MRI of the shoulder joint is indicated for patients complaining of pain and a crack in the joint, stiffness of movements. During the procedure, equipment is used to obtain high-quality images of bones, cartilage, ligament-tendon apparatus. MRI performed with contrast helps to assess blood circulation in the shoulder, visualize the smallest inflammatory foci.
Radiography is usually used to diagnose pathologies of the musculoskeletal system. But it is not always informative when examining the shoulder joint, which has a complex structure. When conducting MRI, not only destructive changes in bone and cartilage tissues are detected, but also damage to the synovial capsule, ligaments, muscles, and nerves.
Magnetic resonance imaging is an examination method in which the shoulder joint is placed in a magnetic field. The cartilage, bones and connective tissue structures contain a different concentration of hydrogen ions, which is directly dependent on the density of tissues. In a magnetic field, protons change their characteristics — charges, motion vectors, and spatial orientation. This is captured by the tomograph sensors and transmit the collected information to a computer. The device reads the changes that occur, converts the data into images painted in different colors. Gray shades prevail in the images, the intensity of which depends on the density of the examined structures. If necessary, a three-dimensional image is created on the screen of the monitor, the most informative when performing an MRI with a contrast medium.
Indications for conduction
Diseases of the shoulder joint can develop under the influence of many external and internal negative factors. The task of performing an MRI of the shoulder becomes not only the detection of foci of pathology, but also the establishment of the cause of their occurrence. Therefore, the diagnostic procedure is indicated for patients in the following situations:
- joint stiffness at rest and (or) when it is bent, unbent;
- morning swelling, swelling of the joint;
- painful sensations that disappear or intensify during physical exertion, movement;
- blocking of movements;
- crepitus – clicks, crunching when bending, bending, changing the position of the body;
- transferred injuries – dislocations, fractures, ruptures of ligaments and tendons;
- discomfort in the shoulder joint.
The causes of one of these symptoms or their combination can be, as a banal muscle strain, and the formation of malignant neoplasms. Radiography is the most informative when examining bone tissue, and MRI will allow visualization of rotational cuffs, tendons, articular lips and other connective tissue structures.
What examination can show
MRI is used to diagnose sports and domestic injuries, as well as their consequences. With complex fractures or complete detachments of the ligaments and tendons, scars that violate trophism remain. There is a risk of developing post-traumatic arthrosis – a progressive degenerative-dystrophic disease. Finding it at an early stage allows you to stop the pathology, to achieve a stable remission. What else can be found during MRI of the shoulder joint:
- acute and chronic articular pathologies of an inflammatory and degenerative nature – osteoarthritis, rheumatic, psoriatic, juvenile, gouty arthritis;
- various injuries of rotational cuffs;
- diseases of infectious etiology – osteomyelitis, synovitis, bursitis;
- plexitis – inflammatory processes of the large nerve plexuses of various localization;
- osteochondropathy (Legg-Calve-Perthes disease, Ostgood-Schlatter disease, Köhler disease, Scheuermann-Mau disease, Schinz disease) – malnutrition of bone tissues and their subsequent necrosis;
- bleeding in the articular cavities, formed hematomas, the accumulation of pathological exudate;
- humeroscapular periarthritis, occurring against the background of the inflammatory process in the synovial capsule, muscles, ligament-tendon apparatus;
- anomalies in the structure of the shoulder that arose in the process of intrauterine or postnatal development;
- systemic pathologies affecting connective tissue structures (lupus erythematosus);
- hypermobility of the shoulder joint;
- neuropathies – non-inflammatory lesions of nerves of traumatic or non-traumatic origin;
- benign neoplasms, cancerous tumors, distant foci of the oncological process.
Magnetic resonance imaging is also prescribed to evaluate the effectiveness of the therapy. Surgeons track the rate of tissue regeneration, traumatologists and rheumatologists – the effect of pharmacological drugs.
