Rotator Cuff tear Imaging - Everything You Need To Know - Dr. Nabil Ebraheim
Dr. Ebraheim’s educational animated video illustrates the shoulder rotator cuff muscles and types of imaging.
AP view x-ray:
True AP (45° lateral)
Patient can be standing, sitting, or lying down.
Get a true AP view of the shoulder which will show the acromiohumeral interval which the normal interval should be between 7-14 mm.
The x-ray may show proximal migration of the humeral head which means there is a chronic rotator cuff tea.
Calcific tendonitis may also be seen on AP view x-ray.
Beam aimed with 10° caudal tilt.
Allows calcification of the acromion.
The supraspinatus outlet view will show the shape of the acromion.
OS acromial may be seen on axillary view x-ray.
MRI is the best study for diagnosing rotator cuff tears.
The MRI takes slices of cuts of the bone and the soft tissue structures as if you are taking a slice from an apple.
The slices of the MRI can be seen in either a coronal, sagittal, or axial orientation.
The normal rotator cuff appears dark on T1 and T2 on the MRI.
Arthrogram is not used routinely.
It is used when the patient is unable to have an MRI (pacemaker).
Similar to a patient with a pacemaker that cannot have an MRI done of the spine (myelogram is done).
Arthrogram will show the dye in the subacromial space.
If the “Geyser Signs” is present with the dye leaking into the subacromial space as well as the AC joint, then there is a huge tear.
If you add MRI to the arthrogram, that will increase the sensitivity and the specificity, and will show also any instability and partial tears better than arthrogram alone.
When it comes to the MRI: the T2 is probably the best in showing the tears.
The problem with MRI is the presence of asymptomatic cuff tear that are seen frequently in patients, especially older patients.
50% of asymptomatic patients 60 years or older will show rotator cuff tears on MRI.
These tears increase in frequency with age.
Rotator cuff tears and patient age is important because of a few points.
1- A lot of asymptomatic tears.
2- Patient is above the age of 40 years old with a dislocated shoulder may also have a rotator cuff tear.
3- Chronic tears are found in older patients which could involve multiple tendons.
4- The surgical outcome of rotator cuff repair depends on the age of the patient, the older the age of the patient, the worse the outcome.
5- Older patients with rotator cuff arthropathy can have reverse shoulder arthroplasty, which is different from younger patients.
When you look at the MRI, you want to know the type of tear (partial or complete), the size of the tear (small, medium, or large).
Rotator cuff tears are classified into either partial thickness or full thickness tears.
- Partial thickness tears are classified by location into three types:
• Articular -sided.
• Bursal sided.
• Intrasubstance.
These tears are also classified according to the size of the tear (greater or less than 50% thickness).
The fluid or dye will extend partially through the thickness of the tendon; however there is no retraction of the tendon.
Full thickness tears:
- Complete tear: the bright fluid signal extends completely through the tendon from superior to inferior.
You want to know how much retraction is involved with the rotator cuff tear.
Massive rotator cuff tears that are greater than 5 cm usually involve multiple tendons.
The tendon will be retracted to the level of the glenoid and there will be atrophy of the muscle with fatty infiltration and probably superior migration of the humeral head.
What is the quality of the muscle?
Check for the presence of fatty atrophy on the sagittal view MRI.
Normally the supraspinatus muscle occupies the fossa in the sagittal view.
When the muscle is atrophied or abnormal, it does not occupy the fossa completely.
Fatty muscle atrophy see on sagittal view usually means that there is either a chronic rotator cuff tear or suprascapular nerve injury.
0- Normal
1- Some fatty streaks
2- More muscle than fat
3- Equal fat and muscle
4- More fat than muscle
It is important to know the proper orientation of the rotator cuff muscles in the sagittal view.
Look at the long head of the biceps in an axial view.
Check for subluxation of the biceps tendon which should mea there is also a tear of the subscapularis tendon.
Remember: the long head of the biceps is anteriorly located.
Look for cysts of the greater tuberosity on MRI which are seen in a lot of patients with rotator cuff tears.
CT Arthtogram:
- Done sometimes post operatively.
- When the patient has anchors, we cannot see them well.
- Some believe that ultrasound is better in these cases.
- Used with frequency and is not expensive.
- It may create dynamic evaluation.
- There is a learning curve for using ultrasound imaging and it cannot evaluate the shoulder joint itself.
- About 20% will show a rotator cuff tear in asymptomatic patients.
Click this link to view the associated video "Rotator Cuff MRI"
• Rotator Cuff MRI - Eve...
Пікірлер: 77
This is the best video on KZread. Everyone else speaks way too fast and you can't even understand what they are saying. Thanks you so much.
Excellent explanation in detail, now I understand MRI clearly, I am planning surgery soon. Thanks a lot for great video...
Excellent presentation. Very helpful for understanding the anatomy of my rotator cuff tear and my planned surgery. Thank you!
Thank you! Very informative for medical professionals.
Great job explaining this doctor!
Thank you Dr. Ebraheim! Great presentation!
Very educational, thank you!
This video was very helpful and easy to understand👍I’m having rotator cuff surgery soon thank you doctor for all the the information my blessings to you💯👍
Very helpful post. I am having surgery next Wednesday. Makes me more convinced I must get this done before I have muscle atrophy set in!
@lashondahursey6116
2 жыл бұрын
How are you.
