Superior Labral Lesions Workup

Updated: Sep 14, 2020
  • Author: S Ashfaq Hasan, MD; Chief Editor: S Ashfaq Hasan, MD  more...
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Workup

Imaging Studies

On plain radiography of the shoulder, an anteroposterior (AP) view of the shoulder in internal and external rotation, outlet, and axillary views should be obtained. [41] Findings are usually normal. Occasionally, a SLAP (superior labrum, anterior and posterior) fracture, which represents a superior humeral head compression fracture, can be observed. Plain radiographs should be carefully reviewed for other potential pathology, such as an os acromiale, an anterior acromial spur, or a degenerative acromioclavicular joint.

Nonenhanced magnetic resonance imaging (MRI) has proved to be unreliable in determining the presence of SLAP tears. [42, 43] It is useful to evaluate potential concomitant pathology, such as partial- or full-thickness rotator cuff tears. It is also valuable in detecting the presence of a paralabral cyst. Ganglion cysts encroaching on the spinoglenoid notch are associated with superior, usually posterior, labral tears.

The use of contrast medium, as in magnetic resonance arthrography, offers improved visualization of intra-articular structures and is thought to improve the ability to accurately detect SLAP tears; however, reported results continue to be highly variable. [44, 45, 46]  A study by Lee et al found that in magnetic resonance arthrography of the shoulder, T1 high-resolution isotropic volume excitation (THRIVE) sequences yielded better results than two-dimensional three-plane proton-density fat-suppressed (2D-PD-FS) sequences for diagnosing SLAP lesions. [47]

Two useful signs on MRI are those of increased signal intensity in the posterior third of the superior labrum and a laterally curved intensity. The sublabral recess does not usually extend to the posterior third of the superior labrum, and therefore, high signal intensity between the labrum and the glenoid in this region is considered to be consistent with a superior labral tear. Another MRI finding considered to be highly suggestive of a superior labral tear is laterally curved signal intensity. On the contrary, a normal sublabral recess results in a medially curved area of signal intensity.

The findings of a retrospective review study indicated that whereas multidetector computed tomography (CT) arthrography showed limitations in the overall percentage of correct classification, it showed high accuracy and interobserver reliability in the diagnosis of SLAP lesions. [48]