This composite diagnostic image features four MRI views (A-D) of a human shoulder, illustrating advanced degenerative joint disease and rotator cuff pathology. Panels A and B are axial and coronal sections showing a massive rotator cuff tear accompanied by severe muscle atrophy. Black arrows indicate fatty infiltration and volume loss in the supraspinatus, infraspinatus, and subscapularis muscles. Panel C highlights the acromioclavicular (AC) joint with white arrows pointing to osteoarthritic changes, including joint space narrowing and subchondral irregularities. Panel D is a T2-weighted MRI demonstrating a 'Geyser sign' (white arrowhead), where a large synovial cyst communicates directly with a markedly degenerated glenohumeral joint through a full-thickness rotator cuff defect. The images collectively demonstrate the progression of chronic rotator cuff insufficiency leading to secondary osteoarthritis and superior joint fluid leakage. This material is suitable for orthopedic and radiology education regarding shoulder instability and end-stage cuff tear arthropathy.

This composite figure presents three MRI views of a right shoulder, illustrating end-stage rotator cuff arthropathy and its secondary manifestations.

This diagnostic image consists of two side-by-side sagittal T1-weighted MRI scans of the shoulder, illustrating the differences between healthy rotator cuff musculature and a chronic massive rotator cuff tear. Panel A shows a healthy shoulder: a black arrow identifies the supraspinatus muscle belly with characteristic low signal intensity (dark appearance); a red arrow indicates hyperintense (bright) subcutaneous fat; and a blue arrow marks the body of the scapula. Panel B demonstrates pathological changes associated with a chronic, massive rotator cuff tear. A white arrow highlights significant fatty infiltration and muscle atrophy within the supraspinatus. In this pathological state, the muscle tissue exhibits a high signal intensity similar to the surrounding subcutaneous fat, indicating replacement of muscle fibers with adipose tissue. This comparison is clinically significant for diagnosing Goutallier stages of fatty degeneration in musculoskeletal radiology and orthopedics, helping to assess the prognosis and surgical reparability of chronic rotator cuff injuries.

This composite figure illustrates the preoperative, intraoperative, and postoperative findings of a complex rotator cuff tear in a left shoulder. Panel 1 is an anteroposterior radiograph demonstrating an elevated acromion, often indicative of chronic rotator cuff pathology. Panels 2 and 3 provide preoperative T2-weighted MRI scans in oblique and transverse planes, respectively; Panel 2 shows a supraspinatus tendon tear with Patte stage 2 retraction, while Panel 3 exhibits mixed hyperintensities within the joint space. Panel 4 presents an intraoperative arthroscopic view confirming a Lafosse I injury of the superior third of the subscapularis tendon. Panel 5 is a follow-up T2-weighted MRI showing successful surgical intervention, characterized by a suture anchor visible in the greater tuberosity of the humerus and evidence of continuous supraspinatus tendon healing. This sequence highlights the diagnostic pathway from radiography and MRI to arthroscopic confirmation and subsequent postoperative evaluation of rotator cuff repair using suture anchors.

This diagnostic imaging composite displays two T2-weighted magnetic resonance imaging (MRI) views of a right shoulder joint, specifically demonstrating an intrasubstance rotator cuff tear. Figure (a) is a coronal T2 Turbo Spin Echo (TSE) Fat-Saturated (FS) image, showing the glenohumeral joint and the supraspinatus tendon. A white arrow indicates a localized area of high signal intensity within the tendon substance, which does not communicate with the bursal or articular surfaces. Figure (b) is a sagittal T2 TSE FS image of the same shoulder, providing a cross-sectional view of the rotator cuff muscles and tendons. The arrow in this view confirms the high-intensity fluid signal within the tendon mid-substance, characteristic of a high-grade partial-thickness intrasubstance tear. Key anatomical structures visible include the humeral head, glenoid, and the rotator cuff complex. These images are used in orthopedics and radiology to differentiate intrasubstance tears from articular-sided or bursal-sided partial tears, which is critical for determining surgical versus non-operative management strategies like PRP injections.

A multi-panel medical image sequence illustrating the diagnosis and surgical repair of a rotator cuff injury. (A) Coronal T2-weighted MRI of the shoulder showing an Ellman III partial articular-sided supraspinatus tendon tear, characterized by a focal high-signal defect at the tendon's footprint. (B) Intraoperative arthroscopic view from the glenohumeral joint confirming the partial articular-sided supraspinatus tendon tear with visible tissue fraying and hyperemia. (C) Intraoperative arthroscopic view demonstrating the surgical intervention, where purple and braided sutures are introduced through the tendon into the joint space as part of a trans-tendon repair technique. (D) Postoperative coronal T2-weighted MRI showing a restored tendon footprint with resolved signal intensity defects, indicating a successful rotator cuff repair. A hypointense linear artifact in the humeral head suggests the presence of a suture anchor. This sequence is intended for orthopedic education, specifically focusing on the management of partial-thickness rotator cuff tears through arthroscopic techniques.