Diagnostic anatomy and diagnostics of enthesal pathologies of the rotator cuff.

Abstract

It was in 2005 when I first met Dr Czyrny in Warsaw. I presented some of my own work on anatomy of the glenohumeral joint in relation to instability at the Congress of the Polish Sports Traumatology Society. During dinner Dr Czyrny and I had a stimulating discussion on this topic where we proved that anatomically inclined orthopedic surgeons and likewise inclined radiologists have a common ground for better understanding. From then on Dr Czyrny scrupulously continued to try and find a way to visualize the fine anatomical structures composing the glenohumeral musculotendino-capsuloligamentous unit. Refined dissection has shown that the glenohumeral capsule with its ligaments on the hand and the tendons of the rotator cuff on the other hand are closely juxtaposed and even interwoven. While it is already a diligent task to distinguish these layers by minute dissection, he has finally arrived at demonstrating that they can also be delineated by imaging. I stand amazed at the detail that Dr Czyrny is able to bring into view, be it by ultrasound or MRI. However, knowledge of normal structures and relationships between tendons and capsuloligamentous structures becomes most useful when it helps us to understand and diagnose pathology. Here, Dr Czyrny takes us a step further. With clear insight of the normal anatomy, he integrates this with observations in numerous clinical cases. In the present paper(1), he demonstrates what we all can see on MRI and ultrasound and how to interpret these findings. He describes how lesions at the humeral enthesis of tendons and ligaments can be generated and how to evaluate them. I look forward to more papers like these.