0:00

All right, this is a 21-year-old man with left shoulder pain.

0:05

He is a weightlifter, and as you can

0:08

see, there is on this axial sequence.

0:13

Proton density with fat suppression, we see a difference

0:18

in the signal intensity emanating from the marrow of

0:22

the acromial process as compared to the distal clavicle.

0:27

So there is bone marrow edema pattern involving

0:31

the distal clavicle with associated edema

0:36

of the acromioclavicular joint capsule.

0:39

On the coronal images, these are T2 fat suppressed

0:43

images, again, the difference in the signal

0:48

intensity emanating from the marrow is apparent.

0:51

The acromial process is normal, similar marrow

0:55

signal as we notice in the proximal humeral

0:59

head, but the distal clavicle has increased.

1:04

T2-weighted signal in keeping with marrow edema.

1:07

So marrow edema pattern also in the oblique sagittal

1:11

images with associated small acromioclavicular

1:15

joint effusion, and capsular sprain.

1:20

There is a low-grade acromioclavicular

1:22

joint capsule sprain in this setting.

1:26

So we have findings compatible with posttraumatic

1:30

distal clavicle osteolysis in a patient who also

1:35

has a grade 1 acromioclavicular joint sprain.

1:40

Looking at this patient's superior labrum, which

1:43

is an area that can be involved in young athletes

1:50

who do weightlifting and overhead activities.

1:56

The superior labrum appears to be completely intact.

2:01

So in summary, grade 1 acromioclavicular joint

2:06

separation plus distal clavicle osteolysis

2:10

with marrow edema pattern in that location.

Wk 1, Case 4 - Review

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0:00

All right, this is a 21-year-old man with left shoulder pain.

0:05

He is a weightlifter, and as you can

0:08

see, there is on this axial sequence.

0:13

Proton density with fat suppression, we see a difference

0:18

in the signal intensity emanating from the marrow of

0:22

the acromial process as compared to the distal clavicle.

0:27

So there is bone marrow edema pattern involving

0:31

the distal clavicle with associated edema

0:36

of the acromioclavicular joint capsule.

0:39

On the coronal images, these are T2 fat suppressed

0:43

images, again, the difference in the signal

0:48

intensity emanating from the marrow is apparent.

0:51

The acromial process is normal, similar marrow

0:55

signal as we notice in the proximal humeral

0:59

head, but the distal clavicle has increased.

1:04

T2-weighted signal in keeping with marrow edema.

1:07

So marrow edema pattern also in the oblique sagittal

1:11

images with associated small acromioclavicular

1:15

joint effusion, and capsular sprain.

1:20

There is a low-grade acromioclavicular

1:22

joint capsule sprain in this setting.

1:26

So we have findings compatible with posttraumatic

1:30

distal clavicle osteolysis in a patient who also

1:35

has a grade 1 acromioclavicular joint sprain.

1:40

Looking at this patient's superior labrum, which

1:43

is an area that can be involved in young athletes

1:50

who do weightlifting and overhead activities.

1:56

The superior labrum appears to be completely intact.

2:01

So in summary, grade 1 acromioclavicular joint

2:06

separation plus distal clavicle osteolysis

2:10

with marrow edema pattern in that location.

Report

Patient History
21-year-old man with left shoulder pain.

Findings
ROTATOR CUFF:
Supraspinatus: Intact.

Infraspinatus: Intact.

Subscapularis: Intact.

Teres minor: Intact.

Biceps tendon and anchor: Small fluid collection along the bicipital groove. Mild tenosynovial thickening proximally. No subluxation/medialization.

ACROMIOCLAVICULAR JOINT: Capsulosynovial thickening with diffuse high-signal edema. Mild surrounding soft tissue high-signal edema/inflammation. Low-grade distal clavicular periarticular osteoedema/stress reaction. Mild diastasis. Intact acromioclavicular ligaments and capsule. No periarticular erosive change or arthropathic cyst formation.

CORACOCLAVICULAR LIGAMENTS: Intact and unremarkable in appearance.

SUBACROMIAL ARCH/OUTLET: No convincing evidence of active lateral outlet impingement.

SUBACROMIAL/SUBDELTOID BURSA: Unremarkable.

GLENOHUMERAL JOINT: No glenoid dysplasia, retroversion, or humeral head decentering. No effusion, capsulosynovial thickening, or intra-articular loose body. No high-grade chondromalacia of the glenohumeral articular surfaces.

GLENOID LABRUM: No traumatic or displaced labral tear.

BONES: Distal clavicular periarticular low-grade osteoedema. No other abnormal marrow edema. No micro- or macro-trabecular fracture or contusion. No focal or aggressive osseous abnormality.

MUSCLES: Diffuse global muscular prominence/muscle hypertrophy. No muscle edema/strain, atrophy, or fatty infiltration.

SOFT TISSUE: Unremarkable.

AXILLA: Unremarkable.

Impressions
1. Acromioclavicular joint capsulosynovial thickening with active capsulitis and stress-related osteoedema of the distal clavicle. In the absence of trauma, favor chronic stress/overuse and microinstability syndrome in an athletic individual. Less likely low-grade acromioclavicular joint sprain (grade 1).
2. Low grade proximal biceps peritendinitis.

Case Discussion

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Jenny T Bencardino, MD

Vice-Chair, Academic Affairs Department of Radiology

Montefiore Radiology

Edward Smitaman, MD

Clinical Associate Professor

University of California San Diego

Practice Cases

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Practice Cases

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Practice Cases

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Practice Cases

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Wk 1, Case 4 - Review