MRI of the shoulder joint

MRI of the shoulder joint is not in vain one of the most effective and safe methods of diagnosing pathologies of bones, joints and soft tissues located in this area. The x-ray, which is popular in the old days, affects the body with unsafe ionizing radiation, is no longer as relevant as magnetic resonance imaging, which does not use harmful rays. And although the danger of x-ray radiation, used in modern radiography and computer tomography devices, is significantly exaggerated, human health is nevertheless put on the forefront.

And if we take into account the fact that in addition to the annual X-ray examination, we are exposed daily to hazardous radiation at home, at work, on vacation, while traveling by plane, etc., the value of MRI is quite high, since the investigation makes it possible to obtain the necessary information for diagnosis without additional exposure.

Anatomy of the shoulder joint

The shoulder in the people is usually called the uppermost part of the arm, adjacent to the shoulder blade. In fact, the shoulder is a structure formed by three bones: a scapula, clavicle and humerus, which represents the upper half of the arm.

The human shoulder is a fairly mobile organ. Two joints take part in its movement: the acromioclavicular (the junction of the clavicle and the scapula) and the humerus (the place of the entrance of the rounded end of the humerus into the cup-shaped basin of the scapula). It is the shoulder joint in the people that is associated with the shoulder, and thanks to this joint, we were able to carry out a wide range of movements by hand. A MRI of the shoulder joint allows in all details to consider this complex structure and evaluate the degree of its functionality.

Bones in the joint area are covered by a strong cartilaginous tissue, which allows the joint to move freely and serves as a kind of shock absorber when striking. The joint itself is surrounded by a connective tissue, from which a protective capsule is formed. Inside the capsule is covered with a thin, but rather strong shell, called the synovial membrane. It is in this shell that a fluid is synthesized, designed to lubricate joints and reduce friction when moving by hand (synovial fluid).

What other important components have we missed by considering the structure of the shoulder joint:

• Articular (or cartilaginous) lip. This is the name of a tissue consisting of collagen and elastic fibers covering the articular cavity. This is a variety of connective tissue, which is still called fibrous. It increases the surface of the cavity, so that the cavity corresponds to the size of the head of the humerus. Fibrous tissue is needed to stabilize the joint at the junction of different bones.
• Rotational brachial cuff. It is represented by a complex of two types of soft tissues: muscles and tendons. It is these tissues that are the cover for the shoulder joint. They also provide a rotational movement of the arm and the bone-cartilage joint itself.
• Deltoid muscle. It is thanks to the presence of this powerful muscle that we are able to raise our hand and various weights.
• The tendon of the biceps muscle of the shoulder, called the biceps (the pride of bodybuilders, because it is the size of this muscle that assess the beauty of the physique and the strength of the hands). This sturdy fabric is responsible for flexing the arm at the elbow and allows you to rotate the forearm.

During the MRI, the doctor is given the opportunity not only to repeat the anatomy of the shoulder, but also to reveal pathological changes in various sections of the shoulder joint.

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Indications for the procedure

And yet, despite the safety of magnetic resonance imaging, this diagnostic method is applied in a limited framework. That is, the MRI of the shoulder joint is performed only in certain cases, when the doctor is difficult to diagnose, based on the results of physical examination and patient complaints.

In what cases may additional research be needed:

• at suspicion on inflammatory-degenerative pathologies of the shoulder joint, such as arthritis or arthrosis,
• for fractures of the bones of the shoulder joint (not only for the diagnosis, but also for assessing the location of bone fragments),
• if there is a suspicion of damage to the rotator cuff of the shoulder (these can be both tendon ruptures, and compression of the bag of joints and tendons, accompanied by pain in people aged 40 and called impingment syndrome)
• with traumatic injuries of the shoulder (tearing of cartilaginous tissue, rupture of ligaments in the shoulder joint region, etc.)
• with sports injuries (for example, severe bruise or dislocated shoulder),
• In the case of injuries caused by the characteristics of work activity (such injuries can result, for example, in working with tools that cause severe vibration),
• at suspicion on infectious-inflammatory processes in a firm and soft tissues of a humeral joint,
• at tumor processes (it helps to determine the localization and size of the tumor, as well as to reveal metastases in bones and soft tissues),
• when appearing in the region of the shoulder composition pain, swelling and bruising of unknown origin,
• with a progressive pain syndrome in the shoulder region in the event that drug therapy does not produce results,
• with limited motor abilities of the shoulder,

MRI of the shoulder joint is one of the most effective diagnostic methods to detect even hidden pathologies. But this technique is also used to evaluate the results of ongoing surgical treatment. In this case, tomography can be performed both with contrast (which is actual for tumor processes and vascular pathologies), and without it.

