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Focal Articular Cartilage Lesions of the Superior Humeral Head

MR Imaging Findings in Seven Patients

Kevin W. Carroll1,2, Clyde A. Helms1 and Kevin P. Speer3

1 Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
2 Present address: 680 Lalique Cir., Apt. 1206, Naples, FL 34119.
3 Department of Orthopaedic Surgery, Duke University Medical Center, Box 3371, Durham, NC 27710.



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  		Fig. 1A. —30-year-old man who sustained anterior shoulder dislocation while playing rugby. Focal articular cartilage defect was diagnosed prospectively on MR imaging. Patient has not undergone surgery because this dislocation is his first, and he has responded to conservative therapy. Oblique sagittal fast spin-echo T2-weighted MR image with fat suppression (TR/TEeff, 3800/63) through left shoulder reveals focal defect (arrow) of articular cartilage and subchondral bone along posterosuperior humeral head (H). Anterior is to left.

 


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  		Fig. 1B. —30-year-old man who sustained anterior shoulder dislocation while playing rugby. Focal articular cartilage defect was diagnosed prospectively on MR imaging. Patient has not undergone surgery because this dislocation is his first, and he has responded to conservative therapy. Axial fast spin-echo T2-weighted MR image with fat suppression (3800/63) shows focal articular cartilage defect (straight arrow) seen in A. Defect and partial volume averaging with subjacent marrow edema are located medial to distictly separate Hill-Sachs lesion (curved arrow). Anterior is toward top. C = coracoid, G = glenoid, H = humerus.

 


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  		Fig. 1C. —30-year-old man who sustained anterior shoulder dislocation while playing rugby. Focal articular cartilage defect was diagnosed prospectively on MR imaging. Patient has not undergone surgery because this dislocation is his first, and he has responded to conservative therapy. Drawing based on B shows characteristic relative location of focal articular cartilage lesion of humeral head. A = anterior, P = posterior, M = medial, L = lateral.

 


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  		Fig. 2A. —30-year-old man, former college swimmer who experienced acute shoulder pain while bench pressing. Cartilage defect was not diagnosed prospectively on MR imaging but only seen in retrospect after arthroscopic identification. Oblique coronal fast spin-echo T2-weighted MR image with fat suppression (TR/TEeff, 3800/63) from MR arthrography of right shoulder depicts irregular defect of articular cartilage of humeral head (straight arrow). Focal area of cartilage thickening (curved arrow) was found on arthroscopy (C) to be cartilage fraying.

 


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  		Fig. 2B. —30-year-old man, former college swimmer who experieced acute shoulder pain while bench pressing. Cartilage defect was not diagnosed prospectively on MR imaging but only seen in retrospect after arthroscopic identification. Oblique coronal spin-echo T1-weighted MR image with fat suppression (TR/TE, 600/20) shows diluted intraarticular gadolinium extending into cartilage defect (open arrow). Note focal thickened cartilage (curved arrow).

 


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  		Fig. 2C. —30-year-old man, former college swimmer who experienced acute shoulder pain while bench pressing. Cartilage defect was not diagnosed prospectively on MR imaging but only seen in retrospect after arthroscopic identification. Arthroscopic image reveals fraying and thickening (curved arrow) of articular cartilage of humeral head (H) and large focal defect (straight arrows) seen on MR imaging (A and B). Glenoid (G) was normal on MR imaging (A and B) and on arthroscopy (C).

 


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  		Fig. 3A. —45-year-old man who experienced sudden shoulder pain performing biceps curls while weight lifting. Focal cartilage defect of this consultation case was diagnosed prospectively on MR imaging. Oblique sagittal fast spin-echo T2-weighted MR image (TR/TEeff, 3900/105) shows focal cartilage defect along posterosuperior humeral head (arrow). Anterior is to left.

 


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  		Fig. 3B. —45-year-old man who experienced sudden shoulder pain performing biceps curls while weight lifting. Focal cartilage defect of this consultation case was diagnosed prospectively on MR imaging. Oblique coronal fast spin-echo T2-weighted MR image with fat suppression (2700/69) shows focal defect (arrow), which was confirmed on arthroscopy.

 

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