MR Arthrography Shoulder

Teaching points 

Usually done under fluoroscopy /ultrasonography/CT guidance to avoid labral cartilage injury. By Dr MGK Murthy and Dr Sudheer Kunkunuru

·        Indications

1.   Primarily for Rotator cuff tear suspicion or evaluation

2.   Cartilage evaluation

3.   All the internal structures including glenohumeral ligaments

·        Technique

PreArthrography  Xray shoulder AP with external and internal rotation views to look for presence of hydroxyl apatite crystals/calcification (which could be confused with rotator cuff  tear producing contrast leak)

-Supine and external rotation

-Mark the joint lateral to humeral head cortex

-20 to 22gauge LP needle perpendicular to fluoroscopy beam. Testing the safe INJOINT position with local anaesthetic after aspiration to test for blood vessels

-Confirm position with iodinated  contrast

- Dilute gadolinium injected to the comfort level usually

10 to 16 ml (Cocktail made of 0.1 ml Gadolinium+10ml Iohexol+10ml 0.9%saline+0.3ml of epinephrine of 1:1000 in 20 ml syringe )