title: Lesions of the biceps pulley as cause of anterosuperior impingement of the shoulder in the athlete: potentials and limits of MR arthrography compared with arthroscopy.
abstract: OBJECTIVE
  This study aimed to evaluate the diagnostic possibilities of MR arthrography in the correct identification of complex tears of the biceps pulley and their possible correlation with anterosuperior impingement (ASI) development.
  
  
  METHODS
  MR arthrography examinations of 23 athletes with clinical suspicion of ASI were reviewed. All examinations were obtained with a 1.5-T unit (Signa Horizon, GE Healthcare). The shoulders were studied with a dedicated surface coil with the patient's arm in the neutral position and in internal and external rotation. In five patients, images in abduction-external rotation (ABER) were obtained. Within 2 month after MR arthrography, the athletes underwent arthroscopic surgery.
  
  
  RESULTS
  MR arthrography images showed a spectrum of tears that, according to the Habermeyer classification, were subdivided into four groups: type 1 in three patients; type 2 in five; type 3 in seven; type 4 in eight. At arthroscopic evaluation, one patient presented type 1 lesion, five type 2, five type 3 and ten type 4. During arthroscopic dynamic manoeuvres, ASI signs were observed in three patients with type 3 lesion and in ten with type 4 lesion.
  
  
  CONCLUSIONS
  MR arthrography is the imaging modality of choice for evaluating lesions of the rotator interval structures, and only complex lesions of the biceps pulley are related to the development of ASI.
authors: Dipartimento di Radiodiagnostica, Università degli Studi di L'Aquila, Ospedale S. Salvatore di Coppito, 67100, L'Aquila, Italy. abarile63@me.com
authors: A
authors: A
authors: Barile
authors: G
authors: G
authors: Lanni
authors: L
authors: L
authors: Conti
authors: S
authors: S
authors: Mariani
authors: V
authors: V
authors: Calvisi
authors: A
authors: A
authors: Castagna
authors: F
authors: F
authors: Rossi
authors: C
authors: C
authors: Masciocchi
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D001265:Athletic Injuries / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D019534:Shoulder Impingement Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D013708:Tendon Injuries / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery