CT and MR Arthrography of the Normal and Pathologic Anterosuperior Labrum and Labral-Bicipital Complex1
Michel De Maeseneer, MD ,
Frans Van Roy, RA,
Leon Lenchik, MD ,
Maryam Shahabpour, MD ,
Jon Jacobson, MD,
Kyung N. Ryu, MD ,
Frank Handelberg, MD and
Michel Osteaux, MD
1 From the Departments of Radiology (M.D.M., M.S., M.O.), Experimental Anatomy (F.V.R.), and Orthopedic Surgery (F.H.), Vrije Universiteit Brussel, Laerbeeklaan 101, 1090 Jette, Belgium; the Department of Radiology, Bowman Gray School of Medicine, Winston-Salem, NC (L.L.); the Department of Radiology, University of Michigan Medical Center, Ann Arbor (J.J.); and the Department of Radiology, Kyung Hee University Hospital, Seoul, South Korea (K.N.R.). Recipient of a Certificate of Merit award for a scientific exhibit at the 1998 RSNA scientific assembly. Received January 21, 2000; revision requested February 23 and received April 6; accepted April 19. Address correspondence to M.D.M. (e-mail: midema@village.uunet.be).
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Figure 1. Normal shoulder anatomy. Photograph of a plastic model shows the superior glenohumeral ligament (purple), middle glenohumeral ligament (dark yellow), anterior band of the inferior glenohumeral ligament (orange), axillary pouch of the inferior glenohumeral ligament (red), biceps tendon (bright yellow), labrum (white), and glenoid (light gray).
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Figure 2. Normal shoulder anatomy. Photograph of a gross specimen shows the labrum (L), biceps tendon (t), anterior band of the inferior glenohumeral ligament (arrowheads), middle glenohumeral ligament (arrow), superior glenohumeral ligament (*), subscapularis tendon (S), glenoid (G), and opening to the subcoracoid recess (O).
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Figure 3. Normal biceps tendon in a 36-year-old man. Transverse MR arthrogram (repetition time msec/echo time msec = 500/12) demonstrates the attachment of the biceps tendon (arrowheads) on the superior labrum (arrows).
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Figure 4. Normal biceps tendon in a 37-year-old woman. Transverse CT arthrogram (1-mm section thickness) shows the biceps tendon (arrowheads) and superior glenohumeral ligament (arrow).
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Figure 5. Normal biceps anchor. Drawing representing a coronal section obtained at the level of the labral-bicipital complex illustrates the biceps tendon (B), superior labrum (L), and glenoid cartilage (C), all of which are intimately related in this region.
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Figure 6. Normal biceps tendon. Drawing of the biceps tendon attachment at the level of the superior labrum and glenoid illustrates attachments to the superior glenoid rim (1), the posterior (2) and anterior (3) labrum, and the base of the coracoid process (4).
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Figure 7. Normal superior glenohumeral ligament in an 18-year-old woman. Sagittal fat-saturated T1-weighted MR arthrogram (750/15) shows the biceps tendon (t), subscapularis tendon (S), middle glenohumeral ligament (open arrows), and superior glenohumeral ligament (solid arrow).
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Figure 8. Normal middle glenohumeral ligament in a 30-year-old man. CT arthrogram (2-mm section thickness) shows the middle glenohumeral ligament (arrowhead) attached to the anterior labrum (arrow).
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Figure 9. Normal middle glenohumeral ligament in an 18-year-old woman. Transverse fat-saturated MR arthrogram (560/14) demonstrates the middle glenohumeral ligament attaching medially on the glenoid neck (arrow).
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Figure 10. Absent middle glenohumeral ligament in a 40-year-old woman. CT arthrogram (2-mm section thickness) demonstrates absence of the middle glenohumeral ligament (*) and a wide anterior joint recess (arrowheads).
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Figure 11. Normal inferior glenohumeral ligament in an 18-year-old woman. Sagittal fat-saturated T1-weighted MR arthrogram (750/15) demonstrates the biceps tendon (t), subscapularis tendon (S), and anterior and posterior bands of the inferior glenohumeral ligament (arrows).
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Figure 12. Normal inferior glenohumeral ligament in a 57-year-old man. CT arthrogram (2-mm section thickness) shows the anterior band of the inferior glenohumeral ligament in the axillary joint recess (arrow).
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Figure 13. Superior sublabral recess. Drawings representing a coronal section through the labral-bicipital complex illustrate type I (1), type II (2), and type III (3) labral attachments. In type I, the labrum (L) is tightly attached to the glenoid, whereas in types II and III, a recess is present between the labrum and glenoid (arrow). B = biceps tendon, C = cartilage.
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Figure 14. Type III superior sublabral recess. Coronal section of a cadaveric shoulder specimen demonstrates a sublabral recess (arrow) between the superior labrum (L) and the glenoid cartilage (c). (Courtesy of Donald L. Resnick, MD, Veterans Affairs Medical Center, San Diego, Calif.)
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Figure 15. Type II superior sublabral recess. Photograph of a plastic model demonstrates a normal recess between the superior labrum and the glenoid (arrows). Note the sharp free edge of the superior labrum.
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Figure 16. Type I labral attachment in a 17-year-old girl. On a coronal MR arthrogram (560/14), the labrum (black arrow) is tightly attached to the glenoid cartilage and biceps tendon (white arrow).
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Figure 17. Type II labral attachment. Coronal fat-saturated T1-weighted MR arthrogram (744/20) shows a small recess between the labrum and the glenoid cartilage (arrow). b = biceps tendon. (Courtesy of P. Vanhoenacker, MD, O.L.V. Ziekenhuis, Aalst, Belgium.)
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Figure 18. Type III labral attachment in a 22-year-old man. Reconstructed image from a coronal CT arthrogram (1-mm-thick transverse sections) shows a large recess between the labrum and the glenoid (arrow).
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Figure 19. Sublabral foramen. Photograph of a plastic model demonstrates a sublabral foramen at the 2 o'clock position between the labrum and the glenoid. A red plastic arrow is shown passing through the foramen.
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Figure 20. Sublabral foramen in a 14-year-old girl. Transverse CT arthrogram (2-mm section thickness) demonstrates contrast material between the anterosuperior labrum and the glenoid cartilage (arrow).
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Figure 21. Buford complex. Photograph of a plastic model demonstrates absence of the anterosuperior labrum (*) and cordlike thickening of the middle glenohumeral ligament (m).
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Figure 22a. Buford complex. Sagittal (a) and transverse (b) fat-saturated MR arthrograms (640/14) demonstrate a thick, cordlike middle glenohumeral ligament (arrowheads). Note the absence of the anterosuperior labrum on the transverse image (arrow in b). S in a indicates subscapularis muscle and tendon.
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Figure 22b. Buford complex. Sagittal (a) and transverse (b) fat-saturated MR arthrograms (640/14) demonstrate a thick, cordlike middle glenohumeral ligament (arrowheads). Note the absence of the anterosuperior labrum on the transverse image (arrow in b). S in a indicates subscapularis muscle and tendon.
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Figure 23. Anterior labrum. Drawings representing a transverse section through the middle aspect of the shoulder joint illustrate various appearances of the anterior labrum. This structure may be triangular (1), undersized (2), blunt-tipped (arrow in 3), or crescentic (4). Alternatively, there may be a recess between the anterior labrum and the cartilage (arrow in 5), the middle glenohumeral ligament may be located proximal to the anterior labrum (m in 6), or the anterior labrum may appear small and be accompanied by a thickened inferior glenohumeral ligament (i in 7).
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Figure 24. Tear of the anterior labrum. Photograph of a plastic model shows extensive fraying of the anterior labrum (arrows).
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Figure 25. Tear of the anterior labrum. Sagittal fat-saturated MR arthrogram (744/20) demonstrates absence of the labrum and residual irregularity of the anterior glenoid (arrows). (Courtesy of P. Vanhoenacker, MD, O.L.V. Ziekenhuis, Aalst, Belgium.)
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Figure 26. Tear of the anterior labrum in a 26-year-old man. Transverse CT arthrogram (2-mm section thickness) shows injected contrast material extending into a tear of the anterior labrum (arrow).
