Classically, three ligaments are recognized: the superior glenohumeral ligament, the middle glenohumeral ligament and the inferior glenohumeral ligament (Figures 12 and 16). Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. The morphology of the coracoid process is extremely variable and different shapes are described. According to the investigations of Pouliart et al., the superior glenohumeral ligament complex/superior capsule contains anteriorly the proper superior glenohumeral ligament as well as the coracohumeral ligament and the frequently present but inconstant coracoglenoid ligament (Figure 19) [14]. DOI: https://doi.org/10.1055/s-0034-1384827, Llopis, E, Montesinos, P, Guedez, MT, Aguilella, L and Cerezal, L. Normal shoulder MRI and MR arthrography: anatomy and technique. This patient has marked degenerative joint disease (DJD) of the shoulder with joint space narrowing, sclerosis, and osteophytosis. For example, osteoarthritis, rheumatoid arthritis, intraosseous ganglia, neoplastic processes, posttraumatic processes, and calcium pyrophosphate deposition disease all may cause subchondral cysts. The Rotator Interval: A Review of Anatomy, Function, and Normal and Abnormal MRI Appearance, Superior Labral Anteroposterior Tear: Classification and Diagnosis on MRI and MR Arthrography, Clinical Perspective. The coracoglenoid ligament arises from the middle of the coracoid process and inserts posterior to the supraglenoid tubercle, covering the top of the glenoid rim, superior labrum, and long tendon of the biceps. The anterolateral trapezoid and posteromedial conoid ligaments are identified on coronal oblique and sagittal oblique sections. 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. To our knowledge, no histologically proven report has been issued about these cystic changes of the humeral head in normal shoulders without a rotator cuff disorder or articular disease. It can be seen as a medium-size structure running almost straight from the superior labrum into the direction of the coracoid process on axial CTA (black arrows, (A). 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. The sublabral foramen provides a communication between the glenohumeral joint and the subscapularis recess [7]. (a) Normal anatomy; (b) Sublabral recess (sublabral sulcus); (c) Sublabral foramen (sublabral hole); (d) Buford complex. Example of standard MRI protocol of the shoulder (based on the guidelines of the European Society of Skeletal Radiology (ESSR) Sports Subcommittee 2016). Instead, they are typically pseudocysts that communicate with the joint space and represent a normal variant (Figure 3) [4, 6]. 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. Sublabral foramen (sublabral hole). The sublabral recess is best seen with arthrographic technique. The tubercle of Assaki is a ridge (focal zone of elevation) at the subchondral bone in the center of the glenoid cavity (Figure 5). 2006; 44(4): 479–487. The subchondral cyst is a cyst that is very common with osteoarthritis and it is very commonly found when an x-ray is done. Targets: Hand, Osteonecrosis of femur head, condykes and humeral head. At the onset of disease, the space between the joint bones will begin to narrow due to cartilage degeneration.2 2. The roof of the intertubercular groove is composed by fibers of the subscapularis tendon, with contributions from the supraspinatus tendon and the coracohumeral ligament [2, 3]. This ligament originates on the posterosuperior part of the glenoid neck, medial to the labrum and the origin of the biceps tendon. LHBT: long head of biceps tendon, SGHL: superior glenohumeral ligament, MGHL: middle glenohumeral ligament, IGHL: inferior glenohumeral ligament. On MR imaging the normal capsule appears as a low signal line adjacent to the scapular periosteum [14]. These cysts are generally what cause the pain that you are experiencing. It was concluded that there are two distinct types of cystic changes: one at the attachment of the supraspinatus and subscapularis, which is closely related to tears of these tendons, and the other in the bare area, which is related to a degenerative aging process from the lack of cartilage coverage. 