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Preparation

MRI of the shoulder joint is considered a safe procedure, so it does not require special preparation. On the eve of the study a person can safely eat various kinds of food and drinks. It does not require restriction of activity. A person can perform labor and household duties as far as it is possible for him to have trauma or illness, which is an indication for conducting MRI diagnostics. There is no need to change the mode of the day.

Even if MRI is performed with contrast, the examination of the shoulder joint does not impose any restrictions on the patients. The only thing that can be required is carrying out allergens to ensure that no intolerance reactions occur during intravenous administration of the coloring substance. However, for diagnostic purposes, contrasts are used, which rarely cause the appearance of allergic reactions.

The doctor can advise the patient to refuse breakfast on the day of the procedure, and on the eve of adhering to an easy diet. This will avoid nausea after the administration of contrast medium.

As part of the preparation for MRI diagnostics, a physical examination of the patient by a doctor and an examination of the patient's anamnesis are carried out. This allows you to put a preliminary diagnosis. In this case, the doctor receives the necessary information about the patient's health, including the risk of undesirable reactions to the contrast.

If there are built-in implants in the body of the researcher, it is necessary to notify the doctor about this. After all, some metal alloys can distort the magnetic field of the device, making unwanted adjustments to the information it receives, and electronic stimulators can themselves fail to work.

If in the past, the patient already had injuries or diseases of the bones and joints of the shoulder girdle, the doctor should preferably provide earlier X-rays or MRI results. This will help avoid false conclusions when decoding new results.

Assigning the patient such a method of diagnosis as an MRI, the doctor should tell in detail how the procedure will be carried out, what during it can be done and what can not be done. If some training is necessary, this should also be notified to the researcher.

If the patient is a woman, she needs to be warned that makeup often includes components containing metal particles. Therefore, before the procedure, it is better to abandon its use. Do not wear jewelry from different metals, because they will still be asked to remove before the start of diagnostic activities. In addition to jewelry, the patient will be offered to remove and leave all metal-containing items. It's about watches, keys, belts with metal buckles. In this list, you can include clothes with rivets and zippers, all kinds of pins used from the evil eye or as jewelry, a knife, ball and pen pens and rods with metal tips, glasses with metal parts. We'll have to leave bank cards with a ferromagnetic strip. Do not be an exception and removable metal dentures.

In private clinics, patients are given a special robe, in which the person should be during the procedure. But it is not forbidden to take light household clothes with you to the diagnostics.

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Technique MRI of the shoulder joint

It must be said that the very technique of MRI examination of the shoulder joint does not present any technical complexity. To carry out the diagnostic, universal devices are used that create inside a magnetic field, safe for humans, but sufficient for obtaining information about the state of hard and soft tissues of the body.

MRI of the shoulder joint allows you to get a clear image on the computer screen or a film of ligaments, tendons, cartilage, bones, i.e. Of all structures of the shoulder girdle and makes it possible to fix any changes in their condition.

The human body is more than 70 percent water, and one of the constituents of this substance are hydrogen molecules (we know this from the school chemistry course). The nuclei of hydrogen atoms placed in the magnetic field begin to absorb electromag- netic pulses coming from the device. The latter cause vibrations of atoms. These signals and catches the device. And since the reflection of signals in tissues of different density is not the same, a picture is obtained on the screen, the individual elements of which have a color of different intensity.

In order to obtain such a picture, the patient (or rather that part of his body that is to be studied) must be inside the device. The person is placed on the pull-out table, where he will stay until the end of the study. During the procedure, the table will be inside the device, but the person always has the opportunity to communicate with the technician in the other room if there are any questions or worsen the condition. In the same way, the patient will receive instructions from the doctor.

