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 be stretched and lax after injury instead
May have instability symptoms similar to RCI tear
Normal RI
RCI prevents excessive humerus 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
Vopat ML et al: Medial dislocation of the long head of the biceps without concomitant subscapularis tear: a case report. J Orthop Case Rep. 9(6):6-10, 2020
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
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
Nakata W et al: Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics. 31(3):791-810, 2011
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
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
Lee JC et al: MRI of the rotator interval of the shoulder. Clin Radiol. 62(5):416-23, 2007
Vinson EN et al: Magnetic resonance imaging findings associated with surgically proven rotator interval lesions. Skeletal Radiol. 36(5):405-10, 2007
Beall DP et al: Magnetic resonance imaging of the rotator cuff interval. Semin Musculoskelet Radiol. 10(3):187-96, 2006
Bigoni BJ et al: MR imaging of the rotator cuff interval. Radiol Clin North Am. 44(4):525-36, viii, 2006
Krief OP: MRI of the rotator interval capsule. AJR Am J Roentgenol. 184(5):1490-4, 2005
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
Bigoni BJ et al: MR imaging of the rotator cuff interval. Magn Reson Imaging Clin N Am. 12(1):61-73, vi, 2004
Cole BJ et al: The anatomy and histology of the rotator interval capsule of the shoulder. Clin Orthop Relat Res. (390):129-37, 2001
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
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
Le Huec JC et al: Traumatic tear of the rotator interval. J Shoulder Elbow Surg. 5(1):41-6, 1996
Seeger LL et al: Case report 815: Tear of the rotator interval. Skeletal Radiol. 22(8):615-7, 1993
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 be stretched and lax after injury instead
May have instability symptoms similar to RCI tear
Normal RI
RCI prevents excessive humerus 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
Vopat ML et al: Medial dislocation of the long head of the biceps without concomitant subscapularis tear: a case report. J Orthop Case Rep. 9(6):6-10, 2020
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
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
Nakata W et al: Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics. 31(3):791-810, 2011
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
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
Lee JC et al: MRI of the rotator interval of the shoulder. Clin Radiol. 62(5):416-23, 2007
Vinson EN et al: Magnetic resonance imaging findings associated with surgically proven rotator interval lesions. Skeletal Radiol. 36(5):405-10, 2007
Beall DP et al: Magnetic resonance imaging of the rotator cuff interval. Semin Musculoskelet Radiol. 10(3):187-96, 2006
Bigoni BJ et al: MR imaging of the rotator cuff interval. Radiol Clin North Am. 44(4):525-36, viii, 2006
Krief OP: MRI of the rotator interval capsule. AJR Am J Roentgenol. 184(5):1490-4, 2005
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
Bigoni BJ et al: MR imaging of the rotator cuff interval. Magn Reson Imaging Clin N Am. 12(1):61-73, vi, 2004
Cole BJ et al: The anatomy and histology of the rotator interval capsule of the shoulder. Clin Orthop Relat Res. (390):129-37, 2001
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
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
Le Huec JC et al: Traumatic tear of the rotator interval. J Shoulder Elbow Surg. 5(1):41-6, 1996
Seeger LL et al: Case report 815: Tear of the rotator interval. Skeletal Radiol. 22(8):615-7, 1993
STATdx includes over 200,000 searchable images, including x-ray, CT, MR, and ultrasound images. To access all images, please log in or subscribe.