How to read your shoulder MRI
Hi, this is Dr. Centeno. And today I'd like to teach you how to read your shoulder MRI, the top three things to know. So this video isn't meant as a substitute for a radiology report or your doctor's opinion, but just to empower you to read your own MRI to learn more about your shoulder, because we at Regenexx believe that empowered patients that understand what's going on are actually very important to the process. So an MRI is a 3D picture that slices through the shoulder in three planes-- sagittal, coronal, and axial. And this is what happens.
You're literally, like slicing through this tomato, slicing through the structures. So in order to understand what's on an MRI, you have to realize that's what's happening. And these are three planes I'm talking about here. You've got the coronal plane, which is looking from the front. You've got the sagittal plane, which is looking from the side. And you've got the sawed-in-half view here, which is sort of looking down on a structure. And you want the coronal image, which may be labeled COR or something like that.
But that's the one you're going to want to pull up, because that's the easiest one to understand. The other ones are a little harder to understand. And you see here in this coronal image this is the main shoulder joint.
And I'll go over this again. This is the rotator cuff coming in this way and attaching to the bone. This is the humerus bone here. And up in this area, you'll see the AC joint on other images. So these are the structures you're going to be looking at.
So just to get a sense of it, from the top here, you see your collar bone coming in. You see the scapula here or the shoulder blade. You see the main shoulder joint. And you see the rotator cuff coming across.
From front, you're going to also see the humerus bone here, the subscapularis which is part of the rotator cuff, the collar bone up here. And from the back, you're going to see the teres and infraspinatus muscles coming across here, which are the back part of the rotator cuff and the supraspinatus coming across here, which is the top part of the rotator cuff and the AC joint made up of a joint between the collar bone and a part of the scapula-- so the AC joint, or acromioclavicular. So I'm now going to go over the top three areas on this view that you should pay attention to. The first one being the AC joint, which is that joint we've just talked about, the joint between the collar bone and the scapula. The second one being the rotator cuff. Everybody talks about the rotator cuff. The third one being the main shoulder joint itself. So as far as the AC joint, it's small.
Well, you want to know is it small and straight, sort of like this one. So a small AC joint-- you can see here the collar bone coming across, and the other part-- just the front part of the scapula is all you're seeing here. But you see a clear joint in the middle.
Or is it big and distorted more like this one over here or even bigger? That's important because as you can see, the rotator cuff comes right under the AC joint. The AC joint can put pressure on the rotator cuff. And so that could be an area of impingement. But, again, is this joint small and straight or bigger and distorted? If it's bigger and distorted, it means it has some arthritis. The second main area look is the rotator cuff itself. Is it smooth and continuous? Are there light spots are large areas of white? So you see a normal rotator cuff supraspinatus tendon coming through here, nice and smooth.
And it attaches there. There is a slight, little area of white right there. But for the most part, that looks pretty normal. Now, if you go over to the right side here, this looks completely different. You've got these large sections of white here. And those large sections of white are fluid.
That's big swelling of the joint. And then if you try to follow the rotator cuff tendon all the way over, you really can't. You start to lose it here. And then it doesn't attach here.
So those are two big tears. So that's how you can get some sense of what a tear in the rotator cuff looks like. Now, is the tendon uniform in color or splotchy. Well, it might not be torn and retracted like the one you just saw, sort of like a rubber band that snaps. It might have other tears, called degenerative tears, in it. So you can see here this section of the rotator cuff is nice and dark. But then we get to this section, and it looks bright and light colored. And when we look over here at this one off to the right, all of this area in here should be nice and dark.
But instead, it's bright. So it means there is some tearing and some degeneration in that rotator cuff tendon. And then the shoulder joint is the final piece. Again, the main shoulder joint is down here. And really, what you're looking for here is a sandwich of grey cartilage. So you want to be able to say that you have this grey cartilage right on top of the bone here and on the other side.
So realize this is a ball and socket joint. And you want to have grey cartilage on both sides of that joint. Here you can see off to the right now that this joint looks quite different. We see large areas of white inside the joint. And only this one area right here actually has some grey. And you can see that the size of the joint is quite different than the one over here. The one on the left has a good space between the bones, between the humerus bone, or the ball and socket joint over here.
But this one doesn't have much space between those two. So it's arthritic, and it's lost cartilage. Now, let's go read an image.
So this is our shoulder joint image. We picked the coronal. You can see the coronal here pretty clearly. And I'm going to scan through this coronal image now so you can get some sense of what that looks like.
So as I scan through it or I just move my mouse, I'm going to see the rotator cuff coming in here pretty clearly. I'm going to see the main shoulder joint right in here. And as I go back a little bit, I will see the AC joint. So that's our 1, 2, 3, the AC joint, the rotator cuff, and then the big shoulder joint right here. Now, you can see that this gentleman actually does have a reasonable amount of cartilage left in here, although it's a little bit thinned.
And over here, you can see that he also has a pretty good rotator cuff tendon. But you can see a little bit of misshapen AC joint here, putting some pressure on the top the supraspinatus tendon or the rotator cuff. But as we look at the quality of the rotator cuff tendon itself, it's not bad. This area out here in the tendon is dark. This area over here is appropriately grey.
We don't see any major tears in that tendon. He's got a little bit of arthritis in the AC joint. And down here in the main shoulder joint, that looks pretty good. One of the things that you do notice is that, and this is a little bit more complex, is at this humerus bone is riding a bit high. But outside of that, there is still cartilage left in the joint, although it's thinning. So that gives you some sense of how to read an MRI. A patient that understands what's wrong with them is important.
So if you want more information, go to regenexx.com. That's R-E-G-EN-E-X-X.com. Thank you so much for watching.
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