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MRI Features of the Acromioclavicular Joint That Predict Pain Relief from Intraarticular Injection

Klaus Strobel1, Christian W. A. Pfirrmann1, Marco Zanetti1, Ladislav Nagy2 and Juerg Hodler1

1 Department of Radiology, Orthopedic University Hospital, Balgrist, Forchstr. 340, Zurich CH-8008, Switzerland.
2 Department of Orthopedic Surgery, Orthopedic University Hospital, Balgrist, Zurich CH-8008, Switzerland.



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  		Fig. 1. —56-year-old man with shoulder pain. Spot radiograph shows fluoroscopically guided selective injection of acromioclavicular joint with osteoarthritic changes. Note needle with correct intraarticular distribution of injected contrast medium (arrow).

 


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  		Fig. 2. —Drawing illustrates schematic measurement of size of acromioclavicular osteophytes and joint capsule thickness on oblique coronal MRI. C = capsule, CrO = cranial osteophyte, CaO = caudal osteophyte.

 


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  		Fig. 3. —70-year-old woman with shoulder pain. Oblique sagittal T1-weighted spin-echo MRI (TR/TE, 600/12) shows severe acromioclavicular joint osteoarthritis with cranial (arrow) and caudal (arrowheads) osteophytes. Pain relief after selective injection of anesthetics was 50%.

 


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  		Fig. 4. —43-year-old man with shoulder pain. Transverse T1-weighted spin-echo image (TR/TE, 600/12) of acromioclavicular joint shows subchondral bone irregularities (arrowheads). Pain relief after injection was 70%.

 


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  		Fig. 5. —50-year-old man with shoulder pain. Oblique coronal T2-weighted fat-saturated turbo spin-echo image (TR/TE, 3300/14) shows edemalike hyperintense signal in bone marrow of lateral end of clavicle (arrow). Pain relief after injection was 65%.

 


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  		Fig. 6. —62-year-old woman with shoulder pain. Oblique coronal T2-weighted spin-echo image (TR/TE, 3500/98) shows fluidlike hyperintense signal in acromioclavicular joint space (asterisk) and hypertrophy of cranial joint capsule (arrows). Pain relief after injection was 70%.

 


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  		Fig. 7. —45-year-old man with shoulder pain. Oblique sagittal T1-weighted spin-echo image (TR/TE, 600/12) shows hypertrophy of cranial (white arrows) and caudal (black arrows) acromioclavicular joint capsule. Pain relief after injection was 50%.

 


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  		Fig. 8. —56-year-old man with shoulder pain. Oblique coronal proton density-weighted spin-echo image (TR/TE, 3300/14) of osteoarthritic acromioclavicular joint shows hypertrophy of joint capsule (arrows). Pain relief after injection was 80%.

 

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