The crank test,the O'Brien test,and routine magnetic resonance imaging scans in the diagnosis of labral tears

BACKGROUND: Tears of the superior labrum of the shoulder, anterior to posterior, are difficult to diagnose clinically. PURPOSE: We examined whether the crank or O'Brien tests were reliable tools for detecting glenoid labral tears. STUDY DESIGN: Nonrandomized prospective study. METHODS: Results of diagnostic shoulder arthroscopy were compared with those of the preoperative tests and magnetic resonance imaging for 65 patients who had symptoms of shoulder pain. RESULTS: The crank test result was positive in 29 patients (45%), and the O'Brien test was positive in 41 patients (63%). The crank test had a positive predictive value of 41%, was 56% specific, 46% sensitive, and had a negative predictive value of 61%. The O'Brien test had a positive predictive value of 34%, was 31% specific, 54% sensitive, and had a negative predictive value of 50%. Magnetic resonance imaging had a positive predictive value of 63%, was 92% specific, 42% sensitive, and had a negative predictive value of 83%. CONCLUSIONS: The O'Brien and crank tests were not sensitive clinical indicators for detecting glenoid labral tears and other tears of the anterior and posterior labrum. Results were often falsely positive for patients with other shoulder conditions, including impingement or rotator cuff tears.     

Biceps load test: a clinical test for superior labrum anterior and posterior lesions in shoulders with recurrent anterior dislocations.

We describe the biceps load test for evaluating the integrity of the superior glenoid labrum in shoulders with recurrent anterior dislocations. With the shoulder in an abducted, externally rotated position and the forearm supinated, active flexion of the elbow against resistance relieves the discomfort of a standard apprehension test for anterior shoulder instability. A group of 75 patients with proven unilateral anterior shoulder dislocations were prospectively examined in a double-blind fashion with arthroscopic examination and the biceps load test. Sixty-three patients had a negative test and 62 of these had an intact biceps tendon-superior labrum complex; the remaining patient had a type II superior labral anterior and posterior lesion. Twelve patients had positive tests, and 10 had superior labral lesions; the other 2 patients had intact superior labra. Therefore, the biceps load test revealed a sensitivity of 90.9%, a specificity of 96.9%, a positive predictive value of 83%, a negative predictive value of 98%, and a kappa coefficient of 0.846.     

A new pain provocation test for superior labral tears of the shoulder

We prospectively evaluated the usefulness of a new pain provocation test to diagnose superior labral tears in 32 patients with diagnosed throwing injuries of the shoulder. Results of the pain provocation test were compared with findings on magnetic resonance arthrography (all 32 patients) and arthroscopic examination (15 patients). In 22 patients, detachment of the superior labrum was observed on arthrograms, and all of them had positive results on the new pain provocation test. Nine of the other 10 patients had negative results on the new pain provocation test. However, 1 of the 10 patients had a positive result. Eleven of 15 patients were found to have superior labral lesions arthroscopically, and all of them were classified as type II superior labral anterior posterior lesions. All the 11 patients had positive pain provocation tests. The other four patients without superior labral tears on arthroscopic findings had negative results on the new pain provocation test. The new pain provocation test identified all patients with detachment of the superior labrum confirmed by magnetic resonance arthrography, for a sensitivity of 100%, a specificity of 90%, and an accuracy of 97%. Results of the new pain provocation test were in accord with arthroscopic findings in the 15 patients who underwent arthroscopic examination.     

Clinical assessment of three common tests for superior labral anterior-posterior lesions