During the examination of bones and joints a person should remain immobile during the whole procedure, and this is not less than 15-20 minutes. Excessively excitable patients and children are recommended before the procedure to sedate (taking sedatives). It is also possible to fix certain parts of the body with the straps provided for this purpose.

The most difficult procedure for finding in an enclosed space of the device is carried by people with claustrophobia. They are recommended to be preset in a drug-induced sleep, which will avoid panic and movements.

If an MRI of the shoulder joint is performed with contrast, the patient will be given a contrast agent in advance. In the study of the structures of the shoulder, we are talking about intravenous injection. After a few minutes, you can carry out diagnostic procedures.

What does the MRI of the shoulder joint show?

Magnetic resonance imaging is a unique method of obtaining the hidden information within the body, which is necessary for an accurate diagnosis. Quite often, laboratory tests, physical examinations and patients' complaints of pain and limited movements in the shoulder do not provide enough information for a specialist to understand which pathology causes the appearance of such symptoms. Only more accurate and specific information on the condition of the shoulder joint, the nature of its damage and even the degree of development of the pathological process can only instrumental studies.

The patient is prescribed one of the research methods: radiography, ultrasound, computed tomography, magnetic resonance imaging. Sometimes these studies are appointed in a complex. The urgency of such diagnostics is especially visible when it comes to the simultaneous damage of various joint structures.

But to study the shoulder joint the most safe and informative technique is Magnetic Resonance Imaging (MRI). This is a non-invasive and painless method of obtaining information about the internal structures of a person without the use of dangerous ionizing radiation.

The previously popular X-ray diagnosis is not only dangerous in itself due to the use of X-rays related to ionizing radiation, but also does not provide enough information about soft tissues in the shoulder girdle. But MRT in addition to hard tissues allows you to visualize soft tissue structures: muscles, ligaments, tendons, cartilage, synovial joint bag. Any changes in them (breaks and cracks in the tendons, changes in the shape and density of various tissues, fractures of the bones, the appearance of unusual tumors, etc.) can be seen on the computer screen, to which the tomograph transmits information. MRI also makes it possible to diagnose the pathology of the nerves and blood vessels of the shoulder.

The doctor gets the opportunity not only to distinguish inflammatory-degenerative changes in structures from fractures and strains, but also to establish the nature of these changes, and also to say how serious the situation is and what methods of treatment in this case will prove to be most effective.

If surgical treatment is required, after it is carried out it is useful to do a repeated MRI of the shoulder joint. This will help the surgeon understand whether he did everything correctly, whether additional operations are required and, if possible, prescribe further treatment.

It should be said that ultrasound also provides sufficient information about the state of soft tissue, but MRI is considered more informative, since it allows to record the slightest pathological changes in soft and hard tissues, which makes it possible to diagnose the disease at an early stage. And when it comes to tumor processes, this moment is vitally important. At the same time visualization of bone tissue on MRI is more detailed than on ultrasound.

If there is a question about what is better than CT or MRI of the shoulder joint, one must understand that, despite the high information value of both methods, each of the techniques has its pros and cons. For example, MRI gives more information about soft tissue damage, while a computer tomogram is more informative when it comes to bone pathologies.

In principle, both CT and MRI give the doctor enough information to diagnose various pathologies of the shoulder girdle. But it must be taken into account that X-rays are used during computed tomography, which means that this study can be considered less safe than MRI. This is especially important when the diagnosis is prescribed to children.

Contraindications to the procedure

Although the MRI of the shoulder joint is considered the safest method for diagnosing shoulder diseases, like any other technique, it has its contraindications. It should be noted that there are few such contraindications, and most of them are related to metal implants.

Recalling information on the properties of metals from the school course of physics, it can be understood that the most dangerous are the interactions of the magnetic field with ferromagnets. Metals, called dia- and paramagnets interact with a magnetic field are much weaker, therefore they are considered to be practically safe.

Ferromagnets actively interacting with the field of a tomograph are capable of changing the field itself, heating up under its influence, changing its shape, etc. This is unacceptable, both from the point of view of the distortion of the readings of the device for MRI (this determines the accuracy of the diagnosis) and because heated metal can lead to tissue burns, and changes in its shape will not allow the implant to perform the function assigned to it. From this, again depends on health, and sometimes the life of the patient.

