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.

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