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MRI SYNOVITIS SPECIFIC SITES IN THE SHOULDER: THE INFERIOR GLENOHUMERAL LIGAMENT IGHL
INFERIOR GLENOHUMERAL LIGAMENT IGHL CAPSULO SYNOVITIS
MRI Capsulo Synovitis IGHL. At our MRI workshops we have an Open Mic policy. People are encouraged to interrupt and ask questions at any time because its best to clear doubts at the time topics are being discussed rather than wait till the end or never get to asking it at all.
One of the more consistent questions is about synovitis in the shoulder where certain sites are specifically involved but don’t have the typical appearance of synovitis we discussed in a previous post The Many Faces of Synovitis.
So, on MRI where do you look and what do you look for in Capsulo Synovitis in the Shoulder. In the shoulder there are two specific areas affected which are really a mixture of synovitis and capsulitis:
- The Inferior Gleno Humeral Ligament (IGHL) and,
- The Rotator Interval.
LET'S LOOK AT THE IGHL IN THIS POST
WHAT IS THE NORMAL APPEARANCE OF THE IGHL
The IGHL, is normally black on PD and PDFS scans and is relatively thin.
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Image above: Yellow arrows normal IGHL low signal on PD. Normal thickness.
WHAT HAPPENS WITH CAPSULO SYNOVITIS?
With capsulitis/synovitis, the IGHL thickens and becomes hyper-intense on the PD and PDFS scans.
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WHAT DOESÂ IGHL THICKENING LOOK LIKE
Image above: Diffuse thickening and increased PD signal of the IGHL (yellow arrows).
WHAT DOES IGHL HYPERINTENSITY LOOK LIKE
Image Above: Thickened IGHL with significant increase in signal on the PDFS image (first image). On the second PD non-fat scan the IGHL is hyperintense (as it should be normally black) but it stands out more on PDFS.
WHAT IS THE BEST SEQUENCE AND PLANE TO ASSESS IGHL CAPSULO SYNOVITIS ON
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- Whilst you can see it on axial scans IGHL capsulo- synovitis is best assessed on Coronal Scans.
- The easiest sequence to recognize the hyper-intensity is the PDFS scan and the thickening is best seen on non fat saturated PD scans.
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