Skip to main content
Log in

Shoulder arthroscopy remains superior to direct MR arthrography for diagnosis of subtle rotator interval lesions

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript



To assess the sensitivity, specificity and accuracy of MR arthrography, as opposed to shoulder arthroscopy, in diagnosing individual rotator interval (RI) structures lesions at different levels of severity.

Materials and methods

Seventy-five patients were enrolled in a prospective study. All the patients were diagnosed with full-thickness rotator cuff tendon tears on unenhanced MRI and had complimentary MR arthrography to search for obscure RI lesions. All the patients then underwent shoulder arthroscopy. The arthroscopist was blinded about the MR arthrography results.


At arthroscopy, 42 patients (56 %) were found to have RI lesion(s) and represented the study group. The remaining 33 patients represented the control group. The sensitivity, specificity and accuracy of MR arthrography for detecting individual RI lesions varied widely depending on the location and severity of the lesions. MR arthrography showed intermediate sensitivity of 67–80 %, specificity of 83–89 % and accuracy of 89–92 % for diagnosing subtle RI lesions; and perfect (100 %) sensitivity, specificity and accuracy for diagnosing biceps long head tendon dislocation. For the rest of RI lesions, MR arthrography showed high sensitivity, specificity and accuracy. Inter-observer agreement was found to be almost perfect (K = 0.81–1.0).


Shoulder arthroscopy remains the gold standard for diagnosing subtle RI lesions. Although MR arthrography has proved to be a valuable tool for diagnosing established RI lesions, it is of intermediate sensitivity for diagnosing subtle RI lesions resulting in early insufficiency of the biceps pulley system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Beall DP, Morag Y, Ly JQ, Johnson MB, Pasque CB, Braley BA, Martin HD, Stapp AM (2006) Magnetic resonance imaging of the rotator cuff interval. Semin Musculoskelet Radiol 10:187–196

    Article  PubMed  Google Scholar 

  2. Burkart AC, Debski RE (2002) Anatomy and function of the glenohumeral ligaments in anterior shoulder instability. Clin Orthop Relat Res 400:32–39

    Article  PubMed  Google Scholar 

  3. Edelson JG, Taitz C, Grishkan A (1991) The coracohumeral ligament. Anatomy of a substantial but neglected structure. J Bone Joint Surg Br 73:150–153

    CAS  PubMed  Google Scholar 

  4. Morag Y, Jacobson JA, Shields G, Rajani R, Jamadar DA, Miller B, Hayes CW (2005) MR arthrography of rotator interval, long head of the biceps brachii, and biceps pulley of the shoulder. Radiology 235:21–30

    Article  PubMed  Google Scholar 

  5. Gohlke F, Essigkrug B, Schmitz F (1994) The pattern of collagen fiber bundles of the capsule of the glenohumeral joint. J Should Elbow Surg 3:111–128. doi:10.1016/S1058-2746(09)80090-6

    Article  CAS  Google Scholar 

  6. Krief OP (2005) MRI of the rotator interval capsule. AJR 184:1490–1494

    Article  PubMed  Google Scholar 

  7. Jost B, Koch PP, Gerber C (2000) Anatomy and functional aspects of the rotator interval. J Should Elbow Surg Am 9:336–341

    Article  CAS  Google Scholar 

  8. Petchprapa CN, Beltran LS, Jazrawi LM, Kwon YW, Babb JS, Recht MP (2010) The rotator interval: a review of anatomy, function, and normal and abnormal MRI appearance. AJR Am J Roentgenol 195:567–576. doi:10.2214/AJR.10.4406

    Article  PubMed  Google Scholar 

  9. Chung CB, Dwek JR, Cho GJ, Lektrakul N, Trudell D, Resnick D (2000) Rotator cuff interval: evaluation with MR imaging and MR arthrography of the shoulder in 32 cadavers. J Comput Assist Tomogr 24:738–743

    Article  CAS  PubMed  Google Scholar 

  10. Grainger AJ, Tirman PF, Elliott JM, Kingzett Taylor A, Steinbach LS, Genant HK (2000) MR anatomy of the subcoracoid bursa and the association of subcoracoid effusion with tears of the anterior rotator cuff and the rotator interval. AJR 174:1377–1380

    Article  CAS  PubMed  Google Scholar 

  11. Le Huec JC, Schaeverbeke T, Moinard M, Kind M, Diard F, Dehais J, Le Rebeller A (1996) Traumatic tear of the rotator interval. J Should Elbow Surg 5:41–46

    Article  CAS  Google Scholar 

  12. Vinson EN, Major NM, Higgins LD (2007) Magnetic resonance imaging findings associated with surgically proven rotator interval lesions. Skeletal Radiol 36:405–410