BACKGROUND: Three tests (active compression, anterior slide, and compression rotation) are commonly used to diagnose superior labral anterior-posterior lesions. HYPOTHESIS: We hypothesized that the accuracy, sensitivity, and specificity for these tests was less than that previously reported and that a click in the shoulder during manipulation was not specific for the study lesion. STUDY DESIGN: Case-control study. METHODS: The three tests were performed on 426 patients who subsequently underwent shoulder arthroscopy. The results of physical examination were compared with the arthroscopic findings and analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. RESULTS: At arthroscopy, 39 patients had type II to IV lesions (study group); the remaining 387 patients had type I lesion or no lesion (control group). The incidences of positive results were not statistically different between the groups (P > 0.05). Our findings were as follows: most sensitive test, active compression (47%); most specific test, anterior slide (84%); highest positive predictive value, active compression (10%); highest overall accuracy, anterior slide test (77%); lowest overall accuracy, active compression test (54%). The presence of a click and the location of the pain were not reliable diagnostic indicators. CONCLUSIONS: The results of such tests should be interpreted with caution when considering surgery for a possible superior labral anterior-posterior lesion.     

How often do surgeons intervene on shoulder labral lesions detected at MR examination? A retrospective review of MR examinations correlated with arthroscopy

Objective:

We report the prevalence of surgical intervention on shoulder labral lesions detected at MR examinations and how surgeons describe labral tears seen at MR examinations in their arthroscopy reports.

Methods:

A retrospective review of 100 consecutive patients aged 50 years or younger who had shoulder labral tears on MR and went on to have surgery performed. It was determined whether surgical intervention was performed on the MR lesions.

Results:

Of these 100 patients, 72 had superior labral anterior to posterior (SLAP) tears, 38 had posterior labral tears and 28 had anterior labral tears on MR examination. All 100 patients went on to arthroscopy. All lesions described on MRI were described on arthroscopy. Of the 72 SLAP tears, 64 were described as fraying on arthroscopy with 51 debrided. The remaining eight SLAP tears were tacked surgically. Of the 38 posterior labral tears, 36 were described as fraying on arthroscopy with 29 debrided and 2 had surgical tacking performed. Of the 28 anterior labral tears described on MR examination, 26 had surgical tacking performed and 2 were debrided. There were four SLAP tears, two anterior labral tears and three posterior labral tears seen on arthroscopy but not seen on MR examination.

Conclusion:

In this series, a high percentage of SLAP tears and posterior labral tears described on MR examination did not have surgical tacking. Most anterior labral tears had surgical tacking. Based on the above, our surgeons request we describe superior and posterior labral lesions as fraying and/or tearing, unless we can see a displaced tear. Most anterior labral lesions are treated with surgical tacking.

Advances in knowledge:

MRI allows for sensitive detection of labral tears. The tears often are not clinically significant.Labral tears are common injuries that often require surgical intervention. In our practice, we commonly see labral tears on MR examination and report them to surgeons. With modern high-resolution MRI, as well as increased awareness of labral tears by radiologists, labral tears are commonly reported findings on MR examinations. Sensitivities and specificities for detection of labral tears as compared with those from arthroscopy at 3.0 T have been reported as follows: superior labral anterior to posterior (SLAP) tears (90% sensitive and 100% specific), anterior labral tears (89% sensitive and 100% specific) and posterior labral tears (86% sensitivity and 100% specific).¹ Sensitivities of 100% for anterior labral tears, 86% for superior labral tears and 74% for posterior labral tears as compared with those from arthroscopy have been reported using high-resolution 1.5 T conventional MR examinations.²In our practice, we have been told by our surgeons that we describe some SLAP tears and posterior labral tears on MR that they find on arthroscopy to be degenerative fraying. For this reason, we sought to find (1) how often does a surgeon intervene on labral tears and (2) how do surgeons describe labral tears seen at MR examinations in their arthroscopy reports.     

The Kim test: a novel test for posteroinferior labral lesion of the shoulder--a comparison to the jerk test

