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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Diagnostic Checklist
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 be stretched and lax after injury instead
- May have instability symptoms similar to RCI tear
- CHL and SGHL can be stretched and lax after injury instead
- 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
- Tear of joint capsule between supraspinatus and subscapularis tendons ± CHL and SGHL tears
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
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Diagnostic Checklist
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 be stretched and lax after injury instead
- May have instability symptoms similar to RCI tear
- CHL and SGHL can be stretched and lax after injury instead
- 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
- Tear of joint capsule between supraspinatus and subscapularis tendons ± CHL and SGHL tears
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