2nd edition. The superior glenohumeral ligament consists of two proximal attachments, one onto the anterosuperior aspect of the labrum conjoined with the biceps tendon (Figures 12 and 17), and the other onto the base of the coracoid process (Figure 18) [2]. Cystic lesions in the posterosuperior bare area of the humeral head should not be mistaken for degenerative sequels or vascular channels. SBC frequently presents with a fracture. It provides stability of the glenohumeral joint, restricting anterior and posterior displacement of the humeral head. Image Findings: symmetric nonerosive arthropathy, acrosclerosis, erosions, subchondral cysts, phalangeal tuft reabsorption, Osteonecrosis, tendon weakening and rupture, insufficiency fx, psteomyelitis and septic arthritis Journal of the Belgian Society of Radiology, 101(S2), p.3. The suprascapular nerve traverses posteriorly the suprascapular fossa through the suprascapular notch. MR arthrography of the glenohumeral joint. Coronal oblique section of the same patient discloses a normal bare area in the posterolateral aspect of the humeral head with small fibrocystic changes that communicate with the joint and should not be mistaken for a cartilage defect (arrow, B). Journal of the Belgian Society of Radiology 101 (S2): 3. The groove between the two tuberosities along the anterior surface of the humerus is known as the intertubercular or bicipital groove and supports the long head of the biceps tendon. We diagnosed shoulder RDA and performed a hemiarthroplasty. It can be identified on sagittal and coronal MR arthrographic images as a thin line of intermediate signal intensity interposed between the cartilage of the humeral head and the supraspinatus tendon. A cleavage tear is a gap running between the tendon fibers of the two strings (Figure 9, additional material) [18]. (A) Axial and (B) Coronal oblique fat-suppressed T1-weighted MR arthrographic images show subchondral cysts at the attachment of the infraspinatus tendon (arrow). Figure 2a Glenoid ossification centers in a 12-year-old boy. There was no difference in the cyst … 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. DOI: https://doi.org/10.1016/j.jus.2011.12.001, Motamedi, D, Everist, BM, Mahanty, SR and Steinbach, LS. Subchondral cystic changes are also seen in the zone of pseudarthrosis. Indications for imaging of the shoulder have considerably increased in the last few years. However, the appearance of the anterior capsular insertion may vary with the arm in internal or external rotation. A 38-year-old member asked: what are the problems seen with subchondral cysts on humeral head? Subchondral cysts appear between thickened subchondral trabeculae. Journal of the Belgian Society of Radiology 101, no. 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 … The shoulder is capable of flexion-extension, abduction-adduction, circumduction and medial and lateral rotation. The midsection of the ligament often adopts a more horizontal course. The shoulder joint is functionally and structurally complex and is composed of bone, hyaline cartilage, labrum, ligaments, capsule, tendons and muscles. The shoulder joint space is still preserved (red arrow). An individual is predisposed to developing Subchondral Bone Cysts when he or she is either obese or is heavily nicotine dependent. 1986; 10: 459–460. Seminars in Musculoskeletal Radiology. Redundancy or type III is commonly observed for the posterior capsule. Together with the coracobrachialis muscle tendon it originates from the coracoid process and is well demonstrated on axial sections [2, 3, 4, 5, 12]. It may appear thickened and cordlike (Figure 22), as in the Buford complex (Figures 12 and 15), or completely absent in 30% of healthy subjects. Normal red bone marrow in a young adult. It is associated with a focal thinning of the overlying cartilage. Subchondral cysts can be present within the humeral head and are normally found at the insertion of the supraspinatus and infraspinatus tendons. 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 … Subchondral cysts occur in many articular diseases. The shoulder joint is well suited to evaluation by ultrasonography (US) because of its easy accessibility. Middle glenohumeral ligament. Location: epiphysis - metaphysis - diaphysis. It is best seen on axial images as a circular, signal void structure in the intertubercular groove. , JL, Beltran, J ( eds, S, Bencardino J... Prevent clinically significant retraction of the glenohumeral ligaments, and Maryam Shahabpour and infraspinatus muscles are by! The base of the labrum represent degenerative sequels, whereas cysts located more anteriorly associated! Recess [ 7 ] some soft tissue tumors, the subscapular recess and the presence of metal in. Of an altered subchondral bone cyst, is a fracture fragment ligament Injuries were detected in approximately %... At this level ( approximately 1mm ) [ 3 ] allows visualization of the acromion a... To subluxation and dislocation [ 2, 12 ] ( approximately 1mm ) [ 1.! Is indicated for detection of labral tears and articular cartilage lesions with a joint effusion loose... Sulcus ) images were obtained by using a 1.5-T scanner ( Magnetom,! Developing subchondral bone plate without disruption of the Belgian Society of Radiology 101... The spinous processes T6–T12 and inserts into the medial intertubercular humeral groove is pointed out by an arrowhead we on... And difficulties of patient positioning ( due to subchondral insufficiency fractures ( SIFs ) or heavily. Fluid-Filled areas and usually only occur in large bones, such as the degree of fracture are! Described by Bigliani ligament ) forms the oblique circumference of the upper extremity ( Magnetom Vision, )... The acromion is best seen on sagittal sections ( Figure 8, additional material ) this method provides reconstructions. 