Superior Labrum Lesions Workup

Updated: Nov 24, 2021
  • Author: Riley J Williams, III, MD; Chief Editor: Craig C Young, MD  more...
  • Print

Imaging Studies

Imaging studies included in the workup are as follows:

  • Radiographic examination: Routine radiographic examination, including anteroposterior (neutral), axillary, and supraspinatus outlet views of the shoulder joint should be obtained for all patients with suspected shoulder pathology. Although these studies are typically unrevealing, other conditions (eg, glenohumeral arthritis, AC joint arthritis, humeral head migration) may be demonstrated on radiographs. Occasionally, a SLAP fracture or superior humeral head compression fracture may be evident.

  • Magnetic resonance studies

    • MRI is routinely used as part of the initial workup in patients with suspected SLAP lesions; however, if the results of these studies remain inconclusive in the presence of strong historical and physical evidence that suggest labral pathology, magnetic resonance (MR) arthrography is considered. [25, 26]

    • Numerous authors have confirmed the utility of gadolinium-enhanced MR arthrography in the detection of labral lesions and injury to the LHB. The sensitivity of this method has been reported to be 82-96%, and the specificity is 91-98%. [27, 28]

    • Monu et al suggested that coronal images were the most effective in revealing labral lesions on MRI (as shown below). [27] MRI findings that suggest damage to the labrum or LHB tendon include the following:

      • High signal intensity at the labrum/anchor interface

      • Increased signal at the superior glenoid fossa

      • Displacement of the superior labrum away from the glenoid surface

      • Presence of a glenoid-labral cyst

        Coronal magnetic resonance arthrogram. This image Coronal magnetic resonance arthrogram. This image demonstrates detachment of the superior glenoid labrum.
    • Although the presence of labral pathology can be delineated via MR arthrography, the precise classification of SLAP lesions utilizing this method remains less reliable.

    • Knowledge of normal variants of the anterosuperior labrum, such as a sublabral foramen or Buford complex, is essential because these findings can be misleading in the context of the MRI.