subchondral cyst humeral head radiology

subchondral cyst humeral head radiology

The distal fibers of the supraspinatus, infraspinatus and teres minor extending lateral to the rotator cable and inserting into the greater tuberosity of the humerus, are called the ‘rotator crescent’. The disadvantages include longer examination time and higher cost, respiratory motion artifacts and patient claustrophia. Stoller, DW. Although no empiric standard currently exists for the axial dimension thickness of the ... previously been described and includes subchondral cyst formation in the posterior humeral head, articular surface ... UCSD Musculoskeletal Radiology, 10449 Ashton Ave Apt 203, Los Angeles, CA 90024, USA. In humeral heads, cystic changes occur because of articular diseases and tumorous conditions. This variant is very uncommon and can be encountered in 1.5–2% of individuals [3, 6, 13]. The aim of this study was to investigate the characteristics of cysts in the tuberosities of the humeral head and their relationship with rotator cuff tear and age. Predilection sites: proximal humerus and femur. 2011; 19: 581–594. Subchondral cystic changes are also seen in the zone of pseudarthrosis. It can be absent in 10% of healthy subjects [3]. These cysts are generally what cause the pain that you are experiencing. 2008; 68(1): 25–35. The interdigitation is more prominent when the shoulder is internally rotated and should not be confused with tendinopathy on MR imaging [7]. The capsular mechanism provides the most important contribution to the stabilization of the glenohumeral joint. It is delimited by the acromion, acromioclavicular joint, coracoid process, and the coracoacromial ligament. Both the anterior and posterior bands of the inferior glenohumeral ligament insert along the inferior aspect of the surgical neck of the humerus (Figures 23 and 24) [2, 5]. DOI: http://doi.org/10.5334/jbr-btr.1467, Kadi, Redouane, Annemieke Milants, and Maryam Shahabpour. Between one and three cystic lesions (mean, 2.3) were observed in each humeral head, and the longest of these cystic lesions was about 2-4 mm (mean, 2.56 mm). SBC frequently presents with a fracture. The two last posterior glenoid rim variants can be associated with varying degrees of posterior shoulder instability due to loss of concavity of the inferior glenoid margin. A variable deep notch or a physiological flattening in the humeral neck is located posterior to the greater tubercle and best visualized on axial images; this pitfall should not be mistaken for a Hill-Sachs impaction which is seen at or above the level of the coracoid process (Figure 4) [4, 5]. As opposed to the other glenohumeral ligaments, its origin is inseparable from the base of the labrum (Figure 12). 2013; 200: 1101–1105. According to his theory, a full-thickness tear will correspond to a rupture of both bundles, a partial-thickness tear to a rupture of one of the two strings. When the cable is larger, it can prevent clinically significant retraction of the tendon [14, 19]. Recognition of the cable is important in order to distinguish it from a tear [7]. The greater tuberosity is located on the lateral aspect of the proximal humerus and is the site of insertion of the supraspinatus, infraspinatus, and teres minor tendons. This patient has marked degenerative joint disease (DJD) of the shoulder with joint space narrowing, sclerosis, and osteophytosis. Radiographics. MRI was performed after the fluoroscopically guided intraarticular injection of 15-20 mL of a solution of diluted gadopentetate dimeglumine (Magnevist, Schering), which was made by mixing 1 mL of the contrast medium with 250 mL of normal saline. A large lytic process (arrows) is seen in the humeral head, which is a subchondral cyst or geode often seen in association with DJD. The axillary pouch or recess has a U-shaped appearance on MRA or CTA when the inferior glenohumeral ligament is normal (Figures 12 and 23) [4, 6, 14, 15]. Together with the coracobrachialis muscle tendon it originates from the coracoid process and is well demonstrated on axial sections [2, 3, 4, 5, 12]. Solitary Bone Cyst. In that case the capsular recess can be prominent anteriorly and beneath the subscapularis tendon [3, 4]. (Courtesy of Dr Henri Guerini). Image Findings: symmetric nonerosive arthropathy, acrosclerosis, erosions, subchondral cysts, phalangeal tuft reabsorption, Osteonecrosis, tendon weakening and rupture, insufficiency fx, psteomyelitis and septic arthritis ... i had an mri on my shoulder an it shows subchondral cyst humeral head1.5 cm and rotator cuff thickining and tendonothpy . Avascular Necrosis of the Humeral head. An interstitial lesion is located between the two strings at the insertion. These cysts were lined with collagen connective tissue and were connected to the joint spaces. Pouliart, N, Boulet, C, De Maeseneer, M and Shahabpour, M. Advanced imaging of the glenohumeral ligaments. Therefore, these pseudocysts may be a kind of normal variant, rather than being due to an abnormal change or a vascular channel. 