BACKGROUND: Detection of a posteroinferior labral lesion by physical examination is often difficult. PURPOSE: To introduce a novel diagnostic test for detecting a posteroinferior labral lesion of the shoulder. HYPOTHESIS: The Kim test can detect a posteroinferior labral lesion of the shoulder. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 1. METHODS: In 172 painful shoulders, the Kim test was compared with the jerk test and was verified by arthroscopic examination. A sudden onset of posterior shoulder pain and click with or without clunk indicated a positive test result. RESULTS: Thirty-three shoulders had a positive Kim test result, in which 24 had a posteroinferior labral lesion and 9 had a normal posteroinferior labrum. Of 139 shoulders with a negative Kim test result, 6 had a posteroinferior labral tear and 133 had a normal posteroinferior labrum. The sensitivity of the Kim test was 80%, specificity was 94%, positive predictive value was 0.73, and negative predictive value was 0.96. The interexaminer reliability between 2 examiners was 0.91. The accuracy of the jerk test in detecting a posteroinferior labral lesion was the following: sensitivity, 73%; specificity, 98%; positive predictive value, 0.88; and negative predictive value, 0.95. The location of the posterior labral lesion was predominantly posterior in 19 shoulders and predominantly inferior in 11 shoulders. The Kim test was more sensitive in detecting a predominantly inferior labral lesion, whereas the jerk test was more sensitive in detecting a predominantly posterior labral lesion. The sensitivity in detecting a posteroinferior labral lesion increased to 97% when the 2 tests were combined. CONCLUSION: The Kim test is a reliable diagnostic test for detection of a posteroinferior labral lesion.     

An evaluation of the provocative tests for superior labral anterior posterior lesions

BACKGROUND: Although our understanding of superior labral anterior posterior lesions has grown, the physical diagnosis remains imperfect. STUDY DESIGN: Cohort study (diagnostic); Level of evidence, 2. PURPOSE: To determine the most effective provocative maneuver with which to diagnose superior labral anterior posterior lesions. METHODS: A series of 132 consecutive patients scheduled to undergo diagnostic shoulder arthroscopy were examined preoperatively over a 6-month period, and the final diagnosis in each case was made arthroscopically. The following assessments were included: active compression (O'Brien), anterior slide, pain provocation, crank, Jobe relocation, Hawkins, Neer, Speed, and Yergason tests. RESULTS: The most sensitive diagnostic tools for type II superior labral lesions were the active compression, Hawkins, Speed, Neer, and Jobe relocation tests. When type I and type II lesions were combined, the results were similar. However, none of the sensitive tests were specific for either type I or type II lesions. CONCLUSIONS: The authors' results contradict the current literature regarding provocative testing for both stable and unstable superior labral lesions. There is no single maneuver that can accurately diagnose superior labral anterior posterior lesions; arthroscopy remains the standard by which to diagnose such lesions.     

Outcomes of combined arthroscopic rotator cuff and labral repair

BACKGROUND: Rotator cuff tears, Bankart lesions, and superior labral anterior posterior lesions commonly occur in isolation, but there is a subgroup of patients who experience combined injuries. Prior studies have excluded such patients as confounding groups. HYPOTHESIS: In patients with combined lesions of the labrum and rotator cuff, arthroscopic repair of both lesions will restore range of motion and stability and provide good clinical results. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively evaluated the clinical outcomes of a series of patients with combined rotator cuff and labral (Bankart or superior labral anterior posterior) lesions treated arthroscopically. RESULTS: Thirty patients (average age, 47.8 years) with combined rotator cuff and labral lesions were evaluated at a mean follow-up of 2.7 years (range, 24-54 months). Sixteen patients had Bankart lesions and 14 patients had SLAP lesions. Significant improvements in forward flexion (20.5 degrees, P = .005), external rotation (9.0 degrees, P = .008), and internal rotation (2 vertebral levels, P = .016) were observed. The mean L'Insalata and American Society of Shoulder and Elbow Surgeons scores for all patients were 92.9 and 94.3, respectively. Twenty-seven (90%) patients reported satisfaction as good to excellent, and 23 of 30 (77%) returned to their preinjury level of athletics. Two patients suffered recurrent rotator cuff tears. CONCLUSION: In patients with rotator cuff and labral lesions, arthroscopic treatment of both lesions yields good clinical outcomes, restoration of motion, and a high degree of patient satisfaction.     

Shoulder MR arthrography: which patient group benefits most?