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Figure 27. Bankart lesion in a 28-year-old man. Transverse CT arthrogram (2-mm section thickness) demonstrates absence of the anteroinferior labrum and a compressed fracture fragment of the bony glenoid (arrow).
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Figure 28. SLAP lesions and anatomic variants. Drawings 1-4 representing a coronal section through the labral-bicipital attachment illustrate the different types of SLAP lesions: type I, fraying or tear of the superior labrum (arrow in 1); type II, detachment of the labral-bicipital complex from the superior glenoid (arrow in 2); type III, a bucket handle tear of the superior labrum (arrows in 3); and type IV, a bucket handle tear with extension into the biceps tendon (arrow in 4). Drawings 5 and 6 illustrate anatomic variants that do not represent SLAP lesions, including degenerative fraying of the biceps tendon (arrow in 5) and a type III superior sublabral recess (arrow in 6).
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Figure 29. Type I SLAP lesion. Photograph of a plastic model shows fraying of the superior labrum (arrows).
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Figure 30. Type I SLAP lesion in a 55-year-old man. Coronal MR arthrogram (560/20) demonstrates a small tear involving the central portion of the superior labrum (arrow).
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Figure 31. Type II SLAP lesion. Photograph of a plastic model shows detachment of the superior labrum from the glenoid (arrows). Note the irregular fraying and hemorrhagic aspect of the free edge of the labrum.
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Figure 32. Type II SLAP lesion in a 37-year-old man. Coronal MR arthrogram (520/14; flip angle, 40°) demonstrates contrast material between the superior labrum and the glenoid (arrow). Note also the slight irregularity of the labral margin (arrowhead).
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Figure 33. Type II SLAP lesion. Coronal fat-saturated MR arthrogram (700/16) shows contrast material between the superior labrum and the glenoid (arrow). Note the lateral extension of the tear of the superior labrum.
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Figure 34. Type II SLAP lesion in a 26-year-old man. CT arthrogram (1-mm section thickness) shows contrast material between the superior labrum and the superior glenoid rim (arrow). The wide separation indicates a SLAP lesion.
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Figure 35. Type II SLAP lesion. On a photograph obtained during arthroscopy, the superior labrum (S) is separated from the superior glenoid rim. Note the irregular fraying of the free edge of the superior labrum (arrowheads). G = glenoid, H = humeral head.
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Figure 36. Type II SLAP lesion versus superior sublabral recess. Drawings representing a coronal section through the labral-bicipital attachment demonstrate a normal recess with a sharp free edge of the labrum (arrow in 1), a type II SLAP lesion with an irregular appearance of the free edge of the labrum (arrow in 2), a type II SLAP lesion with wide separation between the superior labrum and the glenoid (arrows in 3), and a type II SLAP lesion with lateral extension of the labral tear (arrowhead in 4).
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Figure 37. Type III SLAP lesion. On a photograph of a plastic model, the superior labrum is detached from the glenoid and the biceps tendon (arrows), a finding that is similar to a bucket handle tear of the knee meniscus.
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Figure 38. Type III SLAP lesion in a 25-year-old man. Coronal T1-weighted MR arthrogram (500/16) demonstrates contrast material interposed between the labrum and the glenoid (straight arrow) as well as between the labrum and the biceps tendon (t) (curved arrow).
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Figure 39. Type III SLAP lesion in a 34-year-old woman. On a coronal reconstructed image from a CT arthrogram, the labrum (arrow) is clearly separated and displaced from both the glenoid and the biceps tendon (t).
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Figure 40. Type IV SLAP lesion. Photograph of a plastic model shows a bucket handle tear of the superior labrum (arrows). Note the extension of the tear into the biceps tendon (*).
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Figure 41. Type IV SLAP lesion. Coronal fat-saturated T1-weighted MR arthrogram (640/14) demonstrates separation of the superior labrum from the glenoid (arrow). Note the extension of the tear into the biceps tendon (arrowhead) (cf Fig 40).
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Figure 42. Type IV SLAP lesion in a 25-year-old man. Transverse fat-saturated T1-weighted MR arthrogram (660/12) shows a tear extending into the biceps tendon (arrowheads) (cf Figs 40, 41).
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Copyright © 2000 by the Radiological Society of North America.
