Chat with us, powered by LiveChat

How to Read a Shoulder MRI Report

POSTED ON IN Shoulder BY Chris Centeno

how to read a shoulder mri report

Patients often get a shiny new shoulder MRI CD and pop it into their computer before they have the report from the radiologist. For those situations, I have a video on how to read a shoulder MRI, provided at the bottom of this page.

However, once you have the Shoulder MRI Report in hand, the next step is usually a series of Google searches in an attempt to decipher all of the medical jargon and anatomical references. This is a comprehensive guide to those obscure terms and what treatments are usually effective. Basically, how to read a shoulder MRI report.

The Key Parts of the Shoulder

First, realize that the shoulder is broken up into a few key parts:

  1. Rotator cuff – This is made up of the supraspinatus, infraspinatus, subscapularis, and teres muscles and tendons.
  2. Glenohumeral (GH)/AC joint – The GH joint is the main shoulder joint. AC Joint is the joint between the collar bone (clavicle) and shoulder blade (scapula).
  3. Labrum/biceps – The labrum is the lip on the socket of the ball and socket shoulder joint. The biceps tendon attaches at the top of the lip of the main shoulder socket.
  4. The Bursas – These are lubricating sacs around the shoulder that help ease movement of tendons past one another or another structure.

impressionFocus on the Impression

The last part of the report with the conclusions of the radiologist is called the “Impression”. This is where you should focus your attention. One or more of the four areas above will be commented on if there’s an abnormality. I’ll break down what you might read here by each of these areas:

Rotator cuff

The radiologist will comment here if one of the key muscles and/or tendons is injured or damaged (supraspinatus, infraspinatus, subscapularis, and teres muscles and tendons). Issues in the supraspinatus are the most common. These are the terms that are commonly used:

A. Tendinosis/Tendinopathy/Tendinitis – For all practical purposes these all really mean about the same thing – a pissed off, degenerated, and/or swollen tendon.

B. Partial, partial thickness, or incomplete tear – This is what it sounds like, a tear in the tendon or muscle that doesn’t go all the way through.

C. Complete or full thickness tear – This is again what it sounds like, a tear all the way through the tendon. Be a bit careful here as this only means that the tear is through the tendon in one part. Look for other key terms in the body of the report or in the impression like “retracted” or “massive” because these point to a more severe full thickness tear. If those terms aren’t present, then your tear is likely smaller.

The good news is that an irritated tendon or one that’s partially torn is usually easy to help with physical therapy and/or a simple injection. Stay away from cortisone or steroid shots, as these will only weaken the shoulder tendon. In addition, any injection into this area of the shoulder should only be performed with ultrasound guidance, so stay clear of doctors who perform blind and/or unguided injections, as they may be injecting into the wrong spot. Finally, a platelet rich plasma shot is usually a good option for this type of issue, but only if performed under precise ultrasound guidance.

Complete tears will often end up with a recommendation of surgery. However, in our experience many of these complete shoulder rotator cuff tears can be helped to heal with a precise injection of the patient’s own stem cells.

Massive or larger full thickness retracted rotator cuff tears will likely need surgery.

Glenohumeral Joint/AC Joint

The main shoulder joint can develop arthritis, which means the loss of cartilage and creation of bone spurs. The AC joint is the joint between the collar bone and the shoulder blade. Here are terms to look for:

A. Osteoarthritis (OA) – Mild, moderate, severe – this means lost cartilage.

B. Osteophytes – This means bone spurs. These can also be called spurs or spurring. These are outgrowths of the bone caused by instability.

c. Effusion – This means swelling with fluid in the joint.

For mild OA and sometimes moderate, platelet rich plasma (PRP) usually works well to reduce pain and swelling. Also realize that arthritis may be caused by instability in the joint, due to loose ligaments. Instability usually responds well to ligament tightening injections.  OA patients are often offered steroid shots as an option to relieve pain. These shots can chew up cartilage in the joint and make things worse in the long run, so they should be avoided.

Moderate and severe OA patients will usually be offered a shoulder joint replacement. On average, the outcomes for shoulder replacement patients are not nearly as good as hip or knee replacements. For this reason, we recommend that patients consider precise stem cell injections into the main joint under guidance before considering these traumatic surgeries.

Labrum/Biceps Tendon

The labrum is the lip around the socket of the main shoulder joint.

