 Let's start looking at the anatomy. When we look at the anatomy, axial images, let's quickly over the maybe next five minutes look at the anatomy. This is the acromioclavicular joint, always make sure you are covering it in the uppermost sections. This is the section where you may see an osacromial and accessory bone. Do not identify that before the age of 25 years because that's normal ossification that has not fused. Later you can call it an osacromial. Usually asymptomatic can be marrow edema or stress edema adjoining it may lead to impingement but most of the times asymptomatic. Look at this joint space here. As you go inferiorly, look at the supraspinatus muscle bulk, look at the supraspinatus tendon. So it fans out and has a wide insertion on the greater tuberosity. Further inferiorly now I can start seeing the long head of bicep tendon originating from the superior glenoid and coursing in its intraarticular segment. The spine of scapula always make sure you are looking at the anterior and the posterior deltoid muscles because there could be changes there which can be causing symptoms. Next section I can start seeing the superior labrum now. This is the infraspinatus insertion. So the infraspinatus insertion to the greater tuberosity. Further lower down now we can see the anterior superior labrum as a dark, triangular, well-defined structure. For posterior superior labrum please be careful because of the curvature. You can get artificial signals so make sure you look at it on other sequences. This here is the spinal glenoid notch between the spine of scapula and the glenoid. And these are the branches of the supraspinatus nerve here and with the surrounding vessels. So make sure you are looking at this area. Any labral tear here can have a parallel cyst which can extend here and cause compression of the nerve here leading to denervation. This here is the infraspinatus tendon and now you start seeing the subscapularis tendon. Coracoid presses make sure you are looking at it, make sure you look at this distance. Even if you do not measure it every time, make sure that you have an idea as to it not being very narrow. Now you can see the bulk of the subscapularis muscle. You can see the subscapularis tendon insertion and you can also see the bicep tendon in the bicepital groove. Anytime there is bicep tendon dislocation, it is not in the groove. Look at subscapularis. Usually there would be a tear associated. I can still see the spinal glenoid notch, the anterior labrum, the posterior labrum, the articular cartilages seen well and now you can start seeing the teres minor insertion. Further inferiorly, I can identify the labrum well, subscapularis insertion and here is the bicep tendon in the groove. So it should be externally rotated like this or max it could be neutral but you do not want the bicep to do lying here in an internally rotated position scanning the patient because then these structures get all bunched up. Further inferiorly, you can see the anterior inferior capsule. So the capsule itself is thickened and the anterior and posterior inferior portions are known as the inferior glenovumeral ligament bands anterior bad posterior band. So look at this area, look at the bicep tendon also look at the pectoralis major and minor in this area. Sometimes you could have pathology in that. Let us begin looking at the coronal images. Most posterior section you have the infraspinatus tendon inserting to the greater tuberosity. This is the teres minor muscle and this is the infraspinatus muscle. As you come further anteriorly, you can now start seeing the supraspinatus muscle. On coronal, you cannot make out where supraspinatus is beginning and infraspinatus, supraspinatus is ending and infraspinatus is beginning. We see that on the sagittarius. Look at this area for any bony spur along the acromia. This is the inferior glenovumeral ligament. It is the inferior capsule itself which is thickened and that is called as inferior glenovumeral. This is the posterior labrum and this is the spinal glenoid notch that we already spoke about. This is quadrilateral space where the axillary nerves are coarsing. Further anteriorly, I can see the supraspinatus tendon well. This area is the footprint where it attaches to the tuberosity and a centimeter proximal is the critical zone. You can see again look for any spur here, look for any acromio-clavicular joint or osteoarthrosis. This is again the spinal glenoid notch. This is the axillary nerve. So you can have an inferior labral tear and a paralabral cyst coming here compressing this. Now as you come further anteriorly, so this is the plane where you look for the superior labrum and the inferior labrum on the coronal images and now I can start seeing the long head of biceps arising from just above the superior labrum. Further anteriorly and this is also a section where I like to look at the muscle bulk. Is there any atrophy? Now I can see the superior labrum, inferior labrum, the anterior band of the IgHL. This is called the axillary recess and then the anterior and the posterior band. And now in this section I also want to trace the long head of biceps, intraticular portion as it crosses the pulley in the bicepital groove and then the inferior to the bicepital groove. So this is the long head of biceps tendon. I want to look at that. More anteriorly I see the subscapularis muscle and you can see how it's a multi-penet muscle and you have multiple tendon-like appearance which insert onto a wide insertion on the lesser tuberosity. This is the rotator interval which is fat containing and has the coracohumeral ligament that I can see in here. Normally it should have fat within it. This is the multiple fibres of the subscapularis tendon. Look at them on axial as well as on sagittal. Coming to the sagittal images, we can see the supraspinatus muscle. Look at its bulk, any atrophy. This is the infraspinatus muscle. This is the teresminar muscle and this is the subscap muscle. So look at any atrophy. This is a good section to look for the normal pair-like appearance of the glenoid. So if you look at the AP diameter superiorly should be lesser than the AP diameter inferior. So this little bulge out here is what is normal. As I come further laterally, this is the rotator interval area. This is coracohumeral ligament. This is coracohumeral ligament. So it's very important that you take non-fat sat sequences. Yes, you need fat sat to look for marrow edema, to look for fluid, to look for teres. But you need non-fat sat sequences because fat acts like a good natural contrast and that's the reason we don't do orthograms because fat acts like the contrast for all of these. And as I come further, this here is the biceps origin from the superior glenoid tubercle. I can still see the coracohumeral ligament. This is the biceps tendon. This is the superior gleno-humeral ligament. So the gleno-humeral ligaments are really thickenings of the capsule itself. This is the subscap again. This is the infraspinatus supraspinatus teresminar. This is the posterior band and this is the anterior band of the IgHM. This is the auxiliary recess area. Look at the acromioclavicular joint in this section. Look at the under surface of the acromion on this section, little away from the joint. Now start looking at the tendon. This is the biceps tendon. This is the coracohumeral ligament. This is the superior gleno-humeral ligament anterior to it. This is the coracoacromial ligament. So fat will outline these structures very well. When you have fax fat, you only see edema. You don't see these individual structures. Look at the subscapularis tendon. Remember rotator cuff tendons have a wide insertion. So it's not like one point and they interdigitate with each other also. Again, I can see the biceps tendon. I can see the pulley. This is the CHL, coracoacromial ligament and this is the SGH. So it's forming a pulley. This is the subscap tendon. All of this is the supraspinatus. All of this is the infraspinatus. Further, you can see the same anatomy well and now I can tell that this is the demarcation point between supran infraspinatus tendon. There is interdigitating of fibres in this location. All of this is subscap. So anterior most supraspinatus, superior most subscapularis, you'll see well on the sagittal images. On coronal and axial, you may get confused. So keep them together and look at it. Long head of biceps tendon, coraco-humeral ligament, superior gleno-humeral ligament forming the pulley. More laterally, you can see this is the subscap insertion now. This is the supraspinatus insertion and this here is the infraspinatus insertion. This is the long head of biceps tendon here. So look carefully at this area. You can have anterior most supraspinatus stairs that you may miss on coracoacromia. You may not be seeing it carefully and trace it all the way up to its insertion. This much is supraspinatus. This much is infraspinatus. Trace it from medially and this would be the biceps tendon here. Look at the deltoid on these sections.