Summary

In conclusion, MRI is a useful diagnostic method for evaluating nerve disease at the shoulder and elbow. MRI can depict the normal anatomy of the nerves, confirm and identify the cause of the neuropathy, identify the site of entrapment based on muscle denervation patterns, and detect unsuspected space-occupying lesions. MRI can also narrow down the differential diagnosis of nerve disease, such as in the case of suprascapular nerve syndrome versus Parsonage-Turner syndrome, or radial tunnel...

References

MR imaging of sports injuries in the adult elbow a tailored approach. AJR Am J Roentgenol 1996 167 325-31. 2 Steinbach LS, Palmer WE, Schweitzer ME. Special focus session. MR arthrography. Radiographics 2002 22 1223-46. 3 Rosenberg ZS, BeltranJ, Cheung YY. Pseudodefect of the capitellum potential MR imaging pitfall. Radiology 1994 191 821-3. 4 Rosenberg ZS, Beltran J, Cheung YY, et al. MR imaging of the elbow normal variant and potential diagnostic pitfalls of the...

Imaging of Upper Extremities

He role of imaging in the evaluation of sports-related injuries of the upper extremities has evolved significantly over the past decade, with MRI becoming the imaging modality of choice for the evaluation of most soft-tissue injuries ranging from overuse injuries to acute traumatic injuries. Ultrasound has also emerged as a useful problem-solving tool that can be used in the targeted evaluation of certain upper-extremity injuries. To maximize the diagnostic value of these tools, the treating...

Tendons

Flexor Carpi Radialis Axial

Understanding the normal anatomy of the flexor tendons may be simplified by classifying them according to their location within and outside the carpal tunnel. The flexor tendons contained within the carpal tunnel, deep to the flexor retinaculum, include the flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis longus tendons Fig. 1 . A common tendon sheath surrounds the long flexor tendons of the digits, whereas the flexor pollicis longus traverses within its own...

Nerve Abnormalities

Radial Neuropathy

MRI may be useful in evaluating patients with nerve disorders at the elbow. Inflammatory changes within a nerve caused by long-standing compression may alter its morphology and signal characteristics on MRI. Normal nerves Fig. 19. Complete triceps tendon rupture in a 57-year-old male with posterior elbow pain following trauma. Sagittal T2-weighted spin-echo image of the elbow shows a large fluid-filled gap arrowhead between the completely torn and retracted distal triceps tendon arrow and the...

Mechanism Of Injury And Imaging Findingsthe Deceleration Phase

Bennett Lesion Mri

During the deceleration phase, after ball release, there is strong eccentric contraction of all muscle groups to maintain the humerus within the glenoid fossa. Joint loads and compressive forces can be large enough to cause rotator cuff tears 43 . These compressive forces, combined with internal rotation and anterior displacement of the humerus, can also cause grinding of the humeral head on the biceps tendon and anterosuperior aspect of the labrum and lead Fig. 7. Bennett's lesion. Axial...

Nerves

Mri Flexor Pollicis Longus Tendon

Proximal to the wrist joint the median nerve travels between the flexor digito-rum superficialis and FCR muscles. It then courses through the carpal tunnel along with the flexor tendons of the fingers and thumb. The carpal tunnel is a fibro-osseous canal bordered volarly by the flexor retinaculum, medially by the pisiform and the hook of the hamate, laterally by the scaphoid and trapezium, and dorsally by the carpal bones. The flexor retinaculum is composed of three parts the antebrachial...

Normal Mri Appearance

The fibrous structures in the shoulder are highly organized tissues with normally low signal on all pulse sequences. These structures include the joint capsule, glenohumeral ligaments, rotator cuff tendons, and the labrum. When there is disruption of the organization structure because of tendinopathy or tear, the signal intensity increases. Unfortunately, there are confounding factors that may cause artifactually increased signal intensity in the absence of pathology. These are discussed in...

