Carlo Martinoli MD, Presenter: Nothing to Disclose

Raffaella Podestà MD, Abstract Co-Author: Nothing to Disclose

Yoav Morag MD, Abstract Co-Author: Nothing to Disclose

Jon Arthur Jacobson MD, Abstract Co-Author: Nothing to Disclose

Bruce Miller, Abstract Co-Author: Nothing to Disclose

Stefano Bianchi MD, Abstract Co-Author: Nothing to Disclose

To describe the US appearance of the coracohumeral and superior glenohumeral ligaments (forming the reflection pulley) in normal subjects and patients with pulley tears associated with rotator cuff pathology and biceps tendon instability.

A correlative US-anatomic study was performed on freeze-frozen cadaveric shoulders and correlated with the normal US appearance of the reflection pulley in 20 healthy volunteers. Patient’s positioning with the arm in posterior flexion and short-axis planes over the rotator cuff interval were used. Then, 12-5, 15-7 and 17-5MHz US images were obtained in n=21 consecutive patients with pulley lesions confirmed on MR-arthrography. Patients with massive rotator cuff tears and biceps tendon rupture were excluded.

High-resolution US was reliable to image the reflection pulley system in normal subjects. In the patients group, pulley lesions occurred in isolation (n=1) or combined with either subscapularis (n=11) or supraspinatus (n=9) tendons tears. Main US signs of reflection pulley lesions included hypoechoic thickening (n=3), discontinuity (n=7) and nonvisualization (n=11) of the coracohumeral ligament. Pulley thickening was associated with subscapularis tears but not with an abnormal biceps tendon position. Biceps tendon subluxation was observed over the subscapularis in patients with pulley rupture combined with anterior tears of the supraspinatus (n=9) or superior tears of the subscapularis (n=3). In complete tears of subscapularis (n=5), the biceps was dislocated.

US is valuable in detecting lesions of the ligamentous structures forming the reflection pulley regardless of the associated cuff pathology. US allows differentiation of a pulley lesion from an isolated tear of the anterior border of the supraspinatus and superior border of the subscapularis.

Martinoli, C, Podestà, R, Morag, Y, Jacobson, J, Miller, B, Bianchi, S, Ultrasound of the Reflection Pulley of the Long Biceps Tendon.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4417228.html