Why is MRI with contrast agents performed
Often, doctors need to establish the presence of an inflammatory focus in the shoulder joint. For this, a contrast agent is administered intravenously to patients a few minutes before the examination. Most often, it contains a paramagnet – a rare-earth metal gadolinium, which is absolutely inert to the body. MRI with contrast is performed if there is a suspicion of development:
- neoplasms and metastasis. Tumors are supplied with blood, which is well visualized in the obtained images. The use of a contrast medium helps to establish the origin of the neoplasm, the number of formed metastases, the degree of their penetration into neighboring tissues, and features of blood supply;
- joint inflammation. With the help of contrast, you can detect small inflammatory foci in the ligaments, tendons, muscles. It is impossible to identify them during radiography;
- vascular pathologies. Some diseases of the shoulder joint develop due to insufficient intake of nutrient and biologically active substances in the tissues. The cause of the resulting deficit is the poor condition of the veins, arteries and capillaries of the shoulder girdle.
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Before performing a diagnosis using contrast, a patient is assigned a test to establish sensitivity to the rare earth metal. Usually gadolinium does not provoke any external or systemic side effects, is well tolerated by humans.
Diagnostic procedure technique
Special preparation for MRI is not required. If contrast is used in the diagnosis, it is advisable not to eat food for 1-2 hours. All items containing metals should be left in the preliminary training room. The diagnostician will inform you about the progress of the study, indicate how to contact him if his health worsens. Patients with mental disorders, claustrophobia or neurological disorders are indicated for taking tranquilizers or sedatives. How do MRI of the shoulder joint:
- the examined joint is covered with a special hemispherical coil;
- the patient is placed in a tomograph in a horizontal position. The study of the shoulder on obsolete equipment can be carried out in a standing position, but in most clinics such facilities are not used;
- a layer-by-layer scan of a joint takes about half an hour; when using contrast, it takes 40 minutes. During the examination, the patient should not move.
The procedure does not cause any discomfort. It is extremely rare for subjects to complain of dizziness, which is explained by being in a confined space.
Interpretation of the results is carried out by the doctor of radiation diagnostics. Decryption usually does not take more than 2 hours, however, when the radiologist is busy, patients have to wait for the results within a day. What shows the MRI of the shoulder joint:
- inflammatory foci, destructive and degenerative changes in bones and hyaline cartilage are visualized in the form of intensely stained areas;
- inflammation is indicated by cavities formed around the tissues;
- benign and malignant neoplasms look like areas with a denser structure. They are intensely colored and localized on the border between the bones and muscles;
- when the ligaments are torn, a displacement of the torn parts into the articular cavity is noticeable;
- overgrown edges of bone plates and calcified areas signal the irreversible destruction of cartilage, the development of osteoarthritis;
- complete or partial fusion of the joint space indicates ankylosis (immobility of the joint) and the need for surgical intervention;
- the formation of sequestration (dead tissue) is a characteristic sign of infectious arthritis;
- the accumulation of fluid in the synovial bag indicates bursitis, and the presence of effusion in the joint cavity indicates synovitis;
- changes in heat transfer, also determined during the examination, are associated with many diseases of the shoulder joint.
During the decoding of the results, the state of the bone surfaces lined with cartilaginous tissues is assessed. Normally, they should not have pronounced defects. The ligaments, tendons, nerve bundles, and muscle fibers located near the joint are also examined. Changes in soft tissue structures often indicate a sluggish inflammatory process.
MRI is the safest way to examine your shoulder joint. Unlike radiography, during diagnostics there is no undesirable radiation load on the human body. And informative arthroscopic examination is carried out in case of violation of the integrity of soft tissues. But MRI has absolute contraindications:
- the presence of ferromagnetic or electronic implants;
- implantation of artificial heart valves;
- surgical implants located in one of the central nervous system organs, for example, hemostatic clips.
Surgical devices installed in other parts of the body do not serve as absolute contraindications to the study. But there is a likelihood of distortion of the results due to artefacts (interference) generated under the influence of the magnetic field. The decision to use magnetic resonance imaging to detect a specific pathology is made by the radiologist.
The disadvantages of the diagnostic procedure include a rather high cost, the presence of serious contraindications, inaccessibility of equipment in sparsely populated areas. But the advantages of MRI far outweigh its disadvantages. The study is minimally invasive, absolutely safe and highly informative.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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