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MR Arthrography of the Labral Capsular Ligamentous Complex in the Shoulder

Imaging Variations and Pitfalls

¹ Department of Radiology, National Police Hospital, 58 Karakbon-dong, Songpa-gu, Seoul, 138-169, Korea.
² Department of Radiology, Samsung Medical Center, 50 Irwon-dong, Kangnam-gu, Seoul, 135-710, Korea.
³ Department of Orthopedic Surgery, National Police Hospital, Songpa-gu, Seoul, 138-169, Korea.
⁴ Department of Radiology, University of California at San Diego Medical Center, 200 W. Arbor Dr., San Diego, CA 92103.

View larger version (15K): [in a new window]   Fig. 1A. —Labral shapes. Drawings show triangular labrum, anteriorly and posteriorly (A); round labrum, anteriorly and posteriorly (B); cleaved labrum, anteriorly (C); notched labrum, anteriorly (D); notch extends in labrum in more vertical fashion than horizontally oriented cleft; flat labrum, anteriorly and posteriorly (E); and absent labrum, anteriorly and posteriorly (F). Note glenoid rim has no visible labrum.

View larger version (15K): [in a new window]   Fig. 1B. —Labral shapes. Drawings show triangular labrum, anteriorly and posteriorly (A); round labrum, anteriorly and posteriorly (B); cleaved labrum, anteriorly (C); notched labrum, anteriorly (D); notch extends in labrum in more vertical fashion than horizontally oriented cleft; flat labrum, anteriorly and posteriorly (E); and absent labrum, anteriorly and posteriorly (F). Note glenoid rim has no visible labrum.

View larger version (15K): [in a new window]   Fig. 1C. —Labral shapes. Drawings show triangular labrum, anteriorly and posteriorly (A); round labrum, anteriorly and posteriorly (B); cleaved labrum, anteriorly (C); notched labrum, anteriorly (D); notch extends in labrum in more vertical fashion than horizontally oriented cleft; flat labrum, anteriorly and posteriorly (E); and absent labrum, anteriorly and posteriorly (F). Note glenoid rim has no visible labrum.

View larger version (15K): [in a new window]   Fig. 1D. —Labral shapes. Drawings show triangular labrum, anteriorly and posteriorly (A); round labrum, anteriorly and posteriorly (B); cleaved labrum, anteriorly (C); notched labrum, anteriorly (D); notch extends in labrum in more vertical fashion than horizontally oriented cleft; flat labrum, anteriorly and posteriorly (E); and absent labrum, anteriorly and posteriorly (F). Note glenoid rim has no visible labrum.

View larger version (15K): [in a new window]   Fig. 1E. —Labral shapes. Drawings show triangular labrum, anteriorly and posteriorly (A); round labrum, anteriorly and posteriorly (B); cleaved labrum, anteriorly (C); notched labrum, anteriorly (D); notch extends in labrum in more vertical fashion than horizontally oriented cleft; flat labrum, anteriorly and posteriorly (E); and absent labrum, anteriorly and posteriorly (F). Note glenoid rim has no visible labrum.

View larger version (15K): [in a new window]   Fig. 1F. —Labral shapes. Drawings show triangular labrum, anteriorly and posteriorly (A); round labrum, anteriorly and posteriorly (B); cleaved labrum, anteriorly (C); notched labrum, anteriorly (D); notch extends in labrum in more vertical fashion than horizontally oriented cleft; flat labrum, anteriorly and posteriorly (E); and absent labrum, anteriorly and posteriorly (F). Note glenoid rim has no visible labrum.

View larger version (151K): [in a new window]   Fig. 2A. —Glenoid labral shape of various patients on T1-weighted axial MR arthrography. MR arthrograms show triangular variation, anteriorly and posteriorly (A; note middle glenohumeral ligament [arrow]); round variation, anteriorly and flat, posteriorly (B); cleaved variation, anteriorly (arrow, C); notched variation, anteriorly (arrow, D); and absent variation, anteriorly (E).

View larger version (129K): [in a new window]   Fig. 2B. —Glenoid labral shape of various patients on T1-weighted axial MR arthrography. MR arthrograms show triangular variation, anteriorly and posteriorly (A; note middle glenohumeral ligament [arrow]); round variation, anteriorly and flat, posteriorly (B); cleaved variation, anteriorly (arrow, C); notched variation, anteriorly (arrow, D); and absent variation, anteriorly (E).

