How to Read a Shoulder MRI: A Step-by-Step Guide for Clinicians

Systematic Approach to Shoulder MRI Interpretation

1. Clinical History: Review symptoms, trauma history, prior surgeries, and specific clinical questions.
2. Image Quality: Assess signal-to-noise, resolution, artifacts, and sequence parameters (e.g., PD, T2, T1, fat-suppressed).
3. Anatomy Review: Identify bones (humerus, scapula, clavicle), rotator cuff tendons (supraspinatus, infraspinatus, teres minor, subscapularis), labrum, biceps tendon, capsule, ligaments, muscles, and neurovascular structures.
4. Bone & Joints: Evaluate for fractures, osteonecrosis, osteoarthritis (AC joint, glenohumeral), Hill-Sachs lesions, and bony Bankart lesions.
5. Rotator Cuff: Check each tendon for tendinosis, partial-thickness tears, full-thickness tears (measure size, retraction), and muscle fatty infiltration.
6. Labrum: Assess for SLAP tears (types I–IV), Bankart lesions, paralabral cysts, and degenerative fraying.
7. Biceps Tendon: Look for tendinosis, subluxation/dislocation from the bicipital groove, tears, and fluid in the tendon sheath.
8. Muscles: Identify strains, tears, denervation changes (e.g., suprascapular nerve), and atrophy.
9. Capsule & Ligaments: Evaluate capsular thickening (adhesive capsulitis), IGHL complex, and coracohumeral ligament.
10. Neurovascular: Check brachial plexus, axillary nerve, and vessels for compression or mass effect.
11. Contrast Sequences (if MR Arthrogram): Detect labral tears, rotator cuff tears, capsular leaks, and synovitis with higher sensitivity.
12. Clinical Correlation: Match imaging findings to patient’s symptoms and physical exam.
13. Report: Summarize key findings, provide a clear impression, and suggest management (conservative, injection, surgical referral).

Important Reminder

MRI interpretation requires specialized musculoskeletal radiology training. This guide outlines a structured framework; final reads should be performed by a qualified radiologist.