Very informative!
Very informative with the slides . Thanks
Thank you this video was helpful for me.
Very clear and helpful, thank you
Very helpful, thank you!
Awesome video. Very detailed and great explanations. I just had a full tear repaired yesterday and I have been researching what's going on in my shoulder. I had the bicep tendon repaired as well. This video was quite informative, thank you.
That was amazing 👏
Thank you for explaining the mechanics and repairs of this condition. I have a 3.5 year old workplace injury. The surgeons I've consulted seem to be rather eager to perform a very expensive surgery with an iffy outcome. It is my body. I'm old. I've been living with the pain. I'll pass. I'll just write off the lawyer fees. Physical therapy helps.
thank you very much dokter
Very nice !
amazing
u r the best
thank you Dr
Thanx buddy
Thank you so much!
@azlanali562
6 жыл бұрын
Samer Yassin Good
trying to find out what an , increased t2 signal is present within the supraspinatus tendon, means ??? what is signal in a MRI ???
Good, thanks
very useful
thank you, amazing breakdown and information ,
this was great, i still cant understand my mri pictures but at least i feel better now
Will have rotator cuff surgery for replacement & in my 70’s. Because of age will my healing be more painful recovery
Should the MRi be with or without contrast?
What is considered older population in regards to having surgery and prognosis poorer? I am female RN 59. Thank you! Great video
I have this pain it's been whole month.. It is very painful..
I had this done 2 years ago; most painful surgery I’ve ever had!😥
@CS-ox9hn
Жыл бұрын
Why?
@pennytirello1400
Жыл бұрын
@@CS-ox9hn rotator cuff had torn completely off the bone. I’m a lot of cases, they can repair it by scope. I was cut for the repair! It’s a painful, painful recovery!
Outstanding resume of basic information on the subject! I enjoyed every second of it ! JD Carmo, MD, orthopedic surgeon
What are the indications of surgical repair?
جزاك الله خير يا دكتور
If you have torn rotator cuff with atrophy does atrophy mean the tear is old?
@petergianakopoulos4926
2 жыл бұрын
Yes
I just received my ultrasound results for my left shoulder: supraspinatus-focal full thickness tear of the anterior fibers measuring 17mm in maximal dimension. Waiting for an appointment with orthopaedic surgeon. What can I expect out of this? I would love a response please thank you in advance
@donalbershardt9290
2 жыл бұрын
At 57 y.o. I had the Surgery done and had 4 other Repairs done with the same Surgery.. THE Shouder is very Complicated. My recovery was 1 yr. To Raise my arm Straight above my HEAD.. GOOD LUCK 👍
@sylvieboisvert2423
2 жыл бұрын
@@chuck7432 thank you
dok hasil mri supraspinatus bahu saya banyak tear selain tindakan oprasi apa yang harus aku lakukan trima kasih
im very unhappy. I injured my right shoulder 2 years ago and I have all the symptoms of rotator cuff tear yet when I get xray or ultrasound they cant seem to find anything. I cant have an MRI because of a plate and 6 screws in my other shoulder. I have done physio, chiropractic and acupuncture and nothing works and in two years iv had 5 cortisone shots and those don't help either. I swear if one more Dr says im gonna be in severe pain the rest of my life im gonna lose my temper
@mattiacontarino4319
4 жыл бұрын
Hello there, try to work with Athlean X or Guerilla zen fitness. They might help you
Awesome
Obraba kostnega mozga ker naseda kost na kost je ponovna ispostavitev mozna delno z injekcijami z vbrizgavanjem astrogena ker se pocasi obnavlja v kolikor je obraba presegla giblivost bo potrebna operacija? Nisem iz medizine ali zdravilec zelim izvedeti ce so moje trditve samo ko vidim sliko jezika ne poznam ce se ujemajo moje trditve Hvala za odg. Sliko sem pogledala bezno ❤
Great information!!! But shown far too quickly, I couldn't take it all before being shown the next clip!!!!!
Thank you!🙏🏻✝️
I hurted my shoulder in the weight room and I didn't know I did until I went to a chiropractor he sent me to get an mri and it said partial thicknss tear and he stick me 3 times with a cortisone shot and it made my shoulder feel much better but I still need to strengthen the muscles around my should so can I go back into the weight room and start LIFTING weights again but slowly until it's strong again
@TheRealJiggyboy
2 жыл бұрын
How are you now
@crayshaunhenderson1265
2 жыл бұрын
@@TheRealJiggyboy still good but i want it stronger so i can start lifting again
@TheRealJiggyboy
2 жыл бұрын
@@crayshaunhenderson1265 did u dislocate it
@crayshaunhenderson1265
2 жыл бұрын
@@TheRealJiggyboy i hurted my shoulder lifting weights
@crayshaunhenderson1265
2 жыл бұрын
@@TheRealJiggyboy but i want to get my shoulder stronger so i can start back lifting weights again
dok hasil mri supraspinatus bahu saya banyak tear
I think just need have enough time to rest that is fine again. I know what my health and powerful being in me
Rotator cuff
Hello my hart arm no working
Pov: your looking for that pov meme
I didn't know Rick Ross was performing shoulder surgeries.
@TheRealJiggyboy
2 жыл бұрын
Something an idiot would say
sucran
Hard to understand the dialect
dok hasil mri supraspinatus bahu saya banyak tear