In daily practice, the anteroposterior view is performed in neutral position and with internal and external rotation of the arm and completed by a lateral view of the scapula (Y view). Two orthogonal views (anteroposterior and lateral views) of any bone or joint should be ideally obtained. Limited soft tissue evaluation, ionizing radiation and difficulties of patient positioning (due to pain, fracture, ankylosis etc.) are major limitations. 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. 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.Īlthough this chapter is based on MRI, we should not forget the importance of standard radiographs for the evaluation of bone and joint structures. The most common variants and pitfalls are related to the anterosuperior aspect of the shoulder joint. Appropriate MR imaging protocols and sequences and applied MR anatomy of the shoulder (including normal variants) are proposed to help assist management and treatment of common shoulder pathologies encountered (such as rotator cuff tears, impingement syndromes, and instability as well as less frequent causes of shoulder pain). Bony components, rotator cuff tendons and muscles can be assessed on MR imaging without arthrographic technique, whereas the articular structures (including glenohumeral ligaments, capsulolabral structures and hyaline cartilage) require arthrography for more accurate assessment.
The article focuses mainly on Magnetic Resonance Imaging (MRI) as well as MR and CT arthrography, diagnostic procedures of choice for assessment of internal derangement of the shoulder.
Indications for imaging of the shoulder have considerably increased in the last few years. It links the trunk to the upper limb and plays an important biomechanical role in daily activities. The shoulder joint is functionally and structurally complex and is composed of bone, hyaline cartilage, labrum, ligaments, capsule, tendons and muscles.
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