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Shoulder Anatomy
Dr. Mohamed Samieh
Shoulder Joint
• Bones:
– Humerus
– scapula
– clavicle
Shoulder Girdle
Bones of the shoulder joint
• Scapula
–
–
–
–
Glenoid Fossa
Supraspinatus fossa
Spine
Acromion process
Infraspinatus fossa
Subscapular fossa
Coracoid process
• Clavicle
• Humerus
– Greater tubercle
– Intertubercular goove
– Head of Humerus
Lesser tubercle
Deltoid tuberosity
Joints
• Joints
– Sternoclavicular
Shoulder Anatomy
• Joints
– Sternoclavicular
– Acromioclavicular
Shoulder Anatomy
• Joints
– Sternoclavicular
– Acromioclavicular
– Glenohumeral
Shoulder Anatomy
• Ligaments
– Acromioclavicular
Joint
• Acromioclavicular
Ligament
Shoulder Anatomy
• Ligaments
– Glenohumeral Joint
• Glenohumeral
ligaments
– Superior
– Middle
– Inferior
Shoulder Anatomy
• Cartilage
– Glenoid labrum
Shoulder Anatomy
• Shoulder Girdle
Muscles
– Trapezius
Shoulder Anatomy
• Shoulder Girdle
Muscles
– Trapezius
– Serratus Anterior
Shoulder Anatomy
• Glenohumeral
Muscles
– Rotator Cuff
•
•
•
•
Suprispinatus
Infraspinatus
Teres Minor
Subscapularis
Shoulder Anatomy
• Glenohumeral
Muscles
– Latissimus Dorsi
Shoulder Anatomy
• Glenohumeral
Muscles
– Latissimus Dorsi
– Pectoralis Major
Shoulder Anatomy
• Glenohumeral
Muscles
– Latissimus Dorsi
– Pectoralis Major
– Deltoid
Shoulder Anatomy
• Glenohumeral
Muscles
–
–
–
–
Latissimus Dorsi
Pectoralis Major
Deltoid
Biceps
Shoulder Anatomy
• Glenohumeral
Muscles
–
–
–
–
–
Latissimus Dorsi
Pectoralis Major
Deltoid
Biceps
Triceps
Indications
1. unexplained shoulder pain
2. Acute shoulder trauma
3. Impingement syndrome: subacromial, subcoracoid, internal
4. Glenohumeral instability: chronic, recurrent, subacute, acute
dislocation, and subluxation
5. Shoulder symptoms in the overhead or throwing athelete
6. Mechanical shoulder symptoms: catching, locking, napping, crepitus
7. Limited or painful range of motion
8. Swelling, enlargement, mass, or atrophy
9. Patients for whom diagnostic or therapeutic arthroscopy is planned
10. Patients with recurrent, residual, or new symptoms following
shoulder surgery
1.
2.
3.
4.
5.
6.
7.
8.
Rotator cuff abnormalities: supraspinatus, infraspinatus,
Disorders of the long head of the biceps brachii: full-thickness
and partial-thickness tears, tendonopathy,
tendonitis, subluxation, dislocation
Conditions affecting the supraspinatus outlet: acromial shape,
osacromiale, subacromial spurs,
acromioclavicular joint disorders, subacromial bursitis
Labral abnormalities: cysts, degeneration, and tears, including
superior labrum anterior posterior (SLAP)
and Bankart lesions and their variants
5. Muscle disorders affecting the shoulder girdle: atrophy,
hypertrophy, denervation, masses, injuries
Patient Preparation
1. Have the patient to go to the toilet
2. Explain the procedure to the patient
3. Offer the patient ear protectors or ear plugs
4. Ask the patient to undress except for underwear
5. Ask the patient to remove anything containing metal
(hearing aids, hairpins, body jewelry, necklace, etc.)
Positioning
1.
2.
3.
4.
Supine
Shoulder coil (oval surface coil, flexible coil)
Arm in neutral rotation or supination
Cushion the legs
Technique
1- Scout localizer
Sagittal plane
Coronal
plane
Axial plane
2- Sequences (4)
1- axial T2weighted
2-paracoronal
T2
3- Sagittal
4- paracoronal
T1
Sequence 1 axial
1- T2-weighted, fat-saturated
• Plane:- parallel to humeral shaft. Cover from AC joint through
proximal humeral diaphysis.
A.
B.
C.
D.
Slice thickness: 3mm (2-D), approx. 1mm for GRE
Slice gap: 20% of slice thickness (!0.6mm or factor 1.2)
FOV: 200–270mm
Saturation slab: no
MRI with Power 1.5 and 1.0 Tesla:
GRE or, to delineate the glenoid
labrum, FFE:
— TR = 600–700
— TE = 11
— Flip angle 60°
For T2-weighted - fat saturation
TSE, FS:
— TR = 2000–4500
— TE = 90–130
Sequence 2 paracoronal
(parallel to the supraspinatus muscle on the axial slice)
1- T2-weighted, fat-saturated
• Plane:- parallel to humeral shaft. Cover from AC joint through
proximal humeral diaphysis.
A.
B.
C.
D.
E.
Slice thickness: 3mm
Slice gap: 20% of slice thickness (!0.6mm or factor 1.2)
FOV: approx. 260–290mm
Matrix: 512 (256)
Saturation slab: parasagittal, oblique to the slice superior to the lung
For STIR
— TR = 1800–2200
— TE = 60
— TI = 100–130
— Flip angle 90° each
For T2-weighted - fat saturation
TSE, FS:
— TR = 2000–3500
— TE = 100–120
Sequence 3 sagittal
1- T1-– T2 weighted
• Plane:- Prescribe sagittal plane off axial images withline parallel to
bony glenoid. Image from bony glenoid through deltoid muscle.
A. Slice thickness: 3–4mm
B. Slice gap: 20% of slice thickness (!0.6–0.8mm or factor 1.2)
C. Saturation slab: sagittal across the lungs
T1
TR = 500–600
— TE = 10–20
T2
TR = 2000–4500
— TE = 90–130