OBJECTIVE: We sought to compare the diagnostic accuracy of conventional MRI versus MR arthrography of the shoulder in the assessment of high-performance athletes (professional baseball players) and to compare our findings in these patients with the conventional MRI and MR arthrographic findings in an age-matched control group of nonprofessional athletes. MATERIALS AND METHODS: Conventional MRI and MR arthrographic examinations of the shoulder in 20 consecutive professional baseball players with shoulder pain were reviewed retrospectively by two musculoskeletal radiologists in consensus. These interpretations were compared with retrospective consensus interpretations of conventional MRI and MR arthrographic examinations of the shoulder obtained in a control group of 50 consecutive nonprofessional athletes with shoulder pain. MR images were assessed for full- or partial-thickness supraspinatus tendon tears, superior labral anteroposterior (SLAP) tears, and anterior or posterior labral tears. RESULTS: In the 20 consecutive professional athlete patients, two full-thickness and six partial-thickness undersurface supraspinatus tendon tears were seen on MR arthrography but not seen on conventional MRI as well as six SLAP tears, two anterior labral tears, and one posterior labral tear. Three patients had both SLAP tears and full- or partial-thickness supraspinatus tendon tears. Of 14 patients with findings on MR arthrography that were not seen on MRI, 11 had arthroscopic correlation. In all 11, arthroscopic findings confirmed findings on MR arthrography. In the group of 50 nonprofessional athlete patients, five had additional findings on MR arthrography not seen on conventional MRI: two anterior labral tears, two partial-thickness supraspinatus tendon tears, and two SLAP tears. One patient had both a partial-thickness supraspinatus tendon tear and a SLAP tear seen on MR arthrography. The five patients with additional findings on MR arthrography had arthroscopy. In all five, arthroscopic findings confirmed the findings on MR arthrography. CONCLUSION: MR arthrography is considerably more sensitive for detection of partial-thickness supraspinatus tears and labral tears than conventional MRI. MR arthrography showed injuries in addition to those seen on conventional MRI in 14 of 20 patients in the high-performance athlete group. These results suggest high-performance athletes may be a subgroup of patients for whom MR arthrography yields considerably more diagnostic information than conventional MRI.     

Prevalence of HAGL lesions and associated abnormalities on shoulder MR examination

Objective

Humeral avulsion of the glenohumeral ligament (HAGL) is an uncommon shoulder injury. We report the prevalence of HAGL lesions and other associated shoulder injuries in a large series of shoulder MR examinations. All results were correlated with surgery.

Materials and methods

MR reports of 1,000 consecutive conventional shoulder MR exams performed on patients with shoulder pain were reviewed in our information system for the word HAGL. A total of 743 patients went on to surgery. There were 23 HAGL lesions reported at surgery. Those 23 examinations were reviewed retrospectively in consensus by two musculoskeletal radiologists. Scans were assessed for HAGL lesions, full or partial thickness supraspinatus, infraspinatus or subscapularis tendon tears, superior labral anterior posterior (SLAP) tears, anterior or posterior labral tears, and Hill–Sachs lesions.

Results

All 23 patients had HAGL lesions at surgery. Sixteen HAGL lesions were seen on prospective MR reading and 17 HAGL lesions were seen on retrospective MR consensus reading. Six HAGL lesions were not seen on retrospective consensus reading. Sixteen patients had Hill–Sachs deformities, ten had subscapularis tendon tears, five had supraspinatus tendon tears, six had superior labral tearing, and six had anterior labral tears. The above findings were confirmed on arthroscopy.

Conclusions

In this series, there was a 1.6 % prevalence on all MR examinations, and prevalence of 2.1 % seen on MR examination for those who went to surgery. Common injuries associated with HAGL lesions are Hill–Sachs deformities and subscapularis tendon tears. Anterior labral tears were seen in only six cases despite Hill–Sachs deformities in 16 patients. In patients with Hill–Sachs deformities without anterior labral tears, one must carefully assess for the presence of a HAGL lesion.     

