CASE 32
By: Dr. Waleed Althobaity, MD
HISTORY: 39-year-old female complaining of right shoulder pain.
What are your findings?
What are the differential diagnosis?
What is the most likely diagnosis?
FINDINGS:
Coronal PD FS weighted MR images in (A) and (B) demonstrate irregular fluid signal intensity cleft through the super labrum and extending toward the labrum.
Axial PD FS weighted MR images in (C) shows the fluid signal intensity of the superior labrum extending from anterior to posterior aspect of the labrum.
DIFFERENTIAL DIAGNOSIS:
SLAP Tear (Superior Labral Anterior Posterior Tear).
Sublabral recess as normal variant.
DIAGNOSIS:
SLAP Tear.
DISCUSSION AND PEARLS:
The SLAP tear is an injury of the superior labrum that extends in an anterior-to-posterior direction. SLAP lesions are relatively common in athletes, usually resulting from a repetitive traction or torsion injury to the biceps tendon. MRI features are abnormal morphology and hyperintensity of the superior labrum are seen on coronal oblique images. Linear high signal within the normal low-signal labrum is a primary finding. The orientation of the linear signal is important in differentiating a tear from a normal variant, such as a sulcus, sublabral hole or articular cartilage. Signal within the labrum is more likely to be abnormal than signal paralleling the glenoid margin.
Features of labral tears include:
Lateral orientation of the high signal intensity on oblique coronal images.
Irregular margins.
Increased depth of separation from the glenoid articular surface greater than 2 mm.
Extension posterior to the biceps tendon.
Abnormal morphology or signal of the labrum.
In contrast, normal variants features are:
Medially oriented high signal intensity on oblique coronal images, smooth margins.
Minimal separation.
Normal dark labral signal.
Don’t forget an important secondary sign of labral tear is a paralabral cyst. A para-labral cyst may be the first indication of a labral tear and almost always means a labral tear is present.
FURTHER READINGS
Musculoskeletal MRI by Asif Saifuddin.
SLAP lesions: Anatomy, clinical presentation, MR imaging diagnosis and characterization Debra Chang, Aurea Mohana-Borges, Maya Borso, Christine B. Chung.
