Shoulder MRI protocol
The most mobile joint, and the least stable. You are hunting rotator-cuff and labral tears, and success comes down to two things: getting the shoulder into the magnet's isocentre, and planning the oblique views along the tendon.
By the ScanFlo Editorial Team · Updated
In this section · Protocols
When this study is used
- Rotator-cuff tear, impingement or shoulder pain.
- Suspected labral tear or instability after dislocation.
- Assessment of muscle atrophy in chronic cuff disease.
Patient & coil positioning
- Head-first supine; shift the body 2–3 inches toward the unaffected side so the examined shoulder sits at the magnet's isocentre. An off-centre shoulder fails fat suppression.
- Arm neutral, thumb up (palm to thigh), small wedge at the elbow; internal rotation curves the supraspinatus and hides tears.
- Depress the shoulder ('relax it toward your feet, don't shrug'); strap across the chest and sandbag the opposite side against roll.
- Dedicated shoulder array coil centred over the palpated acromion.
Localizer
Three-plane localizer. Axial from the AC joint to the axillary pouch; coronal from the scapular body to the deltoid. The obliques are then planned off the axial.
Sequence planning
For each sequence below you get the reference line the slice group follows, how much it covers, and why the sequence is in the protocol at all. Plan against the localizer, not by eye.
Oblique coronal PD fat-sat
Oblique coronalPlanning: Parallel to the supraspinatus tendon (or the flat scapular body) on the axial. Coracoid to scapular spine. This elongates the tendon from insertion to muscle belly.
Why: The money view for rotator-cuff tears; fluid cutting the black tendon.
Oblique sagittal PD/T2 fat-sat
Oblique sagittalPlanning: Perpendicular to the glenoid on the axial. Deltoid to scapular notch. This is the 'Y-view' of coracoid, acromion and scapula.
Why: Acromion shape (impingement) and the cuff footprint.
Axial PD fat-sat
AxialPlanning: Perpendicular to the glenoid face on the coronal; above the AC joint to below the axillary pouch.
Why: Anterior and posterior labrum (Bankart), biceps tendon in the groove.
Oblique coronal T1
Oblique coronalPlanning: Same plane as the PD.
Why: Muscle atrophy (fatty streaks) marking a chronic tear; bone anatomy.
Representative parameters
Treat these as ranges. Field strength, coil and vendor all move the numbers. What must not move is understanding why each sits where it does.
| Sequence | Field | Matrix / FOV | Notes |
|---|---|---|---|
| PD fat-sat | 1.5–3 T | 320–384 / 14–16 cm | Cuff and labrum |
| T2 fat-sat | 1.5–3 T | 320 / 14–16 cm | Confirms tears (fluid) |
| T1 | 1.5–3 T | 320 / 14–16 cm | Atrophy, anatomy |
| T1 fat-sat (arthrogram) | 1.5–3 T | 320 / 14 cm | If intra-articular contrast given |
Artifacts & how to fix them
| Artifact | Typical cause | Mitigation |
|---|---|---|
| Failed fat-sat | Shoulder off isocentre | Shift the body toward the unaffected side; re-shim |
| Wrap / ghost arm | Chest wall or opposite arm in phase FOV | Swap phase to AP; oversampling; oblique sat band |
| Magic angle | Tendon at 55° looks torn on PD | Compare with T2 (long TE); artefact fades if normal |
| Breathing motion | Chest-wall respiration | Tighten chest strap; shallow belly-breathing; bellows |
What am I looking at?
You are not reporting the study, but recognising pathology helps you keep it in the field of view and know when to add a sequence or contrast. How the common findings read on the console:
| Finding | Sequence to check | How it reads |
|---|---|---|
| Rotator-cuff tear | Oblique coronal PD FS | Bright fluid cutting the black tendon; retraction = full rupture |
| Labral tear (Bankart) | Axial PD FS | The black glenoid triangle detached or missing |
| Hill–Sachs lesion | Axial (top slices) | Wedge dent in the posterolateral humeral head |
| Chronic tear | Oblique coronal T1 | Fatty streaks of muscle atrophy |
Review checklist
- Shoulder at isocentre; fat suppression uniform.
- Supraspinatus profiled full-length on the oblique coronal.
- Y-view acromion shape shown on the oblique sagittal.
- Labrum and biceps groove covered on the axial.
Mistakes that cost repeats
- Scanning the shoulder off-centre and losing fat suppression.
- Internal rotation curving the supraspinatus and hiding a tear.
- Calling a magic-angle tendon torn without checking T2.
- Straight (non-oblique) planes foreshortening the cuff.
Common questions
- Why shift the patient toward the opposite side for a shoulder MRI?
- It places the examined shoulder at the magnet's isocentre. A shoulder scanned off-centre suffers field inhomogeneity, so fat suppression fails and the images turn dark and grainy.
- Why is the arm kept thumb-up (neutral) for the cuff?
- Neutral rotation profiles the supraspinatus tendon along its length. Internal rotation (hand on the stomach) curves the tendon, which can hide a tear from view.
- How do you tell a magic-angle artefact from a real cuff tear?
- Compare with the T2 sequence. Magic-angle brightening on PD (tendon at ~55° to the field) disappears at the long TE of T2. If it's bright on PD but dark on T2, it's the artefact, not a tear.
Try it in ScanFlo: Plan the oblique coronal along the supraspinatus, then a straight coronal, and compare how much of the tendon each shows. The oblique lays it out from footprint to muscle; the straight one foreshortens it. That is why the cuff view is always angled. See ScanFlo MRI →