Sublabral clefts and recesses in the anterior, inferior, and posterior glenoid labrum at MR arthrography
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
To determine the prevalence of a normal variant cleft/recess at the labral–chondral junction in the anterior, inferior, and posterior portions of the shoulder joint.
Materials and methods
One hundred and three consecutive patients (106 shoulders) who had a direct MR arthrogram followed by arthroscopic surgery were enrolled in this IRB-approved study. Scans were carried out on a 1.5-T scanner with an eight-channel shoulder coil. The glenoid rim was divided into eight segments and the labrum in all but the superior and anterosuperior segments was evaluated by two radiologists for the presence of contrast between the labrum and articular cartilage. We measured the depth of any cleft/recess and correlated the MR findings with surgical results. Generalized estimating equation models were used to correlate patient age and gender with the presence and depth of a cleft/recess, and Cohen’s kappa values were calculated for interobserver variability.
For segments that were normal at surgery, a cleft/recess was present within a segment on MR arthrogram images in as few as 7 % of patients (within the posteroinferior segment by observer 1), and in up to 61 % of patients (within the posterosuperior segment by observer 1). 55–83 % of these were only 1 mm deep. A 2- to 3-mm recess was seen within 0–37 % of the labral segments, most commonly in the anterior, anteroinferior, and posterosuperior segments. Age and gender did not correlate with the presence of a cleft/recess, although there was an association between males and a 2- to 3-mm deep recess (p = 0.03). The interobserver variability for each segment ranged between 0.15 and 0.49, indicating slight to moderate agreement.
One-mm labral–chondral clefts are not uncommon throughout the labrum. A 2- to 3-mm deep smooth, medially curved recess in the anterior, anteroinferior or posterosuperior labrum can rarely be seen, typically as a continuation of a superior recess or anterosuperior labral variant.
Supplementary Material (0)
- Robinson G, Ho Y, Finlay K, Friedman L, Harish S. Normal anatomy and common labral lesions at MR arthrography of the shoulder. Clin Radiol. 2006;61(10):805–21. CrossRef
- Lee GY, Choi JA, Oh JH, Choi JY, Hong SH, Kang HS. Posteroinferior labral cleft at direct CT arthrography of the shoulder by using multidetector CT: is this a normal variant? Radiology. 2009;253(3):765–70. CrossRef
- Smith DK, Chopp TM, Aufdemorte TB, Witkowski EG, Jones RC. Sublabral recess of the superior glenoid labrum: study of cadavers with conventional nonenhanced MR imaging, MR arthrography, anatomic dissection, and limited histologic examination. Radiology. 1996;201:251–6.
- Tirman PF, Feller JF, Palmer WE, Carroll KW, Steinbach LS, Cox I. The Buford complex—a variation of normal shoulder anatomy: MR arthrographic imaging features. AJR Am J Roentgenol. 1996;166(4):869–73.
- Modarresi S, Motamedi D, Jude CM. Superior labral anteroposterior lesions of the shoulder: part 1, anatomy and anatomic variants. AJR Am J Roentgenol. 2011;197(3):596–603. CrossRef
- Fitzpatrick D, Walz DM. Shoulder MR imaging normal variants and imaging artifacts. Magn Reson Imaging Clin N Am. 2010;18(4):615–32. CrossRef
- Waldt S, Metz S, Burkart A, Mueller D, Bruegel M, Rummeny EJ, et al. Variants of the superior labrum and labro-bicipital complex: a comparative study of shoulder specimens using MR arthrography, multi-slice CT arthrography and anatomical dissection. Eur Radiol. 2006;16:451–8. CrossRef
- De Maeseneer M, Van Roy F, Lenchik L, Shahabpour M, Jacobson J, Ryu KN, et al. CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. Radiographics. 2000;20:S67–81.
- Beltran J, Bencardino J, Mellado J, Rosenberg Z, Irish RD. MR arthrography: variants and pitfalls. Radiographics. 1997;17:1403–12.
- Park YH, Lee JY, Moon SH, Mo JH, Yang BK, Hahn SH, et al. MR arthrography of the labral capsular ligamentous complex in the shoulder: imaging variations and pitfalls. AJR Am J Roentgenol. 2000;175:667–72.
- Tuite MJ, Blankenbaker DG, Seifert M, Ziegert AJ, Orwin JF. Sublabral foramen and buford complex: inferior extent of the unattached or absent labrum in 50 patients. Radiology. 2002;223(1):137–42. CrossRef
- Rudez J, Zanetti M. Normal anatomy, variants and pitfalls on shoulder MRI. Eur J Radiol. 2008;68(1):25–35. CrossRef
- Tuite MJ, Orwin JF. Anterosuperior labral variants of the shoulder: appearance on gradient-recalled-echo and fast spin-echo MR images. Radiology. 1996;199(2):537–40.
- Kanatli U, Ozturk BY, Bolukbasi S. Anatomical variations of the anterosuperior labrum: prevalence and association with type II superior labrum anterior-posterior (SLAP) lesions. J Shoulder Elbow Surg. 2010;19(8):1199–203. CrossRef
- Cooper D, Arnoczky S, O’Brien S, et al. Anatomy, histology, and vascularity of the glenoid labrum. J Bone Joint Surg Am. 1992;74A(1):46–52.
- Longo C, Loredo R, Yu J, Salonen D, Haghighi P, Trudell D, et al. Pictorial essay. MRI of the glenoid labrum with gross anatomic correlation. J Comput Assist Tomogr. 1996;20(3):487–95. CrossRef
- Moseley HF, Overgaard B. The anterior capsular mechanism in recurrent anterior dislocation of the shoulder. J Bone Joint Surg Br. 1962;44B(4):913–27.