The MRI procedure can not be performed if there are:

• Prostheses of the inner ear (cochlear implants, which are original hearing aids),
• vascular clips (especially in the head region),
• metal stents in the blood vessels,
• artificial heart valves,
• implanted pumps (insulin pump),
• prosthetic joints and bones made of metal,
• nerve stimulators,
• pins, screws, surgical staples, shell fragments and other small items,
• non-removable metal dentures and seals
• tattoo with the use of materials (colorants) containing ferromagnetic particles.

Not all the devices and objects described above interact with the magnetic field. We are talking about ferromagnetic implants. It is best if the patient learns in advance from which material the device is inserted into his body.

Small metal parts help to identify radiography. Therefore, do not neglect this method of research on the eve of the MRI, especially if there are doubts.

The magnetic field has an effect on electronic devices. Therefore, the presence of an implanted pacemaker and other electronic devices, on whose work human life depends, is also considered a contraindication to MRI.

It is believed that such a safe technique as MRI can worsen the condition of patients with heart failure in the stage of decompensation. The decision on the possibility of research in these patients is made by a cardiologist. In the acute stage of the disease, such manipulations should be abandoned.

It is not advisable to perform MRI during pregnancy, but since it is only the upper body, and this technique is considered the most safe, if necessary, the diagnosis is still conducted in open-circuit devices. If there is absolutely no need for diagnosis, it is better to wait until the birth of the child.

MRI of the shoulder joint with contrast, allowing to detect tumor processes at different stages of their development and to assess the state of blood vessels, it is not prescribed for various thickening of the skin, kidney pathology (after all, the contrast is excreted from the body with their help), asthmatic status, blood diseases. It is undesirable to introduce contrast during pregnancy (especially in the first trimester) and breastfeeding. In the latter case, a woman for a while will have to give up breastfeeding.

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Normal performance

Conducting MRI-diagnostics is constructed in such a way as to avoid the negative consequences of the device as much as possible. For example, the device is equipped with a speakerphone and all the unpleasant sensations the researcher can notify the doctor at a distance right during the diagnosis. So in a device with a closed circuit, a person may begin to experience anxiety, a feeling of lack of air, etc. May appear. Usually it is enough just to calm the patient, to carry out the procedure to the end. But in some cases the study can even be interrupted.

During the procedure, the examinee is under the control of a doctor and relatives, who are allowed to be present during the diagnosis as support.

The scanners have a small drawback. In the course of work, they emit a noticeable noise, which can irritate the patient's hearing. To avoid this, examinees are given earplugs or headphones. During the MRI procedure of the shoulder joint, they can listen to light music or enjoy silence.

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Complications after the procedure

No complications after the MRI procedure are usually observed. An exception are situations where a person did not know about finding metal objects in the body or deliberately concealed it. There have been cases of skin burns and people with tattoos made using metal-containing paints.

Ferromagnetic implants under the influence of a magnetic field can theoretically shift from a place and be heated, but usually the temperature of heating is relatively low, and the implants themselves are attached very firmly, and it is unlikely that the scanner will be able to move them from their seats.

Some unpleasant sensations can accompany patients during MRI with contrast. This skin irritation, the appearance of a slight itch, a slight decrease in blood pressure. But only two out of a hundred patients complain of similar side effects from the use of contrast agents. Usually it is about intolerance of the contrast itself.

Patients may also complain of a slight nausea and headaches. But these symptoms are also not related to the effect of the magnetic field. This is a reaction to chemicals (contrasts). If you avoid eating food and drinks on the eve of the procedure, nausea usually does not appear. And the headache passes quickly enough, but if necessary, you can take analgesics.

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Care after the procedure

Attractive MRI diagnosis of the shoulder joint and the fact that no care after the procedure is required, because the technique does not involve a violation of the integrity of tissues or interference in the work of the body. It is enough for the patient to fulfill the doctor's prescriptions, if necessary, to undergo surgical treatment and not to neglect the restorative procedures in order to solve the problem, which triggered the doctor's appointment.

[21], [22]