    Article  PubMed  Google Scholar 

  13. Schaeffeler C, Waldt S, Holzapfel K, Kirchhoff C, Jungmann PM, Wolf P, Stat D, Schröder M, Rummeny EJ, Imhoff AB, Woertler K (2012) Lesions of the biceps pulley: diagnostic accuracy of MR arthrography of the shoulder and evaluation of previously described and new diagnostic signs. Radiology 264:504–513. doi:10.1148/radiol.12112007

    Article  PubMed  Google Scholar 

  14. Seeger LL, Lubowitz J, Thomas BJ (1993) Tear of the rotator interval. Skeletal Radiol 22:615–617

    Article  CAS  PubMed  Google Scholar 

  15. Walch G, Nové-Josserand L, Boileau P, Levigne C (1998) Subluxations and dislocations of the tendon of the long head of the biceps. J Should Elbow Surg 7:100–108

    Article  CAS  Google Scholar 

  16. Buck FM, Grehn H, Hilbe M, Pfirrmann CWA, Manzanell S, Hodler J (2009) Degeneration of the long biceps tendon: comparison of MRI with gross anatomy and histology. AJR Am J Roentgenol 193:1367–1375. doi:10.2214/AJR.09.2738

    Article  PubMed  Google Scholar 

  17. Zanetti M, Weishaupt D, Gerber C, Hodler J (1998) Tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography. AJR Am J Roentgenol 170:1557–1561

    Article  CAS  PubMed  Google Scholar 

  18. Bennett WF (2001) Visualization of the anatomy of the rotator interval and bicipital sheath. Arthroscopy 17:107–111

    Article  CAS  PubMed  Google Scholar 

  19. Bennett WF (2001) Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of “hidden” rotator interval lesions. Arthroscopy 17:173–180

    Article  CAS  PubMed  Google Scholar 

  20. Bennett WF (1998) The specificity of the Speed’s test. Arthroscopic evaluation of the biceps tendon at the level of the bicipital groove. Arthroscopy 14:789–796

    Article  CAS  PubMed  Google Scholar 

  21. Snyder SJ (1989) A complete system for arthroscopy and bursoscopy of the shoulder. Surg Rounds Orthop 3(7):57–65

  22. Grauer JD, Paulos LE, Smutz WP (1992) Biceps tendon and superior labral injuries. Arthroscopy 8:488–497

    Article  CAS  PubMed  Google Scholar 

  23. Dumontier C, Sautet A, Gagey O, Apoil A (1999) Rotator interval lesions and their relation to coracoid impingement syndrome. J Should Elbow Surg 8:130–135

    Article  CAS  Google Scholar 

  24. Van de Reis W, Wolf EM (2001) Arthroscopic rotator cuff interval capsular closure. Orthopedics 24:657–661

    PubMed  Google Scholar 

  25. Gazielly DF, Gleyze P, Montagnon C, Bruyere G, Prallet B (1995) Functional and anatomical results after surgical treatment of ruptures of the rotator cuff. 1: Preoperative functional and anatomical evaluation of ruptures of the rotator cuff. Rev Chir Orthop Reparatrice Appar Mot 81:8–16

    CAS  PubMed  Google Scholar 

  26. Feller JF, Tirman PFJ, Steinbach LS, Zucconi F (1995) Magnetic resonance imaging of the shoulder: review. Semin Roentgenol 30:224–240

    Article  CAS  PubMed  Google Scholar 

  27. Slatis P, Aalto K (1979) Medial dislocation of the tendon of the long head of the biceps brachii. Acta Orthop Scand 50:73–77

    Article  CAS  PubMed  Google Scholar 

  28. Zappia M, Reginelli A, Russo A, D’Agosto GF, Di Pietto F, Genovese EA, Coppolino F, Brunese L (2013) Long head of the biceps tendon and rotator interval. Musculoskelet Surg 2:99–108. doi:10.1007/s12306-013-0290-z

    Article  Google Scholar 

  29. Weishaupt D, Zanetti M, Tanner A, Gerber C, Hodler J (1999) Lesions of the reflection pulley of the long biceps tendon. MR arthrographic findings. Invest Radiol 34:463–469

    Article  CAS  PubMed  Google Scholar 

  30. Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Should Elbow Surg 13:5–12

    Article  Google Scholar 

  31. Barile A, Lanni G, Conti L, Mariani S, Calvisi V, Castagna A, Rossi F, Masciocchi C (2013) Lesions of the biceps pulley as cause of anterosuperior impingement of the shoulder in the athlete: potentials and limits of MR arthrography compared with arthroscopy. Radiol Med 118:112–122. doi:10.1007/s11547-012-0838-2

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

All the authors responsible for this work declare no conflict of interest.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ashraf Anbar.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anbar, A., Emad, Y., Zeinhom, F. et al. Shoulder arthroscopy remains superior to direct MR arthrography for diagnosis of subtle rotator interval lesions. Eur J Orthop Surg Traumatol 25, 689–697 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: