Silvia Mariani MD, Presenter: Nothing to Disclose

Alice La Marra MD, Abstract Co-Author: Nothing to Disclose

Emanuele Costantini MD, Abstract Co-Author: Nothing to Disclose

Francesco Arrigoni, Abstract Co-Author: Nothing to Disclose

Antonio Barile MD, Abstract Co-Author: Nothing to Disclose

Carlo Masciocchi MD, Abstract Co-Author: Nothing to Disclose

To evaluate the added value of the internal and external rotation and abduction and external rotation (ABER) images during arthro-MRI in identifying the LHBT instability and the possible development of an antero-superior impingement (ASI).

We retrospectively analyzed MRI exam of 70 patients who underwent arthro-MRI (1.5T) and arthroscopy within the following 7-45 days. Patients had clinical suspicion of biceps pulley lesions. The shoulder was studied (with dedicated coil) in neutral position, in internal and external rotation and ABER position in all patients.

Patients were divided in 4 groups (Habermayer classification) and evaluated for an unstable LHBT:10 patients had superior gleno-humeral ligament (SGHL) tear (Type I),16 patients SGHL and supraspinatus (SSP) tendon tears (Type II),21 patients SGHL and subscapularis (SSC) tendon tears (Type III) and 23 patients SGHL, SSP and SSC tears (Type IV). At arthroscopy 2 patients were negative,8 patients had Type I,16 patients Type II,19 patients Type III and 25 patients Type IV lesions. MRI internal and external rotation showed an initial anteromedial subluxation of the LHBT in 8 patients with Type II lesion and an anteromedial subluxation of the LHBT in all patients with Type III and Type IV lesions. ABER position showed gleno-humeral antero-superior malalignment in 14 cases. The dynamic tests during arthroscopy, confirmed LHBT instability and ASI features in patients with Type III and Type IV lesions and antero-superior malalignment only in 9 cases.

Only high grade lesions of the biceps pulley can be associated with LHBT instability and antero-superior gleno-humeral malalignment. MRI external and internal rotation led to a better identification of structures of the biceps pulley and the detection of LHBT instability could suggest the presence of ASI.

"Functional" MRI images allow a dynamic evaluation of the LHBT and of the antero-superiror aspect of the gleno-humeral joint; these structures often result unstable in presence of an ASI type III and type IV confirmed by arthroscopic dynamic tests.

Mariani, S, La Marra, A, Costantini, E, Arrigoni, F, Barile, A, Masciocchi, C, Long Head of Biceps Tendon (LHBT) Instability Due to Biceps Pulley Lesion of the Shoulder: Arthro-MRI including “Functional” Images vs Arthroscopy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010675.html