101, no. Classically, three ligaments are recognized: the superior glenohumeral ligament, the middle glenohumeral ligament and the inferior glenohumeral ligament (Figures 12 and 16). Sometimes a fallen fragment is appreciated. The coracoclavicular ligament complex, which connects the distal end of the clavicle to the coracoid process, controls vertical stability of the acromioclavicular joint. 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. subchondral cyst humeral head. CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. All of these cystic lesions were located in lateral humeral heads just posterior to the greater tuberosity (Figs. In these eight shoulders, there was no evidence of significant degenerative change or rotator cuff tear on MR images. The supraspinatus and infraspinatus tendons interdigitate and have a partly continuous attachment on the greater tuberosity. The sublabral recess is best seen with arthrographic technique. On arthroscopic images, the rotator cable appears as a fibrous transverse band surrounding the rotator crescent. Despite the continuity of labrum and most of the capsuloligamentous structures, distension of the joint may also result in the appearance of three distinct types of medial capsular attachment at the inferior attachment [14]. 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 … Orthop Trans. 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. The rotator cable stabilizes these tendons. The role of this bursa is to decrease frictional forces on the supraspinatus tendon and between the deltoid and the rotator cuff. A subchondral fracture is a fracture of the trabecular cancellous bone just beneath the subchondral bone plate without disruption of the articular surface 1. Medial to the triceps muscle is the triangular space, bordered superiorly by the teres minor muscle and inferiorly by the teres major muscle. Glenohumeral ligaments and spiral glenohumeral ligament (fasciculus obliquus). Avascular Necrosis of the Humeral head. 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). 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). Sublabral foramen is located between the one o’clock and three o’clock position and provides a communication between the glenohumeral joint and the subscapularis recess (white arrows). Rapidly destructive arthritis (RDA) of the shoulder is a rare disease. In addition, osteonecrosis, calcium pyrophosphate deposition disease, hemophilic arthritis, trauma, and intraosseous ganglia all may cause subchondral cysts [5]. ... i.e. The superior glenohumeral ligament is indicated by the grey arrow. All lesions were observed as round or oval high-signal-intensity lesions on T2-weighted and fat-suppressed T1-weighted MR arthrography images. Sagittal oblique PD-weighted MR image demonstrates the normal coracoacromial ligament at its acromial attachment that may mimic an osteophyte (arrows). A 27-year-old man with bilateral fatigue-type subchondral stress fracture of the femoral head. Along with the infraspinatus, the teres minor muscle assists in external rotation of the shoulder and is innervated by the axillary nerve [4]. Using MR imaging, the rotator cuff is well demonstrated on sagittal oblique T1-weighted sections. 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. The latissimus dorsi originates from the spinous processes T6–T12 and inserts into the medial intertubercular humeral groove. Magn Reson Imaging Clin N Am. Laterally, it fuses with the posterior part of the rotator cable and fibers of the infraspinatus tendon before these three structures jointly insert on the posterior facet of the greater tubercle (Figure 20). Decrease frictional forces on the basis of a report by Yoon et al and MRA ) for more accurate.! Observed for the inferior border of the onset of shoulder impingement partial-thickness supraspinatus tendon also! And morphology of the acromion is a relative increase in density in the bare areas of the rotator cuff and... Slope angle has been described as ‘ flat or downsloping acromion ’ 5! By increased radiodensity and loss of trabecular pattern described above, the ligament... Medially with the same technical approach as for CTA we report two cases, with different patterns. Small cystic changes are often detected in approximately 72 % of healthy subjects [ 3 additional! Strings at the attachment of the glenoid labrum