Throwers oblique rotator cuff (TORC) MRI view of the shoulder improves reader confidence for internal impingement abnormalities in overhead throwing athletes

The thrower's oblique rotator cuff (TORC) view was developed to more optimally visualize the commonly injured posterosuperior rotator cuff and capsulolabral structures in overhead athletes. The purpose is to evaluate whether the addition of the TORC view to standard MRI sequences improves the diagnostic evaluation of rotator cuff pathology and labral abnormalities in throwing athletes. Shoulder MRIs of MLB pitchers ordered by team physicians from 1/1/2019 to 12/31/2021 were retrospectively reviewed. The inclusion criteria were standard and TORC MRI sequences per individual player and players aged 18-35. The MRIs were read by a musculoskeletal radiologist and two orthopedic surgeons with and without the addition of the TORC plane. The TORC view resulted in minor redistribution of supraspinatus, infraspinatus, and labral classifications. Signal size measurements differed significantly between standard and TORC views at the individual reader level (p = 0.042, p = 0.003, and p < 0.001), with generally larger measurements on the TORC view; however, no significant difference was observed when measurements were pooled across readers (median 17.0 mm; p = 0.197). Inter-reader reliability for signal size improved with the TORC view (ICC 0.47 → 0.73). Overall diagnostic confidence increased significantly for two of three readers with the TORC view (median paired increase, 1.0 point; p < 0.001), while no significant change was observed for the third reader. The addition of the TORC plane was associated with improved reader confidence and inter-reader reliability for quantitative signal size assessment without introducing systematic changes in categorical tendon or labral classification. These findings support the use of the TORC sequence as an adjunct to standard shoulder MRI protocols to enhance interpretive consistency and confidence, particularly in elite overhead throwing athletes.