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Usefulness of the Abduction and External Rotation Views in Shoulder MR Arthrography

¹ All authors: Department of Radiology, Albany Medical Center, 43 New Scotland Ave., Albany, NY 12208.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Abduction and external rotation (ABER) view of the shoulder. Positioning of patient for ABER view.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Abduction and external rotation (ABER) view of the shoulder. Imaging planes taken from coronal localizer sequence for ABER position. Planes should be drawn in line with long axis of humeral shaft.

View larger version (28K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Imaging planes for abduction and external rotation (ABER) view of the shoulder. Diagram of oblique planes of ABER position. Sections are ideally 45° off vertical axis of glenoid, which allows optimal visualization of anteroinferior labroligamentous complex. This complex is prone to effects of obliquity and volume averaging on conventional axial and coronal sequences. Corresponding T1-weighted images are shown in B–D.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Imaging planes for abduction and external rotation (ABER) view of the shoulder. 23-year-old man with normal anatomy. These images correspond to planes shown in A and show locations of humeral head (H), glenoid (G), acromion (A), supraspinatus (SS), subscapularis (SC), biceps tendon (arrow, B), bicipital anchor (B), inferior glenohumeral ligament (arrow, C), anteroinferior labrum (arrowhead, C), and infraspinatus (IS).

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Imaging planes for abduction and external rotation (ABER) view of the shoulder. 23-year-old man with normal anatomy. These images correspond to planes shown in A and show locations of humeral head (H), glenoid (G), acromion (A), supraspinatus (SS), subscapularis (SC), biceps tendon (arrow, B), bicipital anchor (B), inferior glenohumeral ligament (arrow, C), anteroinferior labrum (arrowhead, C), and infraspinatus (IS).

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Imaging planes for abduction and external rotation (ABER) view of the shoulder. 23-year-old man with normal anatomy. These images correspond to planes shown in A and show locations of humeral head (H), glenoid (G), acromion (A), supraspinatus (SS), subscapularis (SC), biceps tendon (arrow, B), bicipital anchor (B), inferior glenohumeral ligament (arrow, C), anteroinferior labrum (arrowhead, C), and infraspinatus (IS).

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —27-year-old man with partial-thickness infraspinatus tear. Coronal fat-suppressed T2-weighted image shows cystic changes in humeral head but no tear.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —27-year-old man with partial-thickness infraspinatus tear. T1-weighted image with arm in abduction and external rotation shows articular surface tear of infraspinatus (arrow).

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —51-year-old woman with intratendinous delamination. Coronal fat-suppressed T2-weighted image shows no abnormality.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —51-year-old woman with intratendinous delamination. T1-weighted image with arm in abduction and external rotation shows partial tear and delamination (arrows).

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Variable appearances may be mistaken for rotator cuff abnormality. 58-year-old man with normal variant of beaklike projection off articular surface of rotator cuff tendon (arrow). Cause is unknown but may be tendon folding.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Variable appearances may be mistaken for rotator cuff abnormality. 59-year-old woman with pseudotear. Intraarticular contrast between folds can mimic a tear (arrow), typically near level of scapular spine (asterisk). Awareness of this variant avoids false-positive diagnoses.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —33-year-old man with partially detached tear of anteroinferior labrum. Axial T2-weighted gradient-refocused echo image shows no abnormality in anteroinferior labrum.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —33-year-old man with partially detached tear of anteroinferior labrum. T1-weighted image with arm in abduction and external rotation shows partially detached tear of anteroinferior labrum (arrowhead) and normal intact periosteum (arrow). Note paralabral cyst in spinoglenoid notch (asterisk).

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Bankart tears and variants. 58-year-old man with osseous Bankart lesion. T1-weighted image with arm in abduction and external rotation (ABER) shows tear and displacement of anteroinferior labrum (white arrow) and bone loss of anterior glenoid (black arrow).

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Bankart tears and variants. 25-year-old man with anterior labroligamentous periosteal sleeve avulsion lesion. T1-weighted ABER image shows avulsed and inferomedially displaced anteroinferior labrum (arrow).

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —Bankart tears and variants. 22-year-old man with glenolabral articular cartilage disruption lesion. T1-weighted ABER image shows anteroinferior labral tear with contiguous chondral defect (white arrow) in contrast to normal posterior articular cartilage (black arrow)

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —17-year-old boy with Perthes lesion. Axial T1-weighted image shows tear of anteroinferior labrum without displacement.

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —17-year-old boy with Perthes lesion. T1-weighted image with arm in abduction and external rotation. With tension on inferior glenohumeral ligament, anteroinferior labroligamentous complex becomes displaced (arrowhead), and intact periosteum, stripped from glenoid, is now visible (arrow).

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —30-year-old man with recurrent pain after repair of Bankart lesion. T1-weighted image with arm in abduction and external rotation shows intact scar complex without recurrent detached tear. Conventional sequences had shown equivocal irregularity of anteroinferior labrum. Note tear of posterosuperior labrum (arrow).

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —22-year-old man with superior labral tear (arrows) extending from bicipital–labral complex to anterior labrum. Note biceps tendon (asterisk).

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11 —28-year-old man with superior labral tear involving bicipital anchor (white arrow). Biceps tendon is diffusely thickened (asterisk); longitudinal split tear was seen on other views. Middle glenohumeral ligament (black arrow) is not involved.

View larger version (55K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12 —Diagram of torsion of bicipital anchor in abduction and external rotation (arrow), transmitting abnormal forces on posterosuperior labrum, which causes posterior "peel-back" superior labral anteroposterior tear.

View larger version (56K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13 —Diagram of effect of glenohumeral internal rotation deficit and posterior capsular contracture during cocking phase of throwing, which is reproduced in abduction and external rotation (ABER) position. Glenohumeral contact point is normal in neutral position but migrates posterosuperiorly in ABER position. Observing this shift of contact point (red arrows) on ABER view can help suggest posterior "peel-back" superior labral anteroposterior tear. White arrow indicates normal contact point. SGHL = superior glenohumeral ligament, MGHL = middle glenohumeral ligament, AIGHL = anterior band of inferior glenohumeral ligament, PIGHL = posterior band of inferior glenohumeral ligament, which is contracted.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14 —41-year-old woman with internal impingement. T1-weighted image with arm in abduction and external rotation shows corresponding tears of posterosuperior labrum (arrowhead) and articular surface of supraspinatus tendon (arrow), as well as contact between rotator cuff and labrum. Contact alone without additional lesions can be a normal physiologic finding.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15 —50-year-old man with chondral defect of humeral head. T1-weighted image with arm in abduction and external rotation shows focal defect of articular cartilage on humeral head (arrow) that was not seen on conventional sequences.

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