 Hello everyone, I am Dr. Uthakash Kabra, radiologist at Gettel Polyclinic and Hospital Jaipur. I hope you and your family are well and safe during these time times. I will be presenting a few interesting shoulder MRI cases today. Starting with case number 1, an MRI was performed for a 25 year old male patient with history of recurrent shoulder dislocation. Let's take a look at the images, coronal PD-FATsat, axial PD-FATsat and sagittal PD-FATsat. Axial PD-FATsat image shows a compression fracture involving the posterior lateral aspect of head of humerus with surrounding marodema at the level of coropoid process. Consistent with the hillside exhalation, care should be taken to not fall a hillside exhalation below the level of coropoid process as the humeral head normally flattens out below. This image shows tear of the anterior and anterior glenoid labrum. Adjacent periosteum is stripped, mildly lifted and displaced anterior immediately from the anterior aspects of glenoid. Consistent with alzalesion or anterior labraligamentus periosteal sleeve avalgen. Coronal PD-FATsat image shows a partial tear of glenoid attachment of inferior gleno-humeral ligament, involving the anterior band consistent with agagal lesion or glenoid avalgen of gleno-humeral ligament. In addition, a partial thickness articular surface tear of the anterior most fibres of supraspinitis tendon is seen at the attachment site. To summarize, this case shows features of anterior gleno-humeral instability with hillside, alza and agal lesions. Moving on to the next case. Before we see the images, let's take a look at the anatomy of the acromioclavicular joint and coricoclavicular ligament complex. The acromioclavicular joint is formed by the lateral aspect of clavicle and acromion process of scapula. It is surrounded by a joint capsule and superior and inferior acromioclavicular ligaments. The coricoclavicular ligament complex is the main stabilizer of ac joint and formed by the conoid ligament and trapezoid ligament marked as C and T respectively. A 65-year-old gentleman involved in a road traffic accident presented with history of pain, an MRI of the shoulder joint was asked. Now, let us see the images. Coronal PD-FAT-SAT, axial PD-FAT-SAT, sagittal T1. The coronal PD-FAT-SAT image shows the acromioclavicular joint dislocation with complete tear of superior and inferior acromioclavicular ligaments and superior displacement of clavicle relative to acromion. Sagittal T1 image shows bone fragments at the anterior superior aspects of the coropoid process. The normal coricoclavicular ligament complex is not visualized. These coronal PD-FAT-SAT images show a complete tear of clavicular retachment of trapezoid ligament. The remaining visualized ligament appears lax. Interstitial tears of conoid ligament are seen. Bone fragments are seen at the anterior superior aspects of the coropoid process. These findings are consistent with coropoid avalgene of coracoclavicular ligament complex. Interstitial tears of trapezius and deltoid muscles are also seen. An incidentally wild-fine lesion is seen in the spine of scapula with punctate hypointensities within, likely representing a conroid lesion, possibly an n-chondroma. Fracture of right third rib is also seen. To summarize, there is type 3 injury of acromioclavicular joint with coropoid avalgene of coracoclavicular ligament complex. Coming to the last case. 30-year-old male patient, a known case of oncology and spondylitis, presented with history of shoulder pain and an MRI of shoulder joint was performed. Let's take a look at the imaging findings. Coronal PD-FS, axial PD-FAT-SAT images, societal T1 and societal PD-FAT-SAT images. Axial PD-FAT-SAT images show a shallow-appearing glenoid, which does not closely follow the umeral head, with a posterior labral tear indicated by the arrow. Acistic lesion is seen in the spinal glenoid notch, causing scalloping of the adjacent glenoid bone. There is posterior sublossation of the umeral head. Society PD-FAT-SAT images show posterior labral tear as indicated by the arrow, spinal glenoid notch cyst and edema within the infaspinatus muscle, which is likely due to compression of the sutra scapular nerve within the spinal glenoid notch. Society PD-FAT-SAT image shows marrow edema involving the posterior aspects of the acromioc process along the site of orager of deltoid muscle. Society PD-FAT-SAT image shows subtly flattening and sclerosis involving the superior aspect of the umeral head and osteophytes along the umeral head. So, to summarize, there is shallow glenoid, which does not closely follow the umeral head, with posterior labral tear and posterior sublossation of head of umerus, consistent with glenoid dysplasia and atraumatic posterior instability as there was no history of trauma. Spinal glenoid notch cyst, causing scalloping of the posterior aspects of the glenoid bone and resulting in edema in the infaspinatus muscle, likely due to compression of the sutra scapular nerve. This is likely a parallel cyst secondary to posterior labral tear. Enthesopathy changes with marrow edema involving posterior aspects of the acromioc process along the site of orager of deltoid muscle. This has been described as a very specific sign for ankylosing spondylitis. Secondary osteoarthritic changes, likely due to glenoid dysplasia and chronic atraumatic posterior instability. Thank you for listening. Stay healthy, stay safe. If you like our videos, like, comment, share and subscribe to our channel.