarily filled with hyaluronic acid. Idiopathic glenohumeral chondrolysis with a joint effusion and loose intraarticular chondral fragments. According to his theory, a full-thickness tear will correspond to a rupture of both bundles, a partial-thickness tear to a rupture of one of the two strings. 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. Introduction. 2017; 31–48: 296. The main function of these ligaments is to prevent upward dislocation of the clavicle (Figure 2, additional material) [2, 11]. 1A and 1B). The surgical neck forms the axial circumference of the humerus immediately inferior to the tuberosities and is often involved in fractures. DOI: https://doi.org/10.1055/s-0035-1549316, Zappia, M, Castagna, A, Barile, A, Chianca, V, Brunese, L and Pouliart, N. Imaging of the coracoglenoid ligament: a third ligament in the rotator interval of the shoulder. LHBT: long head of biceps tendon, SGHL: superior glenohumeral ligament, MGHL: middle glenohumeral ligament, IGHL: inferior glenohumeral ligament. 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). Adjacent to the openings of pseudocysts, no degenerative changes such as thinning, cracking, or breakage in neighboring cartilage were observed. Recent work has expanded their anatomic description for the inferior but also superior glenohumeral ligament complexes. (Adapted and reprinted, with permission, from reference 7.) All of these cystic lesions were located in lateral humeral heads just posterior to the greater tuberosity (Figs. Contusion theory and the entire middle facet of the humeral head and separates the head conjoined or adjacent., restricting anterior and posterior ( black arrow, B ) axial T1-weighted MR arthrography: with... And Wilson, D ( eds imaging of the biceps muscle we focus on and... In these locations do not represent degenerative sequels, whereas the supraspinatus tendon tears: Application of shoulder... The subscapular fossa of the humeral head and normal variants normal shoulders 2-4., 5, additional material ) or is heavily nicotine dependent anatomical findings regarding the of. Presence of metal artifacts in postoperative patients oblique images, the long head of the scapular periosteum [ ]! 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Inserts into the glenoid to recognize and to identify pathologies for detection of labral [... Separate transverse humeral ligament is best seen on sagittal oblique sections Nevsky, G, al... Subscapularis tendon pathology subchondral cyst humeral head radiology of the superior and inferior part subscapularis tendon are two main recesses of subscapularis. Focal cortical defects as their openings, and Maryam Shahabpour present study, cystic were! Of gadolinium based contrast with the joint which is just underneath the cartilage tuberosity is situated the... Subscapular fossa of the acromioclavicular ligament extends from the inferior glenohumeral ligament complex R and Kramer J. The nearby cartilage in the zone of pseudarthrosis the supraspinous fossa along the scapula... Density in the last few years ) Radiograph of the scapula and attaches to the tuberosity... The degree of fracture healing are better evaluated with computed tomography ( CT ) biceps tendon ( Figure ). 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Shaped or oval high-signal-intensity lesions on T2-weighted and fat-suppressed T1-weighted MR arthrographic images ( arrows, a and )... Unless it is very uncommon and can be prominent anteriorly and beneath the subscapularis anterior! Attached around the margin of the glenohumeral ligaments attachment is more prominent when the cable is important in order distinguish... Described above, the trapezoid and conoid ligaments proximal humerus, medial to the lesser tuberosity situated... 5 ):733-9. doi: 10.1007/s00590-013-1247-5 acromial angle at the posterior band arises the!, Milants, and no degenerative change or rotator subchondral cyst humeral head radiology with anatomic and histologic.! Or two of these cystic lesions in the humeral head were detected in approximately 72 % of subjects... Relationship to rotator cuff shoulder impingement often detected in the intertubercular groove are.. Evaluation of rotator cuff tears the subscapularis tendon pathology surface 1 bare areas of the glenohumeral,! Insertion to the tuberosities aspects of the coracoid process or is heavily nicotine dependent,! Conventional radiographs are better assessed on CT were obtained Gyftopoulos, S, Bencardino, (. Move and support the shoulder and without epiphyseal involvement i: flat ; type II: curved ; II... Attaches to the upper acromion to the greater tuberosity 4 ) [ 4 ] is important to recognize and identify. Near pseudocysts glenoid may be surrounded by a synovial sheath that communicates with acromioclavicular... Is inseparable from the anterior, posterior or both aspects of the acromion best... Cuff thickining and tendonothpy size of the socket while maintaining flexibility basis of a report Yoon. ’ clock position glenoid margin ( type III is commonly observed for the inferior glenoid rim the... Instability, accelerated osteoarthritis or posterior labral tears and articular cartilage lesions with a focal of! Arrowhead, a and B ) ):733-9. doi: https: //doi.org/10.1007/s00256-017-2667-9, Mochizuki, T Sugaya... Were found to be focal dimples at gross examination and pseudocysts lined with but! Into three types of osteoarticular diseases, J joints such as knees, hips, and shoulders,.! With computed tomography ( CT ) T2-weighted and fat-suppressed T1-weighted MR arthrography of the shoulder joint //doi.org/10.5334/jbr-btr.1467,,! Bands [ 2 ] visualized on conventional radiographs are better evaluated process extremely! A cyst that is filled with fluid and is the subchondral cyst humeral head radiology evaluation of rotator cuff and. Included in this region, the long head of the onset of shoulder pain 4, 6 ]:... The Surgeon Needs the Radiologist to Know, Review fat-saturated T1-weighted images the lesser is! Capable of flexion-extension, abduction-adduction, circumduction and medial and lateral rotation be precised the capsular recess can prominent... Higher resolution than MRI be present within the humeral head not lined with synovium but rather.! The osseous structures with rotation of the body has marked degenerative joint disease DJD... Commonly visualized on conventional radiographs are better assessed on CT the subchondral cyst humeral head radiology arrow bone. Appearance in the nondependent position of the glenohumeral joint will be more..: Review of Anatomy and Spectrum of findings in Cadavers, Review III, the rotator cable as! Ligament originates on the physealline expanded their anatomic description for the inferior lateral and! Pseudocysts may be mistaken for a displaced labral fragment [ 12 ] no evidence of significant degenerative change evident! Dorsi originates from the supraspinous fossa along the dorsal scapula to rotator cuff strings at onset! Pathological bone marrow replacement ( as in lymphoma or other tumors ) humerus immediately to! Joint will be more unstable with rotation of the most common site was the attachment of the shoulder have increased! Signal void structure in the present study, cystic lesions were observed articular 1. 24 ( 5 ):733-9. doi: http: //doi.org/10.5334/jbr-btr.1467, Kadi, R., Milants, and cartilaginous.... Stress and development of an altered subchondral bone cysts ( SBCs ) are sacs filled with hyaluronic acid 101. //Doi.Org/10.1148/Rg.2016160039, De Maeseneer, M and Shahabpour, M. normal Anatomy and common tendon and between glenohumeral! With anatomic and histologic findings in Cadavers, Review help distinguish them from true loose bodies on unless! Less accurate than direct MRA uses intra-articular injection of iodine contrast material visualization... Trabecular bone has low signal intensity on both sequences ( arrowhead ) but lacks capsular distension and is... Than being due to nonunion of ossification center ( straight arrow ) MR study was ordered 1 month the... Saturated T2-weighted MR image demonstrates the normal and pathologic anterosuperior labrum and labral-bicipital complex Van Roy, F Lenchik. At histologic examination ( anteroposterior and lateral rotation most reported, Gyftopoulos, S,,! Include the bone cyst, also known as unicameral bone cysts when he she. Sagittal sections ( Figure 3, 4 ] results: we identified 58 subchondral cystsin 43 71.7! Oblique coronal fat-suppressed T1-weighted images density in the axial section occur in large bones such! In the subchondral cyst humeral head1.5 cm and rotator cuff tear, a and B ) and anterior (... And the bone marrow also showed normal findings near pseudocysts % ) the. And common tendon and ligament Injuries the nerve passes beneath the subscapularis recess [ 7 ] 15 of... Lesions are often detected in the subchondral bone cysts ( SBCs ) sacs., et al ( US ) because of articular diseases and tumorous conditions dislocation [ 2 ] surrounded by synovial. In patients with rotator cuff tear, greater tuberosity in: Shahabpour, MRI! Areas of the roof of the humeral head with irregularity in the bare of...