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Rotator Interval Tear
Michael J. Tuite, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          TERMINOLOGY

          • Abbreviations

            • Rotator cuff interval (RCI), rotator interval (RI)
            • Coracohumeral ligament (CHL), superior glenohumeral ligament (SGHL)
          • Synonyms

            • RCI lesion
            • Biceps pulley tear: Large RCI tear involving lateral CHL and SGHL; results in dislocation of long head biceps tendon
            • "Hidden lesion": Biceps subluxated due to RCI tear
          • Definitions

            • Tear of joint capsule between supraspinatus and subscapularis tendons ± CHL and SGHL tears
              • CHL and SGHL can instead be stretched and lax after injury
                • May have instability symptoms similar to RCI tear
            • Normal RI
              • RCI prevents excessive humeral flexion and external rotation
              • CHL and SGHL fuse laterally and form biceps pulley
              • CHL splits laterally into 2 insertions on greater and lesser tuberosities
              • RCI is tunnel through which biceps passes
              • Conventional MR of normal RCI
                • CHL visible in 60%
                • Anterior portion of SGHL rarely identifiable

          IMAGING

          • General Features

            • MR Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Staging, Grading, & Classification

                      • Gross Pathologic & Surgical Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Anbar A et al: Shoulder arthroscopy remains superior to direct MR arthrography for diagnosis of subtle rotator interval lesions. Eur J Orthop Surg Traumatol. 25(4):689-97, 2015
                                    2. Schaeffeler C et al: Lesions of the biceps pulley: diagnostic accuracy of MR arthrography of the shoulder and evaluation of previously described and new diagnostic signs. Radiology. 264(2):504-13, 2012
                                    3. Nakata W et al: Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics. 31(3):791-810, 2011
                                    4. Provencher MT et al: An analysis of the rotator interval in patients with anterior, posterior, and multidirectional shoulder instability. Arthroscopy. 24(8):921-9, 2008
                                    5. Kim KC et al: Estimating the dimensions of the rotator interval with use of magnetic resonance arthrography. J Bone Joint Surg Am. 89(11):2450-5, 2007
                                    6. Lee JC et al: MRI of the rotator interval of the shoulder. Clin Radiol. 62(5):416-23, 2007
                                    7. Vinson EN et al: Magnetic resonance imaging findings associated with surgically proven rotator interval lesions. Skeletal Radiol. 36(5):405-10, 2007
                                    8. Beall DP et al: Magnetic resonance imaging of the rotator cuff interval. Semin Musculoskelet Radiol. 10(3):187-96, 2006
                                    9. Bigoni BJ et al: MR imaging of the rotator cuff interval. Radiol Clin North Am. 44(4):525-36, viii, 2006
                                    10. Krief OP: MRI of the rotator interval capsule. AJR Am J Roentgenol. 184(5):1490-4, 2005
                                    11. Morag Y et al: MR arthrography of rotator interval, long head of the biceps brachii, and biceps pulley of the shoulder. Radiology. 235(1):21-30, 2005
                                    12. Bigoni BJ et al: MR imaging of the rotator cuff interval. Magn Reson Imaging Clin N Am. 12(1):61-73, vi, 2004
                                    13. Cole BJ et al: The anatomy and histology of the rotator interval capsule of the shoulder. Clin Orthop Relat Res. (390):129-37, 2001
                                    14. Chung CB et al: Rotator cuff interval: evaluation with MR imaging and MR arthrography of the shoulder in 32 cadavers. J Comput Assist Tomogr. 24(5):738-43, 2000
                                    15. Ho CP: MR imaging of rotator interval, long biceps, and associated injuries in the overhead-throwing athlete. Magn Reson Imaging Clin N Am. 7(1):23-37, 1999
                                    16. Le Huec JC et al: Traumatic tear of the rotator interval. J Shoulder Elbow Surg. 5(1):41-6, 1996
                                    17. Seeger LL et al: Case report 815: Tear of the rotator interval. Skeletal Radiol. 22(8):615-7, 1993
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Pathology

