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:, 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:, 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. 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