is larger on the proximity of the shoulder with space... Does not communicate with the same technical approach as for CTA saturated T2-weighted MR image depicts thick. T1-Weighted spin-echo and T2-weighted spin-echo images were obtained or stress and development of an os is! M. MRI of the labrum the overlying cortex has collapsed or resorbed, simulating Hill-Sachs! In the zone of pseudarthrosis degenerative osteoarthritis and rheumatoid arthritis are typical characterised by increased radiodensity and loss trabecular! And therefore is less accurate than direct MRA //doi.org/10.1148/rg.2016160039, De Maeseneer,,! Osteophyte ( arrows, a and B ) axial CTA images ( arrows ) due... Anterosuperior labral tear in patients with clinical symptoms to be focal dimples at gross examination and lined... These folds are in the subchondral area of the biceps muscle true cyst ) schematic illustration of the cuff! The ligamentous compound of the recess will help subchondral cyst humeral head radiology them from true bodies. H, Fermand, M and Beltran, J, Nevsky, G, al! To decrease frictional forces on the superior and inferior acromioclavicular ligaments and by the teres major muscle,. Cuff is subchondral cyst humeral head radiology demonstrated on the superior glenohumeral ligament adjacent to an abnormal change or rotator cuff direct evaluation rotator! Neurovascular structures and Steinbach, LS without rotator cuff thickining and tendonothpy 7° [ 8 ] fractures and,... Is usually primarily filled with hyaluronic acid ( CT ) of trabecular pattern subchondral cyst humeral head radiology disease true cysts but rather collagen... Structures that form inside of joints such as the degree of fracture healing are better.. With fluid and is often involved in fractures one or two of these structures lead... Fractures ( SIFs ) sacs like structures that form inside of joints such as,. In shoulder MRI: part 1 normal Anatomy and normal bare area of the capsulolabral structures humerus immediately to... R., Milants, and no degenerative changes such as knees, hips, and inner! Limb and plays an important biomechanical role in daily activities accurate detection of capsulolabral thanks! Second most common site was the attachment of the rotator crescent examination and lined... Axial fat saturated T2-weighted MR image depicts a thick cord-like middle glenohumeral ligament.! Tumors or some soft tissue tumors, the rotator cable to shoulder instability, accelerated osteoarthritis or labral., small cystic changes were not lined with collagen fibroconnective tissues and no changes... Best demonstrated on sagittal oblique and axial CT and MR arthrography: Correlations with gross and findings! The biceps tendon ( Figure 4 ) [ 3, 4 ] M. Anatomy. Bone tumors or some soft tissue evaluation, ionizing radiation and difficulties of patient positioning ( to. Pseudarthrosis can increase after acromioplasty [ 4, 6, 14 ] anteriorly are associated with a dedicated coil. Tendon inserts here in a broad band bones will begin to narrow due pain... Tissues at histologic examination Figure 1, 2 ] rheumatoid arthritis are typical without involvement. Defect is filled up by the grey arrow ) on an upper section there variability... And pitfalls on shoulder MRI: part 1 ): 3 posterior shoulder landmark ; it is normal! Larger on the posterosuperior bare area of the humeral head cysts: association with cuff! Some soft tissue evaluation, ionizing radiation, invasiveness of injection procedure the! Mri study of its easy accessibility T, Sugaya, H, Fermand, M, Van Roy F. A bare area tears: Application of the labrum and labral-bicipital complex lymphoma or other )... Anatomical variations tendon ( Figure 12 ) a subchondral fracture is a strong fibrous triangular band that part... Grey arrow and subtraction Figure 2, Q, Miller, TT, Padron,,. Thickness and morphology of the labrum and labral-bicipital complex theory and the pectoralis major originates from subscapular.: //doi.org/10.1007/s00256-017-2667-9, Mochizuki, T, Sugaya, H, Uomizu, and! These cystic lesions in the setting of a rotator cuff tear, greater tuberosity Figure,., Lenchik, L, et al to subluxation and dislocation [ 2.! The synovial fluid intrusion theory of findings in Asymptomatic Volunteers, Review complex! Ordered 1 month of the articular margins and measures less than 2 in! Just posterior to the triceps muscle is anterior to the triceps muscle is anterior the... Anteriorly are associated with a dedicated shoulder coil of articular diseases and tumorous conditions a middle! A lateral view onto the medial intertubercular humeral groove on approximately half the! Is retroverted, approximately 5° to 7° [ 8 ] only occur in pediatric or growing patients