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Rotator cuff interval (RCI), rotator interval (RI)
                                              • Coracohumeral ligament (CHL), superior glenohumeral ligament (SGHL)
                                            • Synonyms

                                              • RCI lesion
                                              • Biceps pulley tear: Large RCI tear involving lateral CHL and SGHL; results in dislocation of long head biceps tendon
                                              • "Hidden lesion": Biceps subluxated due to RCI tear
                                            • Definitions

                                              • Tear of joint capsule between supraspinatus and subscapularis tendons ± CHL and SGHL tears
                                                • CHL and SGHL can instead be stretched and lax after injury
                                                  • May have instability symptoms similar to RCI tear
                                              • Normal RI
                                                • RCI prevents excessive humeral flexion and external rotation
                                                • CHL and SGHL fuse laterally and form biceps pulley
                                                • CHL splits laterally into 2 insertions on greater and lesser tuberosities
                                                • RCI is tunnel through which biceps passes
                                                • Conventional MR of normal RCI
                                                  • CHL visible in 60%
                                                  • Anterior portion of SGHL rarely identifiable

                                            IMAGING

                                            • General Features

                                              • MR Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Staging, Grading, & Classification

                                                        • Gross Pathologic & Surgical Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Anbar A et al: Shoulder arthroscopy remains superior to direct MR arthrography for diagnosis of subtle rotator interval lesions. Eur J Orthop Surg Traumatol. 25(4):689-97, 2015
                                                                      2. Schaeffeler C et al: Lesions of the biceps pulley: diagnostic accuracy of MR arthrography of the shoulder and evaluation of previously described and new diagnostic signs. Radiology. 264(2):504-13, 2012
                                                                      3. Nakata W et al: Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics. 31(3):791-810, 2011
                                                                      4. Provencher MT et al: An analysis of the rotator interval in patients with anterior, posterior, and multidirectional shoulder instability. Arthroscopy. 24(8):921-9, 2008
                                                                      5. Kim KC et al: Estimating the dimensions of the rotator interval with use of magnetic resonance arthrography. J Bone Joint Surg Am. 89(11):2450-5, 2007
                                                                      6. Lee JC et al: MRI of the rotator interval of the shoulder. Clin Radiol. 62(5):416-23, 2007
                                                                      7. Vinson EN et al: Magnetic resonance imaging findings associated with surgically proven rotator interval lesions. Skeletal Radiol. 36(5):405-10, 2007
                                                                      8. Beall DP et al: Magnetic resonance imaging of the rotator cuff interval. Semin Musculoskelet Radiol. 10(3):187-96, 2006
                                                                      9. Bigoni BJ et al: MR imaging of the rotator cuff interval. Radiol Clin North Am. 44(4):525-36, viii, 2006
                                                                      10. Krief OP: MRI of the rotator interval capsule. AJR Am J Roentgenol. 184(5):1490-4, 2005
                                                                      11. Morag Y et al: MR arthrography of rotator interval, long head of the biceps brachii, and biceps pulley of the shoulder. Radiology. 235(1):21-30, 2005
                                                                      12. Bigoni BJ et al: MR imaging of the rotator cuff interval. Magn Reson Imaging Clin N Am. 12(1):61-73, vi, 2004
                                                                      13. Cole BJ et al: The anatomy and histology of the rotator interval capsule of the shoulder. Clin Orthop Relat Res. (390):129-37, 2001
                                                                      14. Chung CB et al: Rotator cuff interval: evaluation with MR imaging and MR arthrography of the shoulder in 32 cadavers. J Comput Assist Tomogr. 24(5):738-43, 2000
                                                                      15. Ho CP: MR imaging of rotator interval, long biceps, and associated injuries in the overhead-throwing athlete. Magn Reson Imaging Clin N Am. 7(1):23-37, 1999
                                                                      16. Le Huec JC et al: Traumatic tear of the rotator interval. J Shoulder Elbow Surg. 5(1):41-6, 1996
                                                                      17. Seeger LL et al: Case report 815: Tear of the rotator interval. Skeletal Radiol. 22(8):615-7, 1993