Parsonageturner Syndrome

The hallmarks of Parsonage-Turner syndrome, also known as acute brachial neuritis, include the sudden onset of severe atraumatic pain in the shoulder Fig. 4. Quadrilateral space syndrome. Oblique sagittal T1-weighted image demonstrates selective fatty infiltration and atrophy of the teres minor muscle TMi . The deltoid muscle is spared. Fig. 4. Quadrilateral space syndrome. Oblique sagittal T1-weighted image demonstrates selective fatty infiltration and atrophy of the teres minor muscle TMi ....

Axillary Nerve

Subscapular Nervemri

The axillary nerve, as the terminal branch of the posterior cord of the brachial plexus, receives contributions from C5 and C6 nerve roots. The nerve courses along the anterior surface of the subscapularis muscle dorsal to the axillary artery. It then makes a sharp turn posteriorly to travel along the inferior gleno-humeral joint surface. Slightly more distally, the nerve, along with the posterior circumflex artery, enters the quadrilateral space. The borders of the quadrilateral space are...

Space Occupying Lesion Aberrant Nerve

Guyon Canal

The most common neuropathy of the upper extremity is the carpal tunnel syndrome, with an estimated incidence of nearly 1 annually, or almost 2.8 million new cases per year, and prevalence of 0.125 to 5.8 74 . The syndrome is most often found in patients between 30 and 60 years of age, has a male female ratio of 1 5, and is bilateral in as many as 50 of patients. Clinical complaints include often transient and reversible pain and paresthesia in the median nerve distribution. In wrist flexion, in...

Pitfalls In Rotator Cuff Imaging

Intermediate or inhomogeneous signal in the cuff tendons are causes of diagnostic difficulty. Although the signal may be because of tendinopathy or partial tearing, artifacts such as magic angle phenomenon, inhomogeneous fat suppression, and partial volume averaging also may cause an increase in signal. Magic angle phenomenon occurs on short TE sequences, such as PD sequences. Artifactually increased signal may be seen where the fibers of the cuff tendons are aligned at a 55-degree angle to the...

Sports Related Injuries of the Elbow An Approach to MrI Interpretation

Tuite, MDa'b' , Richard Kijowski, MDa'b aUniversity of Wisconsin Medical School, 750 Highland Avenue, Madison, WI, 53705 USA bDepartment of Radiology, University of Wisconsin Hospital and Clinics, E3 311, 600 Highland Avenue, Madison, WI 53792, USA MRI is a valuable tool for evaluating the athlete with elbow pain, particularly in those with nonlocalizable pain. MRI also is helpful in sorting out the cause of pain in athletes who may have acute trauma superimposed on tendinopathy or...

Nondisplaced Fractures

Radial Head Fracture

MRI can be helpful in recognizing or characterizing nondisplaced fractures, and the imaging information may alter treatment. There are several types of fractures in which MRI can play a role. One is in identifying an otherwise radio-graphically occult fracture, such as a small radial head fracture Fig. 6 . MRI also can be helpful in avulsion fractures of the sublime tubercle in which it can help determine if the MCL is intact or if there is fibrous nonunion or a pseu-darthrosis 12 . Another...

Ulnar Collateral Ligament Tears

Ucl Tear Mri

Tears of the ulnar collateral ligament may occur following acute valgus stress injury to the elbow or following acute traumatic elbow dislocation 18,19 .Ulnar collateral ligament tears are caused more commonly, however, by chronic repetitive stress to the elbow elicited by sports activities involving overhead throwing 20-23 . Most tears of the ulnar collateral ligament are full-thickness tears that involve the anterior bundle. The vast majority of these full-thickness tears occur in the...

Rotator Cuff Tear

Rotator Cuff Mri Image

The most common concern in the patient who has postoperative pain is retear of the rotator cuff repair. The patient usually presents with a known incident and details a history of acute pain associated with loss of motion. The diagnostic criteria are similar to the preoperative evaluation with the presence of fluid signal on a T2-weighted image that extends through the entire tendon substance. In the case of MR arthrography, simply seeing the contrast extend into the subacromial-subdeltoid...

