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Rotator Interval Tear
Michael J. Tuite, MDSoterios Gyftopoulos, MD, MSc
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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
              • 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

                                      1. 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
                                      2. 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
                                      3. 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
                                      4. Nakata W et al: Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics. 31(3):791-810, 2011
                                      5. 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
                                      6. 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
                                      7. Lee JC et al: MRI of the rotator interval of the shoulder. Clin Radiol. 62(5):416-23, 2007
                                      8. Vinson EN et al: Magnetic resonance imaging findings associated with surgically proven rotator interval lesions. Skeletal Radiol. 36(5):405-10, 2007
                                      9. Beall DP et al: Magnetic resonance imaging of the rotator cuff interval. Semin Musculoskelet Radiol. 10(3):187-96, 2006
                                      10. Bigoni BJ et al: MR imaging of the rotator cuff interval. Radiol Clin North Am. 44(4):525-36, viii, 2006
                                      11. Krief OP: MRI of the rotator interval capsule. AJR Am J Roentgenol. 184(5):1490-4, 2005
                                      12. 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
                                      13. Bigoni BJ et al: MR imaging of the rotator cuff interval. Magn Reson Imaging Clin N Am. 12(1):61-73, vi, 2004
                                      14. Cole BJ et al: The anatomy and histology of the rotator interval capsule of the shoulder. Clin Orthop Relat Res. (390):129-37, 2001
                                      15. 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
                                      16. 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
                                      17. Le Huec JC et al: Traumatic tear of the rotator interval. J Shoulder Elbow Surg. 5(1):41-6, 1996
                                      18. 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

                                              • 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
                                                  • 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

                                                                          1. 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
                                                                          2. 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
                                                                          3. 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
                                                                          4. Nakata W et al: Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics. 31(3):791-810, 2011
                                                                          5. 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
                                                                          6. 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
                                                                          7. Lee JC et al: MRI of the rotator interval of the shoulder. Clin Radiol. 62(5):416-23, 2007
                                                                          8. Vinson EN et al: Magnetic resonance imaging findings associated with surgically proven rotator interval lesions. Skeletal Radiol. 36(5):405-10, 2007
                                                                          9. Beall DP et al: Magnetic resonance imaging of the rotator cuff interval. Semin Musculoskelet Radiol. 10(3):187-96, 2006
                                                                          10. Bigoni BJ et al: MR imaging of the rotator cuff interval. Radiol Clin North Am. 44(4):525-36, viii, 2006
                                                                          11. Krief OP: MRI of the rotator interval capsule. AJR Am J Roentgenol. 184(5):1490-4, 2005
                                                                          12. 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
                                                                          13. Bigoni BJ et al: MR imaging of the rotator cuff interval. Magn Reson Imaging Clin N Am. 12(1):61-73, vi, 2004
                                                                          14. Cole BJ et al: The anatomy and histology of the rotator interval capsule of the shoulder. Clin Orthop Relat Res. (390):129-37, 2001
                                                                          15. 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
                                                                          16. 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
                                                                          17. Le Huec JC et al: Traumatic tear of the rotator interval. J Shoulder Elbow Surg. 5(1):41-6, 1996
                                                                          18. Seeger LL et al: Case report 815: Tear of the rotator interval. Skeletal Radiol. 22(8):615-7, 1993