SLAP Tear, biceps tendon anchor tear – These are sometimes classified as types 1-4. Types 1 and 2 are less severe. Type 1 is usually treated with physical therapy. Type 2 can often be treated with a precise ultrasound guided platelet rich plasma injection. Be aware that this is a high skill procedure with only about 100-200 U.S. physicians capable of performing with a high degree of accuracy. Surgery is usually not needed for these types of labral tears, but is frequently recommended. Type 3 may be responsive to stem cell injections with the same caveats as above. Type 4 may need surgery. However, realize that surgery results for SLAP tears aren’t great.

Labral tear – This lip structure is torn. A specific type of labral tear is known as a Bankart lesion or tear. Many times radiologists will locate the tear on the socket by using a clock face naming system where 12 o’clock is at the top of the socket, 3 pm is the front, 6 pm is the bottom, and 9 pm is the back. Most smaller tears can be treated with precise platelet rich plasma injections.

Labral fraying or fraying of the labrum – This is the same as type 1 above and is usually something treated with physical therapy. PRP injections can also help.

Biceps tendon tear – These are partial or complete tears, similar to the types of rotator cuff tears discussed above with similar recommendations for treatment for each type. If you have a massive biceps tendon tear you will know it without an MRI as some or all the biceps muscle will fall downward, making you look like “Popeye”.

Bursas

These are the lubricating sacs around the shoulder that allow normal motion of tendons as they cross each other and bony areas. They can swell when they get irritated.

Effusion or fluid in the bursa – this means swelling in the bursa and is classified as mild, moderate, or severe. Realize that swelling in these areas is usually due to problems with bio mechanics and aren’t issues themselves. So this is a symptom of a bigger problem.

Impingement, sub-acromial impingement, rotator cuff impingement, type 1, 2, or 3 acromion – This means that the rotator cuff is usually being pressed on or compressed by either the way you move or a bone spur. The acromion is a natural part of the shoulder blade that can place downward pressure on the rotator cuff. The higher the type number, the more downward pressure. For example a type 3 places more pressure than than a type 1.

Be very careful here, as the most common solution offered for patients who fail physical therapy is surgery to “open up” or “decompress” the shoulder by removing bone and/or other structures. The problem with the surgery is that it cuts important ligaments that stabilize the shoulder, which leaves it unstable and causes more problems down the road. In our experience, this surgery is rarely a good idea. A shoulder impingement should be solved with physical therapy and correcting the bad bio mechanics and other issues that started the problem.

The upshot? Reading a shoulder MRI report and understanding what it means can be empowering because it means the patient is armed with knowledge. Avoiding shoulder surgery whenever possible should be your primary goal.

Ready to learn how to tie this information together with your MRI CD? Watch the video below.

The shoulder is an incredibly complex joint and when you put it into 3D space through the power of MRI imaging, it can be pretty difficult to figure out where all of the components described above are located. This video will help you understand what you’re looking at when you go exploring your Shoulder MRI CD.

    comments

    Bigg Scott says

    This is awesome information, Doc. I am 36, been lifting weights for 20 years, had just gotten my bench up to 500 pounds, and then my shoulders started acting up. My doc says I have osteoarthritis in a few joints, but my right shoulder had gotten so bad that I haven't lifted in about 2 months--I THINK I tore something in there. I just had my MRI in a big MRI tube because I am too wide to fit in a regular one. I have the CD and am anxiously awaiting the report so I can know what needs to be done to get me back in the gym! I will be consulting this article again after seeing the report I get. Thank you!

    replies

    Regenexx Team says

    Bigg Scott,
    Sounds like a plan. As well as MRI which is a static image, a Stress Shoulder Ultrasound can give significantly more diagnostic information. Please see: http://www.regenexx.com/shoulder-instability-recovery-time/

    replies

    Karen G says

    so, if my doctor has been doing "blind" steroid injections to my right shoulder off and on for the last 5 years, he is just helping me along to the operating table? My shoulder locks up randomly, previous MRI's show arthritis, cysts, spurs and the like but never any tears. he does one or sometimes two injections and I do my PT exercises religiously and I don't end up back in his office for a year or more. then I reach the wrong way and pop - boom dinosaur arm! off for an injection and I'm good to go - or am I doing more harm than good getting the wrong kind of shot and how to I tell my ortho shoulder specialist um, hey I think you are doing that wrong?

    replies

    Regenexx Team says

    Karen,
    Unfortunately, steroid injections are a net negative as they are lethal to the local stem cells which are your body's repairmen in your joints, break down cartilage, and can injure tendons. Unfortunately as well, they remain a mainstay of orthopedic care as they are covered by insurance and despite the well documented longterm damage, they make patients feel better in the short term. Please see: http://www.regenexx.com/bad-news-shoulder-steroid-shots/ and http://www.regenexx.com/steroid-injection-risks/

    replies

    Cathy Swanson says

    Thank you. Really appreciate this explanation.

