hi it's dr. Centeno and today I'd like to teach you how to read your shoulder MRI the top three things to know so this video isn't meant as a substitute for a radiology report or your doctor's opinion but just to empower you to read your own MRI to learn more about your shoulder because we at regenexx believe that empowered patients that understand what's going on are actually very important to the process so an MRI is a 3d picture that slices through the shoulder and three planes sagittal coronal and axial and this is what happens you're literally just like slicing through this tomato you're slicing through the structures so in order to understand what's my number I you have to realize that that's what's happening and these are three planes I'm talking about here you've got the coronal plane which is looking from the front you've got the sagittal plane which is looking from the side and you've got the Celje in half view here which is kind of sort of looking down on a structure and you want the coronal image which may be labeled cor or something like that but that's the one you're going to want to pull up because that's the easiest one to understand the other ones are a little harder to understand and you see here in this coronal image you can see this is the main shoulder joint and I'll go over this again this is the rotator cuff coming in this way and attaching to the bone this is the humerus bone here and up in this area you'll see the AC joint on other images so these are the structures you're going to be looking at so just to get a sense of it from the top here you see your collarbone coming in you see the scapula here or the shoulder blade you see the main shoulder joint and you see the rotator cuff coming across from front you're going to also see the humerus bone here the subscapularis which is part of the rotator cuff the collarbone up here and from the back you're going to see the Terry's and infraspinatus muscle is coming across here which are part of the back part of the rotator cuff and the supraspinatus coming across here which is the top part of the rotator cuff and then the ACL or bone and a part of the scapula so the AC joint or acromioclavicular so I'm now going to go over the top three areas on this view that you should pay attention to the first one being the AC joint which is that joint we just talked about the joint between the collarbone and the scapula the second one being the rotator cuff everybody talks about the rotator cuff the third one being the main shoulder joint itself so as far as the AC joint it's small well you want to know is it small and straight sort of like this one so a small AC joint you can see here the collarbone coming across and the other part just the front part of the scapula is all you're seeing here but you see a clear joint in the middle or is it sort of big and distorted more like this one over here or even bigger that's important because as you can see the rotator cuff comes right under the AC joint and it can put pressure on the AC joint can put pressure on the rotator cuff and so that could be an area of impingement but again is this joint small and straight or bigger and distorted if it's bigger and distorted it means it has some arthritis second main area to look at is the rotator cuff itself is it smooth and continuous are there light spots or large areas of white so you see a normal rotator cuff supraspinatus tendon coming through here nice and smooth and it attaches there this is a slight little area of white right there but for the most part that looks pretty normale now if you go over to the right side here this looks completely different you've got these large sections of white here and those large sections of white or fluid that's big swelling of the joint and then if you try to follow the rotator cuff tendon all the way over you really can't you start to lose it here and then it doesn't attach here so those are two big tears so that's how you can get some sense of what a tear and the rotator cuff looks like now is the tendon uniform in color or splotchy well it might not be torn and retracted like the one you just saw sort of like a rubber band that snaps it might have other tears called degenerative tears in it so you can see here this section of the rotator cuff is nice and dark but then we get to this section and it looks kind of bright and light colored and when we look over here at this one off to the right all of this area in here should be nice and dark but instead it's bright so it means there's some tearing and some degeneration in that rotator cuff tendon and then the shoulder joint is the final piece again the main shoulder joint is down here and really what you're looking for here are sort of is a sandwich of grey cartilage so you want to be able to say that you have this grey cartilage right on top of the bone here and on the other side so realize this is a ball-and-socket joint and you want to have grey cartilage on both sides of that joint here you can see off to the right now that this joint looks quite different we see large areas of white inside the joint and only this one area right here actually has some grey and you can see that the size of the joint is quite different than the one over here the one on the left has a good space between the bone between the humerus bone or the ball and the socket joint over here but this one doesn't have much space between those two so it's our thrid ik and it's lost cartilage now let's go read an image so this is our shoulder joint image we picked the coronal you can see the coronal here pretty clearly I'm going to scan through this coronal image now so you can get some sense of what that looks like so as I scan through it or I just move my mouse I'm going to see the rotator cuff coming in here pretty clearly I'm going to see the main shoulder joint right in here and as I go back a little bit I will see the AC joint so that's our one two three the AC joint the rotator cuff and then the big big shoulder joint right here now you can see that this gentleman actually does have a reasonable amount of cartilage left in here although it's a little bit thin and over here you can see that he also has a pretty good rotator cuff tendon but you can see a little bit of misshapen AC joint here putting some pressure on the top of the supraspinatus tendon or the rotator cuff but as we look at the quality of the rotator cuff tendon itself it's not bad this area out here and the tendon is dark this area over here is appropriately gray we don't see any major tears in that tendon he's got a little bit of arthritis in the AC joint and down here and the main shoulder joint that looks pretty good one of the things that you do notice is that and this is a little bit more complex is that this humerus bone is riding a bit high but outside of that there's still cartilage left in the joint although it's thinning so that that gives you some sense of how to read an MRI a patient that understands what's wrong with them is important so if you want more information go to regenx comm that's our EG en e XX comm thank you so much for watching