Medial Epicondylitis

Axial Medial Epicondylitis Mri

Medial epicondylitis is a pathologic condition of the common flexor tendon at its origin from the medial epicondyle. Medial epicondylitis is much less common than lateral epicondylitis. Unlike lateral epicondylitis, medial epicondylitis is seen mainly in athletes. Most individuals with medial epicondylitis are involved in sports activities that generate repetitive valgus and flexion forces at the elbow. Medial epicondylitis is believed to represent an incomplete healing response to an initial...

Suprascapular Nerve

Suprascapular Nerve Entrapment

The suprascapular nerve originates from the upper trunk of the brachial plexus, receiving fibers from C5 and C6 nerve roots. The nerve innervates the supraspinatus and infraspinatus muscles and provides sensation to the gle-nohumeral and acromioclavicular joints. After traversing the supraclavicular fossa, the suprascapular nerve, with its accompanying vein and artery, enters the suprascapular notch, making a sharp turn around the scapular spine. There the nerve travels within scapular notch or...

Approach To Rotator Cuff Evaluation

Distal Clavicle Bone Marrow Edema

One approach to evaluating the rotator cuff on MRI is to begin by reviewing the coronal oblique PD images to get an overview of the anatomy Fig. 1 . Proton density images are weighted intermediately between T1 and T2 signal. They provide superior signal-to-noise ratio and spatial resolution, albeit at the expense of soft tissue contrast. Large cuff tears and distortions of the anatomy may be identified. Shoulder alignment may be evaluated also. Occasionally because of improper positioning or...

Ulnar Nerve

Mri Elbow Ulnar Nerve

The ulnar nerve continues directly from the medial cord of the brachial plexus, and contains motor and sensory fibers arising from the C8 and T1 roots. The ulnar nerve crosses from the anterior to the posterior compartment at mid-arm level, piercing the intermuscular septum. The ulnar nerve may pass under the arcade of Struthers, present in 70 of individuals, approximately 8 cm proximal to the medial epicondyle 35 . The arcade of Struthers, made of fibers from Fig. 6. Parsonage-Turner syndrome....

Cubital Tunnel Syndrome

Tardy Ulnar Nerve Palsy Mri

Physiologic and compressive cubital tunnel syndromes have been described. Compressive cubital syndrome may have acute, subacute, or chronic presentation. Normal loss in volume and increased pressure within the tunnel during elbow flexion result in physiologic cubital tunnel syndrome. This can be seen in ''sleep palsy,'' as the arm is held in flexion for prolonged periods of time. Blunt trauma to the cubital tunnel is a typical cause of acute external compression syndrome of the ulnar nerve....

Ulnolunate Impaction Syndrome

Distal Radioulnar Subluxation Mri

Coronal fat-suppressed T1-weighted image from an MR arthrogram radiocarpal joint injection only demonstrates contrast extravasating into the DRUJ asterisk and through the ulnar aspect of the TFCC arrows , consistent with an ulnar-sided TFCC tear. Contrast is also noted extending into the midcarpal joint through a torn lunotriquetral ligament curved black arrow . Tears of the LTL are much less common than scapholunate ligament SLL tears, occurring only about one sixth as...

Median Nerve

Rotator Cuff Mri Image

The median nerve supplies the radial side of the flexor portion of the forearm and hand, and is formed by the blending of the lateral and medial cords of the brachial plexus. It contains both motor and sensory fibers from the C5, C6, C7, C8 and T1 nerve roots. The median nerve descends in the arm in close relationship to the brachial artery. It has no branches at the level of the arm. At Fig. 12. Subcutaneous anterior transposition of the ulnar nerve. Axial T1-weighted image shows a mildly...

