Nondisplaced Tear

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Labral Torn Rotator Cuff

Fig. 2. Subcortical cysts and posterior capsular stripping in a 16-year-old male who had right shoulder pain when throwing for 3 months. (A) Subcortical cysts (arrow) in the greater tuberosity at the insertion of the supraspinatus tendon are seen as high signal intensity on a fat-suppressed T2-weighted image. (B) Axial gradient echo T2-weighted image shows a nondisplaced tear of the posterior labrum and capsular stripping (arrow).

Labral Tear

Fig. 3. Posterosuperior labral tear and impaction of the greater tuberosity in a 17-year-old female pitcher who had right shoulder pain and impingement for 5 years. (A) Axial proton-density image through the superior humeral head, which should normally be round, shows flattening of the posterosuperior aspect (arrows). (B) Axial proton-density weighted image demonstrates curvilinear high signal intensity extending from the articular surface into the posterior aspect of the labral (arrow), indicating a nondetached tear.

Fig. 3. Posterosuperior labral tear and impaction of the greater tuberosity in a 17-year-old female pitcher who had right shoulder pain and impingement for 5 years. (A) Axial proton-density image through the superior humeral head, which should normally be round, shows flattening of the posterosuperior aspect (arrows). (B) Axial proton-density weighted image demonstrates curvilinear high signal intensity extending from the articular surface into the posterior aspect of the labral (arrow), indicating a nondetached tear.

clinically significant and not repaired. In a Type II lesion, there is frank stripping of the superior part of the labrum along with the attached long head of the biceps tendon from the glenoid labrum (Fig. 6). Types III and IV are buckle-handle tears of the labrum that do not or do extend into the long head of the biceps tendon, respectively. Type I and II tears are associated with throwing, whereas Type III and IV tears are associated with a fall on an outstretched arm [29]. Type II lesions are the most common; these have been divided into A, B, and C subtypes, which involve the anterosuperior, posterosuperior (resulting from internal impingement), or entire superior half of the labrum, respectively [30]. MRI findings may be linear abnormal signal intensity within the labrum that extends to the labral surface or frank cleavage of the labrum.

Rotator Cuff Mri Image
Fig. 4. Axial proton-density image shows a small focal divot in the posterosuperior aspect of the humeral head (arrow), mimicking a Hill-Sachs defect, in a 16-year-old male who had pain when throwing for 2 to 3 years.

Fig. 5. Posterosuperior glenoid sclerosis in a 15-year-old male who had pain when throwing a baseball. Axial proton-density weighted image at the level of the proximal humeral physis demonstrates decreased signal intensity within the posterosuperior aspect of the glenoid (arrows) due to sclerosis.

On MR arthrography, contrast material insinuates into the tears [3]. The sensitivity for detection of SLAP lesions on conventional MRI ranges widely, but it is generally 75% to 86%, with sensitivities reported as low as 41% and as high as 98% in four separate studies [31-34]. The sensitivity for MR arthrography ranges from 82% to 89% [29,35,36]. Arm traction may also be applied to the wrist using 1- to 3-kg weights during MR arthrography with the arm in external rotation to improve accuracy in detecting and characterizing SLAP tears. Using this technique in a cadaver model, two observers detected six of seven and five of seven SLAP tears without traction; these figures increased to seven and six, respectively, with arm traction. In addition, both observers categorized only three of seven SLAP tears correctly without traction but characterized six

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Fig. 6. Type II SLAP tear. (A) Oblique coronal fat-suppressed T2-weighted image at the biceps-labral junction demonstrates irregularity of the undersurface of the biceps (small arrows), due to fraying and shallow tears, and linear high signal intensity tear (large arroW) in the superior aspect of the labrum. (B) Oblique coronal fat-suppressed T2-weighted image posterior to the biceps-labral junction shows the high signal intensity tear (arrow) in the superior labrum.

Fig. 6. Type II SLAP tear. (A) Oblique coronal fat-suppressed T2-weighted image at the biceps-labral junction demonstrates irregularity of the undersurface of the biceps (small arrows), due to fraying and shallow tears, and linear high signal intensity tear (large arroW) in the superior aspect of the labrum. (B) Oblique coronal fat-suppressed T2-weighted image posterior to the biceps-labral junction shows the high signal intensity tear (arrow) in the superior labrum.

correctly with arm traction [13]. In clinical series, undercaHing and overcaHing of Type I lesions, as well as confusion of Type II lesions with the sublabral recesses and foramen, which are normal anatomic variants, have been cited as potential sources of decreased accuracy [3,29].

Bennett [37] described mineralization of the posterior inferior glenoid in overhead throwing athletes and believed it was due to traction from the long head of the triceps muscle. However, it actually occurs in the area of the attachment of the posterior band of the inferior glenohumeral ligament [38] and represents a sign of chronic capsular traction from the repetitive throwing motion [39]. Although the Bennett's lesion has been associated with posterior shoulder pain during the late cocking, acceleration, and follow-through phases of the throw [40], it is also found in asymptomatic pitchers [39]. Radiographically, the lesion may be best detected with the patient supine, the beam angled 5° cephalad, and the arm abducted 90° and externally rotated 90° [37]. Alternatively, CT can demonstrate the small traction osteophyte as a crescent-shaped focus of calcification in the posteroinferior aspect of the labrum extending toward the humeral head [41,42]. The lesion may also be seen on axial MR images as a focus of signal void when it is calcified, or as having the same signal as the bony glenoid when it is ossified (Fig. 7). Patients who have larger Bennett's lesions (>100 mm2) tend to have poorer outcomes, with failure to return to their preinjury levels of activity [39].

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Responses

  • tomas
    What is a nondisplaced tear?
    8 years ago
  • magnus
    What is subcortical cystic on the greater tuberosity?
    8 years ago
  • giacobbe
    What is nondisplaced undersurface tear of the labrum posterior inferior?
    8 years ago
  • romola
    What are symptoms of subcortical cysts at greater tuberosity?
    8 years ago
  • MARIGOLD
    What re subcortical cysts in the greater tuberosity region of the arm?
    8 years ago
  • Rudibert
    What is linear high signal in posterior aspect of labrum?
    7 years ago
  • ted roper
    What is a nondisplaced slap tear?
    7 years ago
  • colombano
    Is a subcortial cyst the same as a slsp lesion?
    5 years ago
  • liisi
    What is a non displaced tear in your shoulder?
    4 years ago
  • Severino
    What is nondisplaced posterosuperior labral tear?
    8 months ago
  • eleleta
    When must a Nondisplaced tear of the posterior inferior glenoid labrum be repaired surgically?
    4 months ago
  • wegahta
    What is chronic nondisplaced nearcircumferential labral tear?
    4 months ago

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