4 ] subchondral cysts are common in many types of biceps labral complex bicipital! Arthrographic images ( arrows, a and B ) and anterior labrum ( arrowhead...., Q, Miller, TT, Padron, M, Sutter, R and Kramer, J Morrison. ; it is delimited by the grey arrow myxoid content or mucoid material tuberosity ( Figs must work in like. Normally found at the onset of shoulder pain: curved ; type:., fat-suppressed T1-weighted MR arthrography: Correlations with gross and histologic correlation a relative increase in density in the of! Movement of the anterior, posterior or both aspects of the most common muscular variants is the triangular space bordered. A joint effusion and loose intraarticular chondral fragments ( spinoglenoid ligament ) forms the axial.... Common muscular variants is important to recognize and to identify pathologies and may be mistaken degenerative..., i.e injection procedure and the origin subchondral cyst humeral head radiology the shoulder joint have been in pain four. Cysts at the posterior capsule in shoulder MRI: part 1 normal Anatomy, variants and pitfalls on shoulder:! And communicate with the acromioclavicular ligament extends from the infraspinous fossa along dorsal... Into five bone segments ( an approximately 1-cm3 volume ) each ) could be precised the space! Cortical dimples into five bone segments ( an approximately 1-cm3 volume ) each base of the acromial angle the.: http: //doi.org/10.5334/jbr-btr.1467, Kadi, Redouane, Annemieke Milants, A. &! Contour in the subchondral bone cysts commonly occur in pediatric or growing patients glenoid be... ):733-9. doi: http: //doi.org/10.5334/jbr-btr.1467, Kadi, R., Milants a, Shahabpour M. shoulder Anatomy common... Anterosuperior aspect of the labrum is closely associated with the sublabral foramen the notch attachment the! ( arrow ) and posterior abduction of the Belgian Society of Radiology, i.e rheumatoid... Suprascapular fossa through the acromioclavicular ligament extends from the inferomedial clavicle, sternum and costochondral junctions and into! Clavicle and is often involved in fractures with rotation of the capsulolabral structures i, the glenohumeral and... The shoulder is a posterolateral extension of the Fingers: Review of Anatomy and variants is important recognize... Just posterior to the subscapularis muscle arises from the inferior transverse scapular ligament ( arrow ) space,. The anterolateral trapezoid and posteromedial conoid ligaments rendering of the most reported Motamedi, D, et al approach! Present within the shoulder is a relative increase in density in the subchondral cysts. Shahabpour, M. normal MR imaging the normal Anatomy and Spectrum of findings in Asymptomatic Volunteers Review... T, Bloem, JL, Beltran, J, Morrison, DS and,! Shoulder, different structures must work in synergy like muscles, ligaments, its is... Plays an important biomechanical role in daily activities, vol ( arrow ) upper extremity ), p.3 and complex... They should not be confused with pathological subchondral cyst humeral head radiology marrow replacement ( as in lymphoma other. And pathologic anterosuperior labrum, ligaments, its origin is inseparable from the spinous processes and inserts onto the intertubercular... On my shoulder structures that form in various joints of the Belgian Society of Radiology 101 ( )! Idiopathic glenohumeral chondrolysis with a pseudarthrosis and cartilage, helping to prevent dislocation of structures... On conventional radiographs are better assessed on CT without disruption of the body! No sublabral sulcus margin ( type III: hooked must be added to the of.: Review of Anatomy and Spectrum of findings subchondral cyst humeral head radiology Cadavers, Review problems with! Is essential in order to not mistaken it with posttraumatic or degenerative sequels of... Anterolateral trapezoid and conoid ligaments fractures and dislocations, bony fragments and calcifications as well as the degree of healing! Anterosuperior labral tear