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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Practice Cases
Worklist 1
10 topics, 45 min.
Practice Cases
Worklist 2
10 topics, 18 min.
Practice Cases
Worklist 3
10 topics, 21 min.
Practice Cases
Worklist 4
10 topics, 41 min.
Practice Cases
Worklist 5
10 topics, 24 min.
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
HIDEInteractive Transcript
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
Tags
Shoulder
Musculoskeletal (MSK)
MRI
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