Antero-superior Impingement (ASI) is a form of “ internal impingement “ that happens with an adducted and intrarotated arm,
and sometimes when the arm is simultaneously elevated over 90°,
among the anterior part of the rotator cuff,
the humeral head,
the anterosuperior glenoid labrum and the glenoid edge.
ASI is responsible of an anterior pain felt with “ follow-through “ movements.
The purpose of our study was to evaluate the diagnostic possibilities of MR arthrography for correctly identifying complex tears of the biceps pulley and...
Methods and Materials
We retrospectively reviewed and analyzed arthro-MRI exams of 23 patients (20 males and 3 females) who underwent arthro-MRI exam with a 1.5 Tesla unit and arthroscopy within successive 7-45 days.
All patients were athletes with clinically suspected of biceps pulley damage; they were positive to Palm-up,
O’Brien and Hawkins tests.
the shoulder was studied with dedicated coil with the arm in neutral position,
in internal and external rotation.
ABER position was used in 2 patients.
Intra-articular injection of 13-18 cc of contrast agent...
Images showed a spectrum of tears involving the biceps pulley complex and were subdivided into four groups according to the Habermeyer classification: 3 patients had superior gleno-humeral ligament (SGHL) tear (Type I) (Fig.1),
5 patients had SGHL and supraspinatus tendon (SSP) tears (Type II) (Fig.
7 patients SGHL and subscapularis tendon (SSC) tears (Type III) (Fig.
3) and 8 patients SGHL,
SSP and SSC tears (Type IV) (Fig.4).
Arthroscopic evaluation demonstrated that 1 patient had Type I,
5 patients Type II,
5 patients Type...
ASI was associated with more or less extensive tears of the biceps pulley.
Habermeyer first described the combination of these tears with arthroscopy.
According to this classification we propose an initial diagnosis with a Type I,
III and IV pattern.
Arthroscopic findings matched the proposed initial diagnosis as shown in Table 1.
Arthro-MRI can provide complete depiction of the rotator cuff,
the biceps pulley and the anterior tendinous components of the rotator cuff; its limits are mainly related to the low specificity in the...
Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study.
J Shoulder Elbow Surg.
Impingement of the deep surface of the subscapularis tendon and the reflection pulley on the anterosuperior glenoid rim: a preliminary report.
J Shoulder Elbow Surg 2000;9:483-90.
Anterior internal impingement: an arthroscopic observation.
Anatomy and function of the tendon of...