Lesions of the Biceps Pulley: Diagnostic Accuracy of MR Arthrography of the Shoulder and Evaluation of Previously Described and New Diagnostic Signs

Schaeffeler, Christoph; Waldt, Simone; Holzapfel, Konstantin; Kirchhoff, Chlodwig; Jungmann, Pia M.; Wolf, P; Stat, Dipl; Schröder, M.; Rummeny, Ernst J.; Imhoff, Andreas B.; Woertler, Klaus

doi:10.1148/radiol.12112007

Cited by 74 publications

(79 citation statements)

References 28 publications

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“…Additional treatment might be necessary for these abnormalities [21,22]. We previously reported the usefulness of radial MRI for the detection of incomplete or complete subscapularis tendon tear [23].…”

Section: Discussionmentioning

confidence: 99%

Clinical application of radial magnetic resonance imaging for evaluation of rotator cuff tear

Honda

Morihara

Horii

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

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Section: Discussionmentioning

confidence: 99%

Clinical application of radial magnetic resonance imaging for evaluation of rotator cuff tear

Honda

Morihara

Horii

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

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“…Therefore, tears in this ligament may lead to medial subluxation or dislocation of the LHBT. Recently, Schaeffeler et al (28) showed that the prevalence of isolated SGHL tears is 29%.…”

Section: Introductionmentioning

confidence: 99%

“…Biceps pulley lesions can occur due to acute trauma, degenerative changes, repetitive microtrauma, congenital rotator interval defects, or injuries associated with tear in a rotator cuff (13, 24, 28, 29, 30). These lesions are thought to be responsible for medial subluxation of the LHBT, and they may result in loss of function in the shoulder and pain in the anterior shoulder (24, 25, 31).…”

Section: Introductionmentioning

confidence: 99%

“…The frequency of lesions on isolated biceps pulley is 29-74% (24, 25, 28). A recent study by Braun et al (25) prospectively analyzed the prevalence of pulley lesions, which was reported as 32%, in a consecutive series of patients undergoing arthroscopic shoulder surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Lesion in the biceps pulley and millimetric tears on the superior border of the subscapularis tendon occurred in 19 of 116 shoulders. A recent arthrographic study by Schaeffeler et al (28) concluded that the presence of associated tendinopathy of the LHBT in oblique sagittal MR arthrography images has additional value for the diagnosis of a pulley lesion.…”

Section: Introductionmentioning

confidence: 99%

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Anatomy, Variants, and Pathologies of the Superior Glenohumeral Ligament: Magnetic Resonance Imaging with Three-Dimensional Volumetric Interpolated Breath-Hold Examination Sequence and Conventional Magnetic Resonance Arthrography

et al. 2014

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The purpose of this review was to demonstrate magnetic resonance (MR) arthrography findings of anatomy, variants, and pathologic conditions of the superior glenohumeral ligament (SGHL). This review also demonstrates the applicability of a new MR arthrography sequence in the anterosuperior portion of the glenohumeral joint. The SGHL is a very important anatomical structure in the rotator interval that is responsible for stabilizing the long head of the biceps tendon. Therefore, a torn SGHL can result in pain and instability. Observation of the SGHL is difficult when using conventional MR imaging, because the ligament may be poorly visualized. Shoulder MR arthrography is the most accurately established imaging technique for identifying pathologies of the SGHL and associated structures. The use of three dimensional (3D) volumetric interpolated breath-hold examination (VIBE) sequences produces thinner image slices and enables a higher in-plane resolution than conventional MR arthrography sequences. Therefore, shoulder MR arthrography using 3D VIBE sequences may contribute to evaluating of the smaller intraarticular structures such as the SGHL.

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Shoulder MR Arthrography: Comparative Evaluation of Three Different Contrast Injection Techniques Using an Anterior Approach

Ali

Said

Elhamd

et al. 2020

Magnetic Resonance Imaging

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BackgroundMR arthrography (MRA) is commonly used in the assessment of shoulder internal derangements. Correct intra‐articular contrast injection is required for this modality. Anterior injections under fluoroscopic, ultrasound‐guidance, or without image‐guidance have been described in the literature. However, no simultaneous comparison has been performed between the three techniques.PurposeTo compare the accuracy and performance of fluoroscopy (FL)‐guided, ultrasound (US)‐guided and non‐image‐guided intra‐articular contrast injection via an anterior approach for performing shoulder MRA.Study TypeProspective.SubjectsTwo‐hundred and ten patients (180 men and 30 women; mean age, 33 ± 12 years; range 20–60 years) with clinically suspected shoulder pathology.Field Strength/Sequence1.5T/fat‐suppressed T1‐weighted, T2‐weighted, and 3D‐gradient‐echo images.AssessmentPatients underwent shoulder MRA after anterior intra‐articular contrast injection under FL‐ or US‐guidance or without image‐guidance. Patients were randomized among the three techniques with each group comprising 70. The techniques were compared according to the accuracy of intra‐articular needle placement, attempts success rate, pain during and 24 hours after injection, procedure times, contrast extravasation rate, joint distension, and MRA diagnostic efficacy. Pain was assessed by the visual analog scale (VAS) pain‐score.Statistical TestsPearson's chi‐squared and Kruskal–Wallis tests.ResultsFL‐ and US‐guided injections (100% accuracy) were significantly more accurate than non‐image‐guided (85.7% accuracy) (P < 0.05). US‐guidance was the least painful, with statistical differences between image‐guided and non‐image‐guided techniques regarding the first attempt success rate (95.7% and 92.8% for FL‐ and US‐guided vs. 78.6% for blinded), VAS‐score 24 hours‐post‐procedure (1.7 ± 1.7, and 1.5 ± 1.4 vs. 2.2 ± 1.4), procedure time (11.9 ± 1.6, and 7.4 ± 1.7 vs. 4.3 ± 0.76 minutes), and contrast extravasation rate (5.7%, and 8.6% vs. 30%) (all P < 0.05). Procedure time was also significantly different between FL and US‐guidance (P < 0.05).Data ConclusionImaging‐guided injections are more accurate and tolerable than non‐image‐guided and should be considered to confirm intra‐articular needle position, hence adequate capsular distension and good diagnostic quality of shoulder MRA. US guidance is a less painful, rapid, and safe alternative to the FL approach.Evidence Level: 2Technical Efficacy Stage: 5.J. MAGN. RESON. IMAGING 2021;53:481–490.

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Lesions of the Biceps Pulley: Diagnostic Accuracy of MR Arthrography of the Shoulder and Evaluation of Previously Described and New Diagnostic Signs

Abstract: MR arthrography is accurate in the detection of pulley lesions; the displacement sign, nonvisibility or discontinuity of the SGHL, and tendinopathy of the LHBT on oblique sagittal images are the most accurate criteria for the detection of pulley lesions.

Cited by 74 publications

References 28 publications

Clinical application of radial magnetic resonance imaging for evaluation of rotator cuff tear

Clinical application of radial magnetic resonance imaging for evaluation of rotator cuff tear

Anatomy, Variants, and Pathologies of the Superior Glenohumeral Ligament: Magnetic Resonance Imaging with Three-Dimensional Volumetric Interpolated Breath-Hold Examination Sequence and Conventional Magnetic Resonance Arthrography

Shoulder MR Arthrography: Comparative Evaluation of Three Different Contrast Injection Techniques Using an Anterior Approach

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