Skip to main content

Advertisement

SpringerLink
Log in

MR arthrographic assessment of suspected posteroinferior labral lesions using flexion, adduction, and internal rotation positioning of the arm: preliminary experience

  • Technical Report
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

Imaging the shoulder in the position of flexion, adduction, and internal rotation (FADIR) may be useful in characterizing lesions of the posteroinferior labrum. The purpose of this preliminary study is to illustrate the diagnostic utility of FADIR positioning in the assessment and characterization of posteroinferior labral tears.

Materials and Methods

In the FADIR position, the arm is placed across the chest, with the hand on the contralateral shoulder and palm facing outwards. FADIR positioning was performed if there was a subtle or equivocal abnormality of the posteroinferior labrum on conventional MR arthrography sequences. A retrospective review of the charts of 9 people who were imaged using FADIR positioning in addition to routine MR arthrographic sequences of the shoulder was performed. The review included the indication for the study, documentation of presence of clinical posterior instability, and surgical correlation, where available.

Results

In all 9 patients, FADIR positioning helped confirm, exclude, or better characterize a posteroinferior labral abnormality by increasing the diagnostic confidence.

Conclusion

Flexion, adduction, and internal rotation positioning appears to be a useful adjunct in evaluating patients with equivocal or subtle posteroinferior labral abnormalities on conventional MR arthrography sequences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Bradley JP, Forsythe B, Mascarenhas R. Arthroscopic management of posterior shoulder instability: diagnosis, indications, and technique. Clin Sports Med. 2008;27:649–70.

    Article  PubMed  Google Scholar 

  2. Robinson CM, Aderinto J. Recurrent posterior shoulder instability. J Bone Jt Surg Am. 2005;87:883–92.

    Article  Google Scholar 

  3. Millett PJ, Clavert P, Hatch III GFR, Warner JJP. Recurrent posterior shoulder instability. J Am Acad Orthop Surg. 2006;8:464–76.

    Google Scholar 

  4. Tibone JE, Bradley JP. The treatment of posterior subluxation in athletes. Clin Orthop Relat Res. 1993;(291):124–37.

  5. Lamar DS, Williams GR, Iannotti JP, Ramsey ML. Posterior instability of the glenohumeral joint: diagnosis and management. Univ Pa Orthop J. 2001;14:5–14.

    Google Scholar 

  6. Antoniou J, Harryman II DT. Posterior instability. Orthop Clin North Am. 2001;32:463–73.

    Article  CAS  PubMed  Google Scholar 

  7. Vidal LB, Bradley JP. Management of posterior shoulder instability in the athlete. Curr Opin Orthop. 2006;17:164–71.

    Article  Google Scholar 

  8. Papendick LW, Savoie III FH. Anatomy-specific repair techniques for posterior shoulder instability. J South Orthop Assoc. 1995;4:169–76.

    CAS  PubMed  Google Scholar 

  9. Jbara M, Chen Q, Marten P, Morcos M, Beltran J. Shoulder MR arthrography: how, why, when. Radiol Clin North Am. 2005;43:683–92.

    Article  PubMed  Google Scholar 

  10. Hottya GA, Tirman PFJ, Bost FW, et al. Tear of the posterior stabilizers after posterior dislocation: MR imaging and MR arthrographic findings with arthroscopic correlation. AJR Am J Roentgenol. 1998;171:763–8.

    CAS  PubMed  Google Scholar 

  11. Beltran J, Rosenberg ZS, Chandnani VP, et al. Glenohumeral instability: evaluation with MR arthrography. Radiographics. 1997;17:657–73.

    CAS  PubMed  Google Scholar 

  12. Beltran J, Kim DH-M. MR imaging of shoulder instability injuries in the athlete. Mag Reson Imaging Clin N Am. 2003;11:221–38.

