Shoulder MRI — rotator cuff tear

A rotator cuff tear is one of the most common shoulder conditions in adults. MRI is the gold standard for diagnosis — it shows tendon damage with millimetre precision.

Anatomy of the rotator cuff

The rotator cuff consists of four muscles and their tendons:

• The supraspinatus muscle — the most commonly injured (approx. 70% of cases)
• Infraspinatus muscle — external rotation
• Teres minor muscle — external rotation
• Subscapularis muscle — internal rotation

Classification of injuries

Indications for shoulder MRI

• Shoulder pain lasting >6 weeks despite conservative treatment
• Limited range of motion
• Clicking/cracking during movement
• Weakness (Jobe’s test, Hawkins’ test)
• Following injury (fall, strain)
• Athletes (tennis, basketball, swimming, hockey)
• Before planned surgery

What an MRI of the shoulder shows

The standard APERTA protocol for the shoulder includes:

• T1 sagittal — anatomy, muscle atrophy
• T2 fat-saturated oblique coronal — rotator cuff lesions (gold standard)
• PD fat-saturated axial — cartilage, labrum
• T2 sagittal — subacromial space

MR arthrography of the shoulder — when required

MRI arthrography (MRA) with gadolinium injection into the joint is performed in cases of:

• Suspected labral tear (SLAP, Bankart)
• Shoulder instability
• Small partial rotator cuff tears not visible on standard MRI
• Overhead athletes

After an MRI — what next?

The shoulder MRI results will be interpreted by:

1. Orthopaedic surgeon — decision on conservative vs surgical treatment
2. Physiotherapist — a rehabilitation programme tailored to the injury
3. Orthopaedic surgeon — if arthroscopy is indicated