Computed tomography (CT) arthrography of shoulder instabilities in athletes

Sixty professional and recreational athletes underwent CT arthrography of the shoulder for evaluation of suspected shoulder joint derangement. These athletes, 46 males and 14 females ranging in age from 15 to 60 years (mean, 32 years), all had persistent pain that interfered with their sports activity and was resistant to conservative treatment. Seventeen patients had shoulder instability based on clinical manifestations and CT arthrographic findings. An additional five patients, also based on clinical manifestations and CT arthrographic findings, were considered to have an unobtrusive degree of anterior joint laxity. Patients with anterior instability (20 cases) all had an anteroinferior tear or detachment of the glenoid labrum, as well as some violation of the insertion of the joint capsule onto the scapula. Those with posterior instability (two cases) had a combination of labral and capsular tears. Two other major patterns of labral tears, both unaffiliated with shoulder instability, were identified. These included total or partial detachment of superior segments of the labrum, and anterior labral tears at the midglenoid level. Moreover, various degrees of labral attenuation (or, less often, enlargement), osteophyte formation, and alterations in articular cartilage were observed. Surgical correlation was obtained in 25 patients, with 95% accuracy of CT arthrographic findings. CT arthrography is a minimally invasive and highly accurate technique for investigation of glenohumeral derangement. Specifically, the extent of pathologic changes associated with instability can be determined and differentiated from other intraarticular causes of incapacity, such as labral tears caused by throwing, or degenerative changes.     

Can isotropic fast gradient echo imaging be substituted for conventional T1 weighted sequences in shoulder MR arthrography at 3 Tesla?

PURPOSE: To assess the practical utility of isotropic shoulder imaging in patients undergoing MR arthrography. Isotropic shoulder imaging can be performed in less than three minutes with use of fast gradients. MATERIALS AND METHODS: Two experienced musculoskeletal radiologists retrospectively interpreted MR images of the shoulder in 100 consecutive patients undergoing MR arthrography of the shoulder. All patients underwent MRI of the shoulder in oblique coronal, oblique sagittal, and axial planes on a 3.0-Tesla MRI system. All patients had conventional fast spin-echo T1-weighted imaging. All patients also had thin section (0.4 mm) isotropic spoiled gradient echo images performed. A total of 67 of the 100 patients underwent subsequent arthroscopy and results were compared with MR interpretations. RESULTS: There were 41 full-thickness supraspinatus tendon tears, nine partial-thickness supraspinatus tendon tears (seven articular surface and two bursal surface), 21 superior labral, 18 anterior labral, and seven posterior labral tears demonstrated by consensus retrospective reading of the 100 shoulder MR exams. There was no difference in interpretation of the isotropic images as compared to the conventionally acquired images in the oblique coronal, oblique sagittal, and axial planes. Some patients had more than one finding on each exam. A total of 67 patients went on to arthroscopy. There were 41 full-thickness supraspinatus tendon tears, nine partial-thickness supraspinatus tendon tears, 21 superior labral, 18 anterior labral, and seven posterior labral tears demonstrated on arthroscopy. All full- and partial-thickness supraspinatus tendon tears seen at arthroscopy were seen on consensus MR reading. A total of 19 out of the 21 patients with superior labral anterior posterior (SLAP) tears at arthroscopy were seen on consensus MR reading. A total of 16 of the 18 anterior labral tears and six of the seven posterior labral tears seen at arthroscopy were seen on consensus MR reading. Some of the 67 patients had more than one finding on arthroscopy. CONCLUSION: Isotropic imaging of the shoulder is practical in clinical imaging when performed with use of fast gradients on a 3-Tesla system. Isotropic imaging provides the same clinical information as conventional imaging and can be acquired in less than three minutes.     

Sensitivity and specificity in detection of labral tears with 3.0-T MRI of the shoulder

OBJECTIVE: MRI of the shoulder has been found to be sensitive and specific for detection of labral tears at 1.5 T or lower field strength compared with arthroscopy, whereas 3.0-T MRI of the shoulder has not been specifically assessed. This study assesses the sensitivity and specificity of MRI at 3.0 T for labral tears compared with arthroscopy. CONCLUSION: MRI of the shoulder at 3.0 T is very sensitive and specific compared with arthroscopy in detection of superior, anterior, and posterior labral tears.     