    Article  Google Scholar 

  13. Tirman PF, Palmer WE, Feller JF. MR arthrography of the shoulder. Magn Reson Imaging Clin N Am. 1997;5:811–39.

    CAS  PubMed  Google Scholar 

  14. Chandnani VP, Yeager TD, DeBerardino T, et al. Glenoid labral tears: prospective evaluation with MRI imaging, MR arthography, and CT arthrography. AJR Am J Roentgenol. 1993;161:1229–35.

    CAS  PubMed  Google Scholar 

  15. Cvitanic O, Tirman PF, Feller JF, et al. Using abduction and external rotation of the shoulder to increase the sensitivity of MR arthrography in revealing tears of the anterior glenoid labrum. AJR Am J Roentgenol. 1997;167:837–44.

    Google Scholar 

  16. Song HT, Huh YM, Kim S, et al. Anterior-inferior labral lesions of recurrent shoulder dislocation evaluated by MR arthrography in an adduction internal rotation (ADIR) position. J Magn Reson Imaging. 2006;23:29–35.

    Article  PubMed  Google Scholar 

  17. Harish S, Nagar A, Moro J, et al. Imaging findings in posterior instability of the shoulder. Skeletal Radiol. 2008;37:693–707.

    Article  PubMed  Google Scholar 

  18. Resnick D, Kang HS, Pretterklieber ML. Shoulder. In: Resnick D, Kang HS, Pretterklieber ML, editors. Internal derangement of joints, vol 1. 2nd ed. Philadelphia: Saunders; 2007. p. 713–1122.

    Google Scholar 

  19. Kaplan LD, Flanigan DC, Norwig, et al. Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med. 2005;33:1142–6.

    Article  PubMed  Google Scholar 

  20. Shah N, Tung GA. Imaging signs of posterior glenohumeral instability. AJR Am J Roentgenol. 2009;192:730–5.

    Article  PubMed  Google Scholar 

  21. Tung GA, Hou DD. MR arthrography of the posterior labrocapsular complex: relationship with glenohumeral joint alignment and clinical posterior instability. AJR Am J Roentgenol. 2003;180:369–75.

    PubMed  Google Scholar 

  22. Saupe N, White LM, Bleakney R, et al. Acute traumatic posterior shoulder dislocation: MR findings. Radiology. 2008;248:185–93.

    Article  PubMed  Google Scholar 

  23. Simons P, Joekes E, Nelissen RG, Bloem JL. Posterior labrocapsular periosteal sleeve avulsion complicating locked posterior shoulder dislocation. Skeletal Radiol. 1998;27:588–90.

    Article  CAS  PubMed  Google Scholar 

  24. Yu JS, Ashman CJ, Jones G. The POLPSA lesion: MR imaging findings with arthroscopic correlation in patients with posterior instability. Skeletal Radiol. 2002;31:396–9.

    Article  PubMed  Google Scholar 

  25. Kim SH, Ha KI, Yoo JC, Noh KC. Kim’s lesion: an incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy. 2004;20:712–20.

    PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We extend thanks to all MR technologists at St. Joseph’s Healthcare for their help with this study. We would also like to thank Glen Oomen for preparation of the illustrations, Dr. Nick Plaskos for his help.

Author information

Authors and Affiliations

  1. Department of Radiology, McMaster University, Hamilton, ON, Canada

    Mary M. Chiavaras & Srinivasan Harish

  2. Department of Diagnostic Imaging, St. Joseph’s Healthcare, Hamilton, ON, L8N 2A6, Canada

    Srinivasan Harish & Janet Burr

Authors
  1. Mary M. Chiavaras
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Srinivasan Harish
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janet Burr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Srinivasan Harish.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chiavaras, M.M., Harish, S. & Burr, J. MR arthrographic assessment of suspected posteroinferior labral lesions using flexion, adduction, and internal rotation positioning of the arm: preliminary experience. Skeletal Radiol 39, 481–488 (2010). https://doi.org/10.1007/s00256-010-0907-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-010-0907-3

Keywords

Search

Navigation