Radial Nerve

The radial nerve, a terminal branch of the posterior cord of the brachial plexus, supplies the extensor musculature of the arm and forearm as well as the overlying skin. The radial nerve carries motor and sensory fibers from the C5, C6, C7, C8, and T1 nerve roots. The nerve descends between the medial and long heads of the triceps muscle in the proximal arm. At the proximal humeral shaft, the radial nerve traverses within the humeral spiral groove. In the distal arm, the nerve perforates the...

Nondisplaced Tear

Labral Tear

Subcortical cysts and posterior capsular stripping in a 16-year-old male who had right shoulder pain when throwing for 3 months. A Subcortical cysts arrow in the greater tuberosity at the insertion of the supraspinatus tendon are seen as high signal intensity on a fat-suppressed T2-weighted image. B Axial gradient echo T2-weighted image shows a nondisplaced tear of the posterior labrum and capsular stripping arrow . Fig. 3. Posterosuperior labral tear and impaction of the greater...

Entrapment Neuropathies of the Shoulder and Elbow in the Athlete

Bencardino, MDa , Zehava Sadka Rosenberg, MDb aDepartment of Radiology, Huntington Hospital, North Shore Long Island Jewish Health System, 5 Twelvepence Court, Melville, NY 11747, USA bDepartment of Radiology, Hospital for Joint Diseases, New York University Medical Center, 305 East 17th Street, New York, NY 10003, USA Entrapment neuropathy secondary to nerve compression by mechanical or dynamic forces may be a cause of upper extremity pain and weakness in the athlete. Anatomically...

Treatment For Intasubstance Tear Of The Extensor Carpi Ulnaris Tendon

Partial Tear Scapholunate Ligament

Scapholunate instability is the most common carpal instability. It may occur after a traumatic extension injury to the wrist or result from repetitive stress, as in chronic crutch walking 65 . Weakness and pain about the dorsal radial aspect of the wrist are frequent complaints. On clinical examination, a positive scaphoid shift test may be found 66 . This result consists of a click elicited when bringing the wrist from ulnar to radial deviation while the scaphoid tuberosity is stabilized by...

Lateral Epicondylitis

Lateral Epicondylitis Mri

Lateral epicondylitis is a pathologic condition of the common extensor tendon at its origin from the lateral epicondyle. Lateral epicondylitis also is known as tennis elbow because more than 50 of tennis players develop the condition at some time or another 36 . Lateral epicondylitis is far more common in Fig. 13. Normal ulnar band of the lateral collateral ligament. Coronal fat-suppressed T2-weighted fast spin-echo image of the elbow shows the normal low signal intensity ulnar band of the...

Rotator Cuff Tears

Partial Thickness Rotator Cuff Tear

The spectrum of rotator cuff pathology ranges from tendinopathy and fraying to partial- or full-thickness tearing. Partial-thickness tears may be classified further as occurring on the articular or bursal surface of the tendon. A third type of partial-thickness tear is the intrasubstance tear, which occurs within the substance of the tendon without extending to the tendon surface. This type of tear is uncommon but is important to identify on MRI because the tendon surface may appear normal at...

Triceps Tendon Injury

Triceps Tendon Mri

Rupture of the triceps tendon is a rare injury. Triceps tendon rupture occurs in both males and females and in individuals of all ages. Rupture of the triceps tendon is almost always the result of a single traumatic event. The mechanism of injury usually is a fall on an outstretched hand. Less common mechanisms of injury include a direct blow to the posterior elbow and a forceful eccentric contraction of the triceps muscle with the elbow flexed. Most tears of the triceps tendon occur at the...

Normal Mri Rotator Cuff

Mri Labral Tear Anterior

The superior and inferior labra are visualized best on coronal oblique images, whereas the anterior and posterior labra are seen best on axial images Figs. 14 and 15 . A labral tear is diagnosed when an irregular line of fluid or intra-artic-ular contrast tracks into the labral substance or between the labrum and the glenoid articular cartilage Fig. 16 . When a labral tear extends through the joint capsule, a paralabral cyst may develop in an extra-articular location. The cyst may be the most...