    replies

    Regenexx Team says

    Gald you enjoyed it Cathy!

    replies

    Janet J says

    Thanks for this - getting MRI tonight - have a confirmed Glenoid 20% dominant arm break of 7wks old (from a serious fall) 1st Orthopedic took non surgical approach - sling through this week. Pain still acute and cannot take arm away from/above, behind body w/out acute pain. Sought 2nd opinion - leads to this 1st MRI tonight as he is suspecting possible RC tear as well - 1st Ortho ruled out by in ofc. ultrasound only. Do you agree that that this is a good route? I cannot work as a Sign Language Interpreter (I am Nationally Certified and it is my full time profession) without the full use and range of motion of my arm which I am unsure the 1st Ortho really grasped. Agreed on this route of the 2nd Ortho?
    Thank you!

    replies

    Regenexx Team says

    Janet,

    We'd need more information like an MRI, medical history, etc, which are submitted as part of the Candidacy process. Ruling out a Rotator Cuff Tear is a good idea, although, it could be less obvious things as well. What would not be a good idea would be Rotator Cuff surgery. If you'd like us to weigh in, please submit the Candidate form. Please see: https://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/

    replies

    Laura B. says

    My disc has my neck MRI images and MRI transcribed report.
    The disc is supposed to have the transcribed report for my left shoulder with and without contrast too, but there is no dictated / transcribed report - only a blank header.
    Is the news that bad, they didn't want me nosing through the disc before my doctor could talk to me? Or was it Friday, they had too much going on and forgot.
    What's the common practice here? Princess Valium just wore off from the MRI study - I'll be up all night now.

    Incidentally, I was a medical transcriptionist for many years and understood the MRI report of my neck - standard jargon.

    I can't wait to compare my shoulder report to this site. Saved to my favorites - thank-you!

    replies

    Regenexx Team says

    Laura,
    No way to know. We don't use the report. Our Doctors read the MRI images directly as radiologists are looking for completely different things than we are looking for.

    replies

    Jill says

    Hi there. I got these results today from my MRI 4 days ago. (I had a torn rotator cuff repair and bicep tenodesis 3 years ago on the left shoulder - successful.) Is this similar? (Rheumatoid arthritis is also a problem.)

    "
    Patient I believe has a full-thickness tear of the supraspinatus tendon with a gap in the tendon measuring approximately 2.5 cm. The infraspinatus tendon appears partially torn. Subscapularis tendon may be partially torn on its superior aspect. The biceps tendon demonstrates abnormal signal in its distal portion probably representing some tendinopathy. Superior labrum demonstrates no bony abnormality.

    IMPRESSION: Full-thickness rotator cuff tear with gap in the supraspinatus tendon. Probable abnormal biceps tendon.

    replies

    Regenexx Team says

    Jill,
    Not sure what you're referring to when you ask if this is similar, as there are many different issues discussed on the "Read Your Own Shoulder MRI" Blog. Current MRI not unusual for a patient having had a rotator cuff surgery and tenodesis.

    replies

    Jill says

    Just wondering if the impression posted above for my right shoulder is similar to the situation from a few years ago on my left shoulder - rotator cuff repair and bicep tenodesis. Sorry - I should have made that more clear. Different techs and different medical offices doing the MRIs use different language - not the same wording for the right shoulder (above) as it was for my left shoulder (now fixed).

    replies

    Chris Centeno says

    Jill, we take looking at MRIs very seriously as part of the candidacy process. Hence, I would need to review the films to see if you're a candidate for what we do. We also have many excellent physicians on the network throughout the country who could do the same.

    replies

    Crystal says

    My MRI findings state that tendinopathy of the supraspinatus and infraspinatus tendon. No fluid-filled rotator cuff tear. What does this mean do I have a messed up rotator cuff?

    replies

    Regenexx Team says

    Crystal,
    We don't use reports, we'd need to see the MRI images themselves in a Candidacy evaluation, but if it hasn't healed on it's own, would likely benefit from treatment. This tear din't show up on the MRI: https://www.regenexx.com/watch-advanced-image-guided-injection-shoulder-step-procedure-suite-dr-schultz/

    replies

    Chris Centeno says

    This would mean that your tendons have small micro tears and are "beat up", but not completely torn.

    replies

    Phillip Zirlott says

    I got my MRI report what does a dehiscent ac joint mean?

    replies

    Chris Centeno says

    That's not a common descriptor used in reports about AC joints, but it would likely mean separated AC joint.

    replies

    Add comment

    Your comment will be revised by the site if needed.

    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

    View Profile

    Search Blog

    Categories