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Performing and interpreting MRI of the shoulder in patients after surgery is a difficult task. The normal anatomic features are distorted by the surgical alterations as well as the artifacts that result from metal and other materials used in the surgical procedures. This article reviews the common surgical procedures undertaken in patients with rotator cuff disease and shoulder instability, and how they affect the appearance of the relevant anatomic structures on MRI examination. It also reviews the more common causes for residual and recurrent abnormalities seen in such patients and how MRI can be used to diagnose such lesions, thus aiding the orthopedic surgeon in treating these difficult clinical problems.

Now in its Second Edition, this resident-friendly reference explains the basics of MRI...then walks readers easily through the radiologic evaluation of shoulder disorders, particularly rotator cuff disease and shoulder instability. Written in an inviting, easy-to-follow style and illustrated with more than 600 scans, this long-awaited new edition will be a favorite practical reference for residents, practicing radiologists, and orthopaedic surgeons. The book features contributions from expert radiologists and orthopaedic surgeons. Chapters review MRI techniques and shoulder anatomy, describe and illustrate MRI findings for a wide variety of conditions, and explain how abnormalities seen on MR images relate to pathophysiology and clinical signs.

Imaging serves an important role in the diagnosis and classification of Kienböck’s disease. The four-stage system proposed by Lichtman et al. in 1977 is an imaging-based classification system, which has significant implications for treatment planning. Whereas the initially proposed Lichtman classification was based primarily on radiographical osseous findings, advancements in the understanding of computed tomography (CT) and magnetic resonance imaging (MRI) features of Kienböck’s disease have allowed incorporation of these two modalities into the classification system. The appearance of imaging features of Kienböck’s disease mirrors the natural course of the disease—progressing from marrow edema of the lunate (stage I) to trabecular sclerosis (stage II), to lunate collapse (stage III), and ultimately to secondary degenerative changes of the wrist. MRI has proven to be useful for the detection of early Kienböck’s disease, which is frequently not demonstrated on radiography and CT. It is also useful for assessing and staging the articular cartilage involvement and monitoring the revascularization and response to treatment. This chapter discusses the diagnostic criteria and imaging features of Kienböck’s disease. It utilizes the Lichtman classification as a framework in this description. A comparison of the utility of the various imaging modalities and a discussion of the differential diagnoses for Kienböck’s disease are also included.