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Abduction and External Rotation in Shoulder Impingement: An Open MR Study on Healthy Volunteers—Initial Experience¹

¹ From the Departments of Radiology (G.E.G., S.T.W., C.F.B.) and Orthopedic Surgery (G.C., T.M.), Stanford University School of Medicine, 300 Pasteur Dr, SO-68B, Stanford, CA 94305-5105; Harvard Combined Orthopaedics Program, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Mass (G.P.P.); and Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, Va (S.S.B.). Received June 9, 2006; revision requested August 15; revision received November 11; accepted December 7; final version accepted February 2, 2007. Supported by NIH grants EB002524-01 and EB005790-01 and by the Whitaker and Lucas Foundations. Address correspondence to G.E.G. gold{at}stanford.edu).

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Volunteer positioned in 0.5-T open MR imager. (a) Unloaded ABER position at 90° external rotation. (b) Loaded ABER position at 111° external rotation.

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Volunteer positioned in 0.5-T open MR imager. (a) Unloaded ABER position at 90° external rotation. (b) Loaded ABER position at 111° external rotation.

View larger version (54K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Computer-generated models from MR image data of shoulder in neutral position. (a) Anterior and (b) posterior views of insertion sites of rotator cuff tendons. Red = supraspinatus, blue = infraspinatus, yellow = subscapularis.

View larger version (54K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Computer-generated models from MR image data of shoulder in neutral position. (a) Anterior and (b) posterior views of insertion sites of rotator cuff tendons. Red = supraspinatus, blue = infraspinatus, yellow = subscapularis.

View larger version (34K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Computer-generated models from MR image data of shoulder in loaded ABER position. (a) Anterior, (b) posterior (arrow = minimum distance between the glenoid and infraspinatus insertion), and (c) inferior views show insertion sites of rotator cuff tendons. Red = supraspinatus, blue = infraspinatus, yellow = subscapularis. Note proximity of labrum to infraspinatus insertion site.

View larger version (61K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Computer-generated models from MR image data of shoulder in loaded ABER position. (a) Anterior, (b) posterior (arrow = minimum distance between the glenoid and infraspinatus insertion), and (c) inferior views show insertion sites of rotator cuff tendons. Red = supraspinatus, blue = infraspinatus, yellow = subscapularis. Note proximity of labrum to infraspinatus insertion site.

View larger version (56K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: Computer-generated models from MR image data of shoulder in loaded ABER position. (a) Anterior, (b) posterior (arrow = minimum distance between the glenoid and infraspinatus insertion), and (c) inferior views show insertion sites of rotator cuff tendons. Red = supraspinatus, blue = infraspinatus, yellow = subscapularis. Note proximity of labrum to infraspinatus insertion site.

View larger version (165K): [in this window] [in a new window] [Download PPT slide]   Figure 4a: Transverse 3D gradient-echo MR images (30/10) with volunteer in (a) neutral position, (b) unloaded ABER position at 90° external rotation, and (c) 111° external rotation. Note infraspinatus tendon (arrow) deformed between the greater tuberosity and posterosuperior glenoid in the loaded study.

View larger version (141K): [in this window] [in a new window] [Download PPT slide]   Figure 4b: Transverse 3D gradient-echo MR images (30/10) with volunteer in (a) neutral position, (b) unloaded ABER position at 90° external rotation, and (c) 111° external rotation. Note infraspinatus tendon (arrow) deformed between the greater tuberosity and posterosuperior glenoid in the loaded study.

View larger version (159K): [in this window] [in a new window] [Download PPT slide]   Figure 4c: Transverse 3D gradient-echo MR images (30/10) with volunteer in (a) neutral position, (b) unloaded ABER position at 90° external rotation, and (c) 111° external rotation. Note infraspinatus tendon (arrow) deformed between the greater tuberosity and posterosuperior glenoid in the loaded study.

View larger version (25K): [in this window] [in a new window] [Download PPT slide]   Figure 5: Graph shows average minimum distance (± standard deviation) for eight volunteers from the acromion to the humeral head in neutral and loaded ABER position. * = structure was significantly closer (P < .01) to acromion in loaded ABER position. GT = greater tuberosity, Infra = infraspinatus insertion site, LT = lesser tuberosity, Subscap = subscapularis insertion site, Supra = supraspinatus insertion site.

View larger version (25K): [in this window] [in a new window] [Download PPT slide]   Figure 6: Graph shows average minimum distance (± standard deviation) for eight volunteers from the glenoid to humeral head in loaded ABER position. * = structure was significantly closer (P < .01) to glenoid in loaded ABER position (P < .01). Abbreviations same as in Figure 5.