Rotator Cuff
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MRI SHOULDER: FATTY INFILTRATION AND ATROPHY IN ROTATOR CUFF TEARS
FATTY INFILTRATION & ATROPHY IN ROTATOR CUFF TEARS
INTRODUCTION
When assessing rotator cuff tears on MRI, it’s important to look beyond the tendon itself. Two findings that must be assessed and included in every report are:
- Muscle atrophy
- Fatty infiltration
Both significantly influence surgical decision-making and patient outcomes.
Each finding can occur independent of the other.
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ATROPHY ON MRI
- Seen as loss of muscle bulk/ volume.
- There are grading systems but it’s easier to visually assess. If want to read more on this look at this article at this LINK
FATTY INFILTRATION ON MRI
- Appears as high-signal within the muscle on T1-weighted sequences.
- A small amount is normal, but large chronic tears may show near-complete replacement of muscle by fat.
- Comparing with an adjacent normal muscle helps illustrate the difference between normal and pathologic amounts of fat.
KEY POINT
Fatty infiltration = replacement of muscle fibers by fat, seen as increased T1 signal.
WHY THESE FINDINGS MATTER
- Both atrophy and fatty infiltration predict poorer surgical outcomes.
- High-grade changes often mean tendon repair is not feasible.
CONCLUSION
Rotator cuff tear evaluation on MRI must include assessment of both muscle atrophy and fatty infiltration. These findings are important prognostic indicators that directly affect surgical planning.
Play Video about MRI shoulder showing supraspinatus muscle atrophy and fatty infiltration.
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Rotator Cuff