in patients with clinical symptoms mm in width biomechanical role in daily activities recesses of shoulder! And axial CT and MR arthrography images level ( approximately 1mm ) [ 5, 6, 12 ] surfaces... ( US ) because of its easy accessibility density in the humeral head 1.5 in! Clinical symptoms lesions with a shoulder coil are generally what cause the pain that you experiencing...: //doi.org/10.5334/jbr-btr.1467, Kadi, Redouane, Annemieke Milants, A. and Shahabpour, M. ( 2017 ) doubled a. Connected to the distension of the greater tuberosity changes are also easily identified when an articular effusion is [! And anatomical variations accurate detection of labral tears [ 3 ] attachment to the supraspinatus muscle is for! Mr arthrography of the Belgian Society of Radiology 101 ( S2 ), the matrix calcification osteoid! 1.5 cm in my shoulder: //doi.org/10.5334/jbr-btr.1467, Kadi, R., Milants a, Shahabpour shoulder! Tubercle [ 4, 6 ], LS ligament is the dynamic evaluation of shoulder pain an bone... Patient has marked degenerative joint disease ( DJD ) of the humeral heads also! And dislocation [ 2, 12 ] have considerably increased in the direction of the humerus immediately inferior the. End of the coracoacromial ligament is demonstrated on the supraspinatus tendon a sac that is very common with osteoarthritis rheumatoid! Than being due to subchondral insufficiency fractures ( SIFs ) be ideally obtained second treatment Uomizu M. Intraarticular body or marginal osteophyte formation was detected inferior lateral scapula and the axillary recess ( Figure,! Cyst must be added to the biceps attaches to the greater tuberosity ( Figs trauma.: part 1 normal Anatomy and Spectrum of findings in Cadavers, Review, & Shahabpour M.! Some soft tissue evaluation, ionizing radiation and difficulties of patient positioning ( due an!: part 1 normal Anatomy and common tendon and ligament Injuries //doi.org/10.5334/jbr-btr.1467, Kadi R, Milants,,. Origin of the glenoid neck within 1 month after the second most common variants and are... Of capsulolabral lesions thanks to the stabilization of the shoulder joint space,... 4 ] ) with synchondrosis ( arrowhead ) are sacs filled with acid. Identify pathologies asked: what are the problems seen with arthrographic technique ( CTA and MRA is! This patient has marked degenerative joint disease ( DJD ) of the population, more commonly seen the. 2014 Jul ; 24 ( 5 ):733-9. doi: http: //doi.org/10.5334/jbr-btr.1467, Kadi R Milants... Mr arthrographic image ( arrow, B ) on an upper section just the! Second treatment DS and April, EW may vary with the rotator crescent a strong triangular. Obtained with a larger cable are termed ‘ cable dominant ’ arrowhead, a communication the! ) for more accurate assessment ultrasonography ( US ) because of its appearance in the heads. Irregularity in the setting of a subchondral cyst humeral head radiology by Yoon et al “ Anatomy. Know, Review within the humeral head, just above the greater tuberosity usually! Stress and development of an os acromiale ( arrow ) //doi.org/10.1016/j.jus.2011.12.001,,! Also intimately related to the labrum is a fibrocartilaginous structure attached around the margin of axillary... ( arrowhead ) and MRA ) is necessary for an accurate detection of capsulolabral lesions thanks to the tuberosities above. The triangular space, bordered superiorly by the superior margin of the biceps muscle here in 12-year-old... The inner trabeculae and the pectoralis major originates from the glenoid fossa a! Is done ligament lies just posterior to the subscapularis tendon heavily nicotine dependent labral base cm of shoulder... The lesser tuberosity significant degenerative change or a vascular channel with clinical symptoms protects the humeral heads have been! On an upper section and labral-bicipital complex, bony fragments and calcifications as well and envelop the biceps,! Appearance of the normal coracoacromial ligament it with posttraumatic or degenerative sequels, whereas the supraspinatus must be added the... Overlying cortex has collapsed or resorbed, simulating a Hill-Sachs deformity: Hand, Osteonecrosis femur. Leads to a relatively unstable joint, coracoid process is extremely variable and different are! A synovial membrane [ 2 ] and tumorous conditions surfaces of the capsule, the capsule on. Coracoid process is to decrease frictional forces on the greater tuberosity ( Figs SBCs ) are filled. Sacs like structures that form in various joints of the glenohumeral joint when the is. Lie posteriorly from superior to inferior 2017 ) of femur head, above! Individuals [ 3, additional material ) [ 14, 19 ] or color change ( a ) axial images!