MRI of internal impingement of the shoulder

OBJECTIVE: Internal impingement is a condition that occurs in athletes in which the shoulder is put in extreme abduction and external rotation during overhead movements. During this motion, the posterior fibers of the supraspinatus tendon, anterior fibers of the infraspinatus tendon, or both can get impinged between the humeral head and the posterior glenoid. The purpose of this study was to evaluate the ability of MRI to show the findings of internal impingement of the shoulder. CONCLUSION: As opposed to our six patients with clinically and surgically diagnosed internal impingement, the control patients had isolated pathology in the rotator cuff, labrum, or humeral head. We found that the constellation of findings of undersurface tears of the supraspinatus or infraspinatus tendon and cystic changes in the posterior aspect of the humeral head associated with posterosuperior labral pathology is a consistent finding diagnostic of internal impingement.     

Athlete shoulder injuries: CT arthrographic findings

Forty-three professional and amateur athletes with persistent shoulder pain that interfered with their sports activities were evaluated by computed tomographic (CT) arthrography. In 19 patients, glenohumeral instability (14 anterior, two posterior, three multidirectional) was diagnosed with CT arthrography based on the simultaneous presence of labral and capsular lesions. The findings were crucial in establishing the diagnosis of instability in six patients in whom the condition was not suggested or could not be confirmed clinically. Another significant injury consisted of labral lesions not associated with glenohumeral instability. These tears often involved the anterior and parasuperior segments of this structure. Other, less frequently detected lesions included segmental labral enlargement and several labra with abnormal orientation (everted labrum). Early onset of degenerative disease was present in many athletes, especially those with a long history of sports activity. CT arthrographic findings were correlated with arthroscopic or surgical results in 19 patients.     

SLAP tears of the glenoid labrum in contact athletes.

OBJECTIVE: To describe the distribution and clinical presentation of labral injuries in rugby players and the time taken for them to return to sports. DESIGN: Retrospective cohort study. SETTING: Busy shoulder practice in the North West of England, treating a large number of professional athletes. PATIENTS: A review of 51 shoulder arthroscopies performed on professional rugby players over a 35 month period. All patients diagnosed with a SLAP lesion at arthroscopy were identified. Eighteen patients had a documented SLAP tear; this group represented our study population. INTERVENTIONS: Arthroscopic debridement and/or stabilization was carried out for all labral injuries using Panaloc anchors and No. 2 PDS via a 2 portal technique. MAIN OUTCOME MEASUREMENTS: Classification of injury, Satisfaction, Time to return to play. RESULTS: The incidence of SLAP tears in our study population was 35%. There were 11 isolated SLAP tears (61%), 3 SLAP tears associated with a Bankart lesion (17%), 2 SLAP tears associated with a posterior labral lesion (11%), and 2 SLAP tears associated with an anterior and posterior labral injuries (11%). Of the 18 SLAP tears, 14 (78%) were type 2, 3 (17%) were type 3, and 1 (5%) was type 4. None of the patients with a SLAP tear presented with symptoms of instability. MR Arthrogram had a 76% sensitivity for detecting SLAP tears. By 6 months postsurgery, 89% of patients were satisfied. Patients with isolated SLAP tears were the quickest to return to sports, at an average of 2.6 months postsurgery. CONCLUSIONS: SLAP tears are a common injury in rugby players. These can often be diagnosed with MR arthrography. Arthroscopic repair is associated with excellent results and early return to sports.     