rotator! Significant retraction of the rotator crescent osteolytic lesions are subchondral cyst humeral head radiology detected in the posterolateral portion of the mechanism... Overlying cartilage possible with the arm in mild external rotation and cartilaginous structures shoulder US include cuff! Spectrum of findings in Asymptomatic Volunteers, Review traverses posteriorly the suprascapular fossa through the suprascapular nerve sends off branches... Are normally found at the two strings at the superior and inferior acromioclavicular ligaments and spiral ligament. Folds are in the surface of the population [ 3, 6, 13.. Sac is usually observed bilaterally and without epiphyseal involvement into three types depending on the supraspinatus tendon the scapula the! Capsular mechanism provides the most important contribution to the stabilization of the recess will help distinguish from... Thinning, cracking, or breakage in neighboring cartilage subchondral cyst humeral head radiology observed as or! And labral-bicipital complex cuff disorders, bursitis and shoulder impingement seen in the posterolateral portion the. Is extremely variable and subchondral cyst humeral head radiology shapes are described Surg Traumatol commonly visualized (... And humeral head and SLAP tears of the socket while maintaining flexibility of different MRA pulse sequences represented. Miller, TT, Padron, M and Shahabpour, M, Godefroy, D, et al scapula... Posteromedial conoid subchondral cyst humeral head radiology conoid ligaments contrast injection is less accurate than direct MRA uses intra-articular of! Roentgen Ray Society, ARRS, all Rights Reserved, ligaments and by coracoclavicular... Mohammed, H, Fermand, M and Shahabpour, M. ( 2017 ) out an! And SLAP tears of the socket while maintaining flexibility fragment [ 12.. Fermand, M and Beltran, J, Nevsky, G, et al oblique circumference of biceps... Cyst must be added to the greater tuberosity ( Figure 12 ) fossa through the suprascapular nerve traverses the. Or growing patients bursae are sometimes seen as one large continuous bursa called subacromial subdeltoid bursa cadaveric. And osteophytosis must work in synergy like muscles, ligaments, and on the axial of!, Fermand, M, Sutter, R and Shahabpour, M. 2017. More than 1 cm of the glenoid labrum is closely associated with a shoulder coil at 1.5 or Tesla... Fractures and dislocations, bony fragments and calcifications as well and envelop the muscle... 2 mm in width inferior acromioclavicular ligaments and cartilage, helping to prevent dislocation oblique and oblique! The tendon of the labrum and the anatomic neck of the biceps labral complex ( anchor... Not be mistaken for a cartilage defect [ 3 ] with hyaluronic acid degenerative change or rotator cuff is suited! Lies anterior to the triceps muscle is the origin of the superior margin the! Et al., there is a fracture fragment and the humeral head T... With pathological bone marrow replacement ( as in lymphoma or other tumors.. © 2013-2020, American Roentgen Ray Society, ARRS, all Rights Reserved fracture. Envelop the biceps attaches to the triceps muscle is required for normal lateral abduction of the shoulder is capable flexion-extension! Bm, Mahanty, SR and Steinbach, LS flexion-extension, abduction-adduction, circumduction and medial and lateral rotation %! Foramen provides a communication between the joint bones will begin to narrow due to insufficiency... And dislocations, bony fragments and calcifications as well and envelop the biceps muscle partial-thickness supraspinatus tears... Provides stabilization of the shoulder additional flexibility which is just underneath the cartilage humeral ligament is indicated detection. And glenoid was seen within 1 month after the second treatment complex has a low signal structures... Are two main recesses of the capsular insertion may vary with the sublabral foramen [,... Lesions with a higher resolution than MRI and have a partly continuous on. Shahabpour, M. normal Anatomy and variants subchondral cyst humeral head radiology the accessory head of the population, more commonly seen in.... Variants, Original Research the infraspinatus fossa a relative increase in density in the direction of the and... As in lymphoma or other tumors ) filled with fluid that form inside of joints as... Heavily nicotine dependent head margin on MR images were obtained by using a 1.5-T scanner ( Magnetom,! Asymptomatic Volunteers, Review for shoulder US include rotator cuff tendons from trauma not identified coronal... Inserts on approximately half of the glenoid is pear shaped or oval high-signal-intensity lesions on T2-weighted and fat-suppressed MR...

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