- O’Brien SJ, Allen AA, Fealy S, Rodeo SA, Arnoczky SP. Developmental anatomy of the shoulder and anatomy of the glenohumeral joint. In: Rockwood CA, Matsen FA, editors. The shoulder. Philadelphia: Saunders; 1998. p. 1–33.
- Prodromos CC, Ferry JA, Schiller AL, Zarins B. Histological studies of the glenoid labrum from fetal life to old age. J Bone Joint Surg Am. 1990;72(9):1344–8.
- Rispoli DM, Athwal GS, Sperling JW, Cofield RH. The macroscopic delineation of the edge of the glenoid labrum: an anatomic evaluation of an open and arthroscopic visual reference. Arthroscopy. 2009;25(6):603–7. CrossRef
- Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74. CrossRef
- Team RDC. R: A language and environment for statistical computing. http://www.R-project.org; Vienna, Austria: R Foundation for Statistical Computing; 2009.
- Carey VJ, Lumley T, Ripley B. gee: Generalized Estimation Equation solver. R package version. http://CRAN.R-project.org/package=gee. 2010.
- Kreitner K, Botchen K, Rude J, Bittinger F, Krummenauer F, Thelen M. Superior labrum and labral-bicipital complex: MR imaging with pathologic-anatomic and histologic correlation. AJR Am J Roentgenol. 1998;170:599–605.
- Bencardino JT, Beltran J, Rosenberg ZS, Rokito A, Schmahmann S, Mota J, et al. Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder. Radiology. 2000;214:267–71.
- Tuite MJ, Rutkowski A, Enright T, Kaplan L, Fine JP, Orwin J. Width of high signal and extension posterior to biceps tendon as signs of superior labrum anterior to posterior tears on MRI and MR arthrography. AJR Am J Roentgenol. 2005;185(6):1422–8. CrossRef
- Jin W, Ryu KN, Kwon SH, Rhee YG, Yang DM. MR arthrography in the differential diagnosis of type II superior labral anteroposterior lesion and sublabral recess. AJR Am J Roentgenol. 2006;187(4):887–93. CrossRef
- Palmer WE, Caslowitz PL, Chew FS. MR arthrography of the shoulder: normal intraarticular structures and common abnormalities. AJR Am J Roentgenol. 1995;164(1):141–146.
- Van Grinsven S, Kesselring FO, van Wassenaer-van Hall HN, Lindeboom R, Lucas C, van Loon CJ. MR arthrography of traumatic anterior shoulder lesions showed modest reproducibility and accuracy when evaluated under clinical circumstances. Arch Orthop Trauma Surg. 2007;127(1):11–7. CrossRef
- Palmer WE, Caslowitz PL. Anterior shoulder instability: diagnostic criteria determined from prospective analysis of 121 MR arthrograms. Radiology. 1995;197(3):819–25.
- Applegate GR, Hewitt M, Snyder S, Watson E, Kwak SM, Resnick D. Chronic labral tears: value of magnetic resonance arthrography in evaluating the glenoid labrum and labral-bicipital complex. Arthroscopy. 2004;20:959–63.
- Cvitanic O, Tirman PF, Feller JF, Bost FW, Minter J, Carroll KW. Using abduction and external rotation of the shoulder to increase the sensitivity of MR arthrography in revealing tears of the anterior labrum. AJR Am J Roentgenol. 1997;169:837–44.
- Lee MJ, Motamedi K, Chow K, Seeger LL. Gradient-recalled echo sequences in direct shoulder MR arthrography for evaluating the labrum. Skeletal Radiol. 2008;37(1):19–25. CrossRef
- Waldt S, Burkart A, Imhoff AB, Bruegel M, Rummeny EJ, Woertler K. Anterior shoulder instability: accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries. Radiology. 2005;237(2):578–83. CrossRef
- DePalma A. Surgery of the shoulder. 2nd ed. Philadelphia: Lippincott; 1973. p. 206–35.
- DePalma AF, Gallery G, Bennett G. Variational anatomy and degenerative lesions of the shoulder joint. In: Edwards J, editor. Instructional course lectures: the American Academy of Orthopedic Surgeons. St. Louis: Mosby; 1949. p. 225–81.
- Tena-Arregui J, Barrio-Asensio C, Puerta-Fonolla J, Murillo-Gonzalez J. Arthroscopic study of the shoulder joint in fetuses. Arthroscopy. 2005;21(9):1114–9. CrossRef
- Deutsch AL, Resnick D, Mink J, Berman J, Cone R, Resnick C, et al. Computed and conventional arthrotomography of the glenohumeral joint: normal anatomy and clinical experience. Radiology. 1984;153:603–9.
- Ilahi OA, Labbe MR, Cosculluela P. Variants of the anterosuperior glenoid labrum and associated pathology. Arthroscopy. 2002;18(8):882–6. CrossRef
- Rao AG, Kim TK, Chronopoulos E, McFarland EG. Anatomical variants in the anterosuperior aspect of the glenoid labrum: a statistical analysis of seventy-three cases. J Bone Joint Surg Am. 2003;85-A(4):653–9.
- Waldt S, Burkart A, Lange P, Imhoff AB, Rummeny EJ, Woertler K. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. AJR Am J Roentgenol. 2004;182:1271–8.
About this Article
- Sublabral clefts and recesses in the anterior, inferior, and posterior glenoid labrum at MR arthrography
Volume 42, Issue 3 , pp 353-362
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- MR arthrography
- Normal variants
- Industry Sectors
- Author Affiliations
- 1. Department of Radiology, University of Wisconsin School of Medicine and Public Health, Box 3252, 600 Highland Avenue, Madison, WI, 53792-3252, USA
- 2. Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA