Rotator cuff

- 1-2 cm proximal to insertion site is CRITICAL zone, due to decreased vascularity

o Often undergoes fibrillar and/or myxoid degeneration
- Supraspinatus
o 95% occur from impingement syndrome at the criticalzone
 Downsloping AC joint if osteophyte or thickened capsule present
 Natural degeneration
o Look at the oblique coronal to show the critical zone, look lateral to bicipital
groove (anteriormost fibers is where most cuff tears begin
o T2 bright signal in critical zone signifies tear, or of it is focally thinned --? Partial
tear
o Intermediate T2 signal with focal thickening  myxoid degeneration (tendinosis)
o Full thickness tear, evaluate retraction as high level retraction may obviate
surgery
- Partial tear
o Bursal side tear 30x less common than articular side partial tear
 o MC at articular surface site of greater tuberosity (rim rent)

AC joint
- Types of acromion, I, II, III
o Type not so much important, relay if it is anteriorly or laterally downsloping to
identify bony impingement
- Os acromiale
o Unfused acromion results in pulling by deltoid and subsequent impingement

Humerus
- Sclerosis and cystic change of greater tuberosity
- Cmmonly seen im impingment syndromand with rotator cuff tears

Labrum
- Anterior larger than posterior
- Superior – evaluate on oblique coronal (SLAP lesions)
o SLAP lesions – MC seen in throwing athletes w/insertion of long-head biceps on
labrum resulting in avulsion during throwing motion
- Anterior inferior (Bankhart deformity)
o Dislocation may result in 3 abormalities of the labrum
 Detachment
 Tear
 Labroligamentous tear
- Normal variants
o Superior labrum at biceps attachment is a sublabral recess (thin and smooth)
 Hard to differentiate from SLAP tear
o Sublabral foramen
 Anterior superior quadrant of the glenoid (which never sees labral path)
o Buford complex
 Absent anterosuperior labrum with thickened middle GHL
Biceps tendon
- Fluid running within tendon sheath may be from communication with the joint
- Ruptured tendon likely seen anteromedially, associated with supraspinatus tear

Suprascapular notch
- Nervce proximally innervates supraspinatus
o Heads inferiorly through the spinoglenoid notch to innervate the infraspinatus
- Ganglion from associated torn/detached posterior labrum results in compression of the
inferior suprascapular nerve
o Results in infraspinatus atrophy
o Important to note as this is extracapsular and will not be seen during arthroscopy

Quadrilateral space syndrome

- Atrophy of the teres minor muscle impinging the axillary nerve from scarring in this
space
- Deltoid never involved in this
Forestier’s disease
- DISH with fx and cord signal

Spinal lesions
- posterior elements: osteoblastoma, ABC, osteoid osteoma, myeloma, mets
- vertebral body: chordoma, GC tumor, LCH, ewing,lymphoma, mets, myeloma

Pulmonary artery aneurysm

- Asx, may be seen in the setting of prior Swan-Ganz, Behcet’s syndrome (Hugh Stovin
syndrome)

GB calculus erosion
- External compression of CBD by stone in cystic duct  Mirrizi syndrome
- Erosion of stone into from GB  duodenum = Bouveret syndrome
- Gallstone ileus – stone eroding into the GI tract with SB obstruction

Ampullary carcinoma
- Higher incidence with Gardner syndrome (hamartomatous dz)

Hyperplastic cholecystosis = adenomyomatosis

Xanthogranulomatous cholecystitis – thick GB wall

Melanoma = commonly w/GB mets

Recurrent pyogenic cholangitis = oriental cholangitisst

Caroli disease
- Central dot sign
- May also have intrahepatic calculi forming within the intrahepatic biliary cystic dilatation

Vascular
- Klippel-Trenaunay Weber syndrome – pain and accelerated joint degen from capillary-
lymphatic-venous malformation
o Can use MRV