الفهرس 
Gross anatomy of the shoulderOnly 14 pages are availabe for public view
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Abstract
joint is anatomically complex, where its stability depends on a combination of osseous structures and soft tissue structures surrounding the shoulder known as the labral ligamentous complex, joint capsule, muscles and tendons where they are acting as dynamic as well as static stabilizers preventing the joint from exceeding the optimized range of motion. Shoulder pain is a common clinical complaint that may be due to a wide spectrum of disorders, the most common of which are impingement syndrome, rotator cuff disease and glenohumeral instability Imaging plays a major role in the management of shoulder problems. MRI & MRA have replaced arthrography for evaluating the integrity of the rotator cuff and shoulder instability. The shoulder is commonly imaged using MRI, with or without intraarticular contrast medium. Some anatomic structures, such as the rotator cuff tendons and bony components, can be assessed without arthrographic technique, whereas the glenohumeral ligaments and labrum require arthrographic technique for more accurate assessment. MRA has a distinct role in certain cases, such as patients who are likely to have non-surgical treatment, and provides information on areas not seen by arthroscopy, like the internal structure of the rotator cuff. Therefore both MRA and arthroscopy have complimentary roles in the diagnosis of shoulder pathology. The aim of this work is to show the value of 1.5 T MRI in evaluation of shoulder pain. This study was performed between April 2011 and September 2013 and was conducted on 100 patients complaining of shoulder pain. There were fifty six males and forty four females, their ages ranged between 19 & 69 years (mean age, 31 years). The patients were referred to the radiology department from the out patient clinics and the orthopedics department of Menoufia University Hospital for MRI examination of the shoulder. Seventy nine patients suffered right shoulder pain while twenty one had left side pain (P value < 0.0001). All our patients were examined by conventional MRI while only 8 of them had additional MRA study. This was followed by arthroscopy to all patients. The results of conventional MRI and arthroscopy were comparable confirming that conventional MRI in cases of shoulder pain is a valuable diagnostic modality that can show good anatomic information, the acromion shape, and presence of subacromial bursal abnormalities, rotator cuff abnormalities including tendinosis, partial-thickness and full-thickness tears, degenerative changes of the acromioclavicular joint, as well as labral tears. Conventional MRI showed that patients below 31 years had higher incidence of labral injuries while those ≤ 31 years had higher incidence of rotator cuff tendon injuries. The Rotator cuff tendon pathological lesions were the most common, involving mostly the supraspinatus tendon. MRI of the shoulder is an accurate, useful and established technique as a diagnostic tool to assess the rotator cuff pathology especially detecting full-thickness tears; however, it was found to be less reliable in detecting partial-thickness tears. Rotator cuff tendinosis is often difficult to be distinguished from a partial-thickness tear. However, many cases of tendinosis may actually be partial-thickness rotator cuff tears. MRA is more accurate than MRI to clarify the intra-articular anatomy, intra-articular damage and the identification and differentiation of intra-articular pathologies such as the ALPSA lesion from a Bankart lesion, which would necessitate a different approach to the surgical repair. MRA appears to be less effective than arthroscopy with regard to capsular laxity and identification of loose bodies. With advances in technology allowing for faster imaging times, improved spatial resolution and tissue contrast enhancement can be achieved and allow excellent visualization of the labrum and so MRA will not be routinely used. In conclusion, we finally recommend that any patient complaining of shoulder pain must be evaluated by full clinical history and physical examination. The following imaging protocol is recommended: Plain X-ray to exclude fractures in post-traumatic cases. Conventional MRI which should be done for all patients with shoulder pain. Direct MR arthrography is recommended for Athletes with chronic injuries, patients suspected to have Labral lesions, Capsular lesions, Biceps anchor lesions, either clinically or following conventional MRI, Chronic recurrent instability and patients refusing diagnostic arthroscopy or surgery or generally unfit for surgical or arthroscopic intervention who are likely to have nonsurgical treatment including Conservative rehabilitation such as physiotherapy. Arthroscopy is still the diagnostic gold standard pre operative investigation as well as a therapeutic technique, but it could be avoided when MRI and/ or MRA provide a clear diagnostic picture.