MRI Shoulder — routine
Acromioclavicular joint and acromion superiorly to below the glenoid inferiorly, including the whole rotator cuff, the glenoid labrum and the myotendinous junctions.
Typical, not policy
Timings, volumes and delays here are representative values drawn from published guidance. Scanner generation, injector, cardiac output and local preference all move them. Confirm against your department's own protocol before you rely on a number.
When to use it
- Suspected rotator cuff tear, particularly where surgery is being considered.
- Impingement symptoms not responding to conservative management.
- Suspected biceps tendon pathology or subscapularis tear.
- Suspected labral injury in an older patient, or where an arthrogram is not available or not tolerated.
- Suspected cuff arthropathy, or characterisation of an abnormality seen on radiographs.
Technique
- Oblique-coronal plane aligned to the supraspinatus tendon, oblique-sagittal perpendicular to it, and an axial series through the glenohumeral joint.
- Fluid-sensitive fat-suppressed sequences in oblique-coronal and oblique-sagittal planes, with a T1 or proton-density sequence for anatomy and marrow.
- Small field of view — practice audits repeatedly show the field of view is the parameter most often set too large — with slice thickness of roughly 3-4 mm.
- The oblique-sagittal series should extend medially far enough to assess muscle bulk and fatty atrophy, which drives surgical decision-making.
Where it goes wrong
- Field of view too large, the most frequently documented deviation from practice parameters in shoulder MRI, and the one that costs tendon detail.
- Oblique-coronal plane not aligned to the supraspinatus, so the tendon is imaged obliquely along its length.
- Oblique-sagittal coverage stopping lateral to the muscle bellies, so fatty atrophy cannot be graded.
- Magic-angle effect in the tendon at around 55 degrees to the main field on short-echo sequences, mimicking tendinopathy.
- Arm positioned in internal rotation, which slackens and distorts the cuff.
Clinical questions that reach this study
Contrast
None
- Unenhanced. Where a labral question dominates and the patient is young, the escalation is to a direct arthrogram rather than to intravenous contrast.
Acquisition
- Breathing
- Not applicable; the arm is immobilised in a dedicated surface coil, ideally in neutral or slight external rotation.
- Preparation
- No preparation. Confirm the side and state whether instability or impingement is the question — it decides whether an arthrogram is warranted. Shoulder replacements and fixation devices need conditionality checking and generate substantial artefact.
Safety checks this protocol carries
Derived from the contrast agent and phases above, not authored here — which is why they cannot drift apart from what the protocol actually does.
- MR safety screening for implants and foreign bodies· radiographer at scan