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Sonography of the Glenoid Labrum

A Cadaveric Study with Arthroscopic Correlation

Mihra S. Taljanovic1,2, Kara Lubben Carlson1,3, John E. Kuhn4, Jon A. Jacobson1, Lydia O. Delaney-Sathy1 and Ronald S. Adler1,5

1 Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Dr., TC 2910, Ann Arbor, MI 48109-0326.
2 Department of Radiology, University of Arizona HSC, 1501 N. Campbell Ave., Tucson, AZ 85724-5067.
3 Radia Medical Imaging, Evergreen Hospital Medical Center, 12040 N.E. 128th St., Kirkland, WA 98034.
4 Section of Orthopaedic Surgery, University of Michigan Health System, 24 Lloyd Wright Dr., Box 0363, Ann Arbor, MI 48106.
5 Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021.



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  		Fig. 1A. —Labral quadrant designation and sonographic transducer placement. Arrows indicate sonographic imaging plane or level of transducer placement. Drawing shows articular surface of glenoid divided into four quadrants.

 


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  		Fig. 1B. —Labral quadrant designation and sonographic transducer placement. Arrows indicate sonographic imaging plane or level of transducer placement. Photograph shows patient position for sonographic evaluation of anterosuperior (AS) quadrant in axial plane with arm abducted.

 


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  		Fig. 1C. —Labral quadrant designation and sonographic transducer placement. Arrows indicate sonographic imaging plane or level of transducer placement. Photograph shows patient position for sonographic evaluation of anteroinferior (AI) quadrant in axial plane with arm abducted and externally rotated.

 


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  		Fig. 1D. —Labral quadrant designation and sonographic transducer placement. Arrows indicate sonographic imaging plane or level of transducer placement. Photograph shows patient position for sonographic evaluation of posterosuperior (PS) and posteroinferior (PI) quadrants in axial plane with arm internally rotated.

 


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  		Fig. 2A. —The normal glenoid labrum. G = glenoid, H = humerus. Transverse sonogram of anteroinferior shoulder in cadaveric specimen from 85-year-old woman shows normal triangle-shaped hyperechoic labrum (arrows).

 


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  		Fig. 2B. —The normal glenoid labrum. G = glenoid, H = humerus. Transverse sonogram of posterosuperior shoulder in cadaveric specimen from 80-year-old man reveals normal triangle-shaped hyperechoic labrum (arrows).

 


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  		Fig. 2C. —The normal glenoid labrum. G = glenoid, H = humerus. Transverse sonogram of posteroinferior shoulder in cadaveric specimen from 85-year-old woman shows normal triangle-shaped hyperechoic labrum (arrows).

 


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  		Fig. 3. —Normal labrum misdiagnosed as labral tear in cadaveric specimen from 81-year-old woman. Although labrum appeared normal on arthroscopy (not shown), transverse sonogram of anteroinferior glenoid labrum shows no identifiable labral tissue between glenoid (G) and humerus (H).

 


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  		Fig. 4. —Degenerative glenoid labrum in cadaveric specimen from 73-year-old man. Transverse sonogram of posteroinferior glenoid labrum shows irregular contour (arrow) of hyperechoic glenoid labrum, representing degeneration at arthroscopy (not shown). G = glenoid, H = humeral head.

 


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  		Fig. 5. —Degenerative labrum misdiagnosed as normal in cadaver of 84-year-old man. Transverse sonogram of posterosuperior glenoid labrum shows normal-appearing labrum (arrows) proven degenerative on arthroscopy (not shown). G = glenoid, H = humeral head.

 


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  		Fig. 6A. —Glenoid labrum tears in cadaveric specimen from 89-year-old woman. G = glenoid, H = humerus. Transverse sonogram of anteroinferior shoulder shows irregular hyperechoic anteroinferior labrum (arrows) displaced from adjacent glenoid.

 


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  		Fig. 6B. —Glenoid labrum tears in cadaveric specimen from 89-year-old woman. G = glenoid, H = humerus. Correlative arthroscopic image of A confirms displaced anteroinferior labrum tear (arrows) or Bankart lesion.

 


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  		Fig. 6C. —Glenoid labrum tears in cadaveric specimen from 89-year-old woman. G = glenoid, H = humerus. Transverse sonogram of anterosuperior shoulder shows irregular and mixed hyperechoic and hypoechoic labral tissue (arrows) displaced from glenoid.

 


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  		Fig. 7. —Labral tear misdiagnosed as degeneration in cadaveric specimen from 74-year-old man. Although labral tear was revealed on arthroscopy (not shown), transverse sonogram of posterosuperior glenoid labrum shows apparent irregular hyperechoic posterosuperior labrum (arrows) adjacent to glenoid (G).

 


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  		Fig. 8. —Buford complex in cadaveric specimen from 85-year-old man. Transverse sonogram of anterosuperior glenoid labrum shows hyperechoic tissue (arrows) misinterpreted as normal glenoid labrum. Hyperechoic tissue likely represents thickened cordlike middle glenohumeral ligament with absence of anterosuperior glenoid labrum (Buford complex). G = glenoid, H = humeral head.

 

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