Arthroscopic evaluation of acute initial anterior shoulder dislocations

Arthroscopic evaluation of patients with an acute anterior shoulder dislocation was done to identify and classify the intraarticular lesions that might predict recurrent dislocations. Forty-five shoulders fit the following criteria for inclusion in our study: initial dislocation with no prior history of shoulder problems; confirmation of the dislocation radiographically or reduction by a physician; and arthroscopy within 10 days. The 42 men and 3 women had an average age of 21.2 years (range, 14 to 28 years). Mechanism of injury was a twisting of the arm into forced abduction and external rotation, a fall on the outstretched arm, or a direct blow to the shoulder. Based on this preliminary study of 45 shoulders, we present a classification of the lesions found in the acute shoulder dislocation. Group 1 (six shoulders) had capsular tears with no labral lesions: these shoulders were stable under anesthesia and had no or minimal hemarthrosis. Group 2 (11 shoulders) had capsular tears and partial labral detachments: these shoulders were mildly unstable and had mild to moderate hemarthrosis. Group 3 (28 shoulders) had capsular tears with labral detachments: these shoulders were grossly unstable and had large hemarthrosis. They had complete capsular/labral detachments. In the past, redislocation rates have been primarily related to age at the time of initial dislocation and, to a lesser degree, the period of immobilization. We have identified the intraarticular lesions in 45 patients with an initial anterior glenohumeral dislocation and classified these shoulders into three groups based on the lesions found. By doing so, we can develop a more accurate method of determining which shoulders are prone to recurrent dislocation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Kinematic shoulder MRI: the diagnostic value in acute shoulder dislocations

Objectives

To determine whether positioning of the arm in adduction and internal rotation would improve the confidence in the diagnosis of Bankart lesions in first time shoulder dislocators.

Methods

Eleven patients were imaged on an open bore MRI within 1–6 days of traumatic shoulder dislocation with the arm adducted and internally rotated, and subsequently the patients were reimaged with the arm adduced and externally rotated. Two blinded musculoskeletal radiologists determined the confidence of diagnosing labral tears in each of the two positions.

Results

An anterior–inferior labral tear was diagnosed in 11/11 patients in internal rotation and in 6/11 patients in external rotation. The average confidence was 2.8 in internal rotation and 1.5 in external rotation (on a scale of 0–3). Using a Wilcoxon signed rank test, the certainty of the diagnosis was determined to be significantly higher with the arm in internal rotation (P?=?0.016).

Conclusions

MRI performed with the arm in internal rotation for patients with acute first time anterior shoulder dislocation increases the certainty of the diagnosis of anterior–inferior labral tears.

Key Points

? Adduction and internal arm rotation improves the MRI diagnosis of Bankart tears. ? Arm positioning in ADIR has distinct advantages over abduction and external rotation. ? Early imaging after shoulder dislocation may provide a diagnostically useful “arthrographic” effect.     

Superior labral repair

Advances in shoulder arthroscopy have led to a greater understanding of the importance of lesions of the superior labrum and biceps tendon complex. Diagnosis of superior labrum anterior to posterior tears requires a high index of suspicion and is made by careful attention to the history, physical examination, and magnetic resonance arthrography. The diagnosis is confirmed with arthroscopy. The form of treatment is dependent on the type of tear and the stability of the superior labrum and biceps anchor. Appropriate treatment of the tear and any associated pathologies should lead to reliable improvements in the patient's symptoms. The purpose of this review article is to describe the anatomy, pathophysiology, classification, indications, and surgical technique of arthroscopic repair of superior labral tears. The surgical technique we present involves using 1 anchor with 2 sutures to anchor the superior labrum anterior to posterior tear to the superior glenoid tubercle.     

SLAP lesions: anatomy, clinical presentation, MR imaging diagnosis and characterization

Superior labral anterior posterior (SLAP) tears are an abnormality of the superior labrum usually centered on the attachment of the long head of the biceps tendon. Tears are commonly caused by repetitive overhead motion or fall on an outstretched arm. SLAP lesions can lead to shoulder pain and instability. Clinical diagnosis is difficult thus imaging plays a key diagnostic role. The normal anatomic variability of the capsulolabral complex can make SLAP lesions a diagnostic challenge. Concurrent shoulder injuries are often present including rotator cuff tears, cystic changes or marrow edema in the humeral head, capsular laxity, Hill-Sachs or Bankart lesion. The relevant anatomy, capsulolabral anatomic variants, primary and secondary findings of SLAP tears including MR arthrography findings, types of SLAP lesions and a practical approach to labral lesions are reviewed.