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Case 4 - Labral tear versus hyaline cartilage undercutting

from Section 1 - Shoulder

Published online by Cambridge University Press:  05 July 2013

D. Lee Bennett
Affiliation:
University of Iowa
Georges Y. El-Khoury
Affiliation:
University of Iowa
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Summary

Imaging description

To identify labral tears, morphologic criteria such as absence, fraying, detachment, displacement, or deformity, can be used. Fluid or contrast within the labral substance is also an indication of a labral tear (Figure 4.1). Labral tears occasionally present on MR imaging as focal or diffuse increase in signal intensity extending to the surface on all imaging sequences, but this is less reliable. In standard MR images, higher signal intensity is present between the labrum and the glenoid cartilage in short-TE sequences, occurring in the transition zone between two histologic structures. Areas of the transitional zone do not fill with contrast material in arthrographic images.

Importance

Pitfalls in standard MR imaging are related to the presence of transitional zones. The transitional zone is the area located between the fibrocartilage of the labrum and the hyaline cartilage of the glenoid.

Typical clinical scenario

Tears of the labrum are common in athletes with instability, especially those in sports that require forceful and repetitive adduction and overhead rotation of the humerus.

Differential diagnosis

Articular cartilage is frequently present between the labrum and the glenoid cortex, predominantly in the superior half of the joint. This interface can simulate a labral tear on axial MR images (Figure 4.2).

Teaching point

The most common variants and pitfalls are related to labral lesions in the anterior-superior aspect.

Type
Chapter
Information
Pearls and Pitfalls in Musculoskeletal Imaging
Variants and Other Difficult Diagnoses
, pp. 7 - 8
Publisher: Cambridge University Press
Print publication year: 2013

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References

Beltran, J, Bencardino, J, Mellado, J, Rosenberg, ZS, Irish, RD.MR arthrography of the shoulder: variants and pitfalls. Radiographics 1997;17:1403–1412.CrossRefGoogle ScholarPubMed
Mohana-Borges, AV, Chung, CB, Resnick, D.Superior labral anteroposterior tear: classification and diagnosis on MRI and MR arthrography. AJR Am J Roentgenol 2003;181:1449–1462.CrossRefGoogle ScholarPubMed
Monu, JU, Pope, TL, Chabon, SJ, Vanarthos, WJ.MR diagnosis of superior labral anterior posterior (SLAP) injuries of the glenoid labrum: value of routine imaging without intraarticular injection of contrast material. AJR Am J Roentgenol 1994;163:1425–1429.CrossRefGoogle ScholarPubMed
Rudez, J, Zanetti, M.Normal anatomy, variants and pitfalls on shoulder MRI. Eur J Radiol 2008;68:25–35.CrossRefGoogle ScholarPubMed
Steinbach, LS.MRI of shoulder instability. Eur J Radiol 2008;68:57–71.CrossRefGoogle ScholarPubMed

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