View larger version (148K): [in a new window]   Fig. 2C. —Glenoid labral shape of various patients on T1-weighted axial MR arthrography. MR arthrograms show triangular variation, anteriorly and posteriorly (A; note middle glenohumeral ligament [arrow]); round variation, anteriorly and flat, posteriorly (B); cleaved variation, anteriorly (arrow, C); notched variation, anteriorly (arrow, D); and absent variation, anteriorly (E).

View larger version (158K): [in a new window]   Fig. 2D. —Glenoid labral shape of various patients on T1-weighted axial MR arthrography. MR arthrograms show triangular variation, anteriorly and posteriorly (A; note middle glenohumeral ligament [arrow]); round variation, anteriorly and flat, posteriorly (B); cleaved variation, anteriorly (arrow, C); notched variation, anteriorly (arrow, D); and absent variation, anteriorly (E).

View larger version (123K): [in a new window]   Fig. 2E. —Glenoid labral shape of various patients on T1-weighted axial MR arthrography. MR arthrograms show triangular variation, anteriorly and posteriorly (A; note middle glenohumeral ligament [arrow]); round variation, anteriorly and flat, posteriorly (B); cleaved variation, anteriorly (arrow, C); notched variation, anteriorly (arrow, D); and absent variation, anteriorly (E).

View larger version (161K): [in a new window]   Fig. 3A. —Three types of capsular insertion on T1-weighted MR arthrography. MR arthrogram shows type 1 (insertion on labrum, solid arrow) in posterior capsular insertion and type 3 (insertion more medial to junction of labrum and glenoid, open arrow) in anterior capsular insertion in 21-year-old man.

View larger version (154K): [in a new window]   Fig. 3B. —Three types of capsular insertion on T1-weighted MR arthrography. MR arthrogram shows type 2 (insertion at junction of labrum and glenoid, solid arrow) in posterior capsular insertion and type 3 (open arrow) in anterior capsular insertion in 19-year-old man.

View larger version (159K): [in a new window]   Fig. 4. —21-year-old man with back pain. T1-weighted axial MR arthrogram fails to show middle glenohumeral ligament at superomedial level of glenohumeral joint, indicating absence of ligament. Note tendon of subscapularis muscle (arrow).

View larger version (150K): [in a new window]   Fig. 5A. —T1-weighted MR arthrograms show findings resembling labral tears. Undercutting of labrum (arrow) is increased signal of hyaline cartilage underneath anterior labrum.

View larger version (103K): [in a new window]   Fig. 5B. —T1-weighted MR arthrograms show findings resembling labral tears. Sublabral hole (arrow) is noted in anterosuperior portion of glenoid (high-signal-intensity effusion is interposed in this foramen).

View larger version (142K): [in a new window]   Fig. 5C. —T1-weighted MR arthrograms show findings resembling labral tears. Oblique coronal view of same patient as in B shows "double Oreo cookie configuration" with black (glenoid cortex, open arrow), white (sublabral hole, solid arrow), black (labrum, arrowhead), white (sulcus, open arrowhead), and black (biceps tendon, white arrow) areas, which are not superior labrum anteroposterior lesions.

View larger version (121K): [in a new window]   Fig. 5D. —T1-weighted MR arthrograms show findings resembling labral tears. Sublabral recess (arrow) is visible underneath anterosuperior portion of glenoid labrum.

View larger version (137K): [in a new window]   Fig. 5E. —T1-weighted MR arthrograms show findings resembling labral tears. Middle glenohumeral ligament (arrow) is thick and cordlike with absence of anterosuperior labrum, indicating Buford complex.

View larger version (132K): [in a new window]   Fig. 5F. —T1-weighted MR arthrograms show findings resembling labral tears. Synovial folds in axillary pouch simulate intraarticular bodies (arrows).

View larger version (105K): [in a new window]   Fig. 5G. —T1-weighted MR arthrograms show findings resembling labral tears. Oblique coronal MR arthrogram shows small sulcus (solid arrow) between superior labrum (arrowhead) and biceps tendon (open arrow).

View larger version (7K): [in a new window]   Fig. 6A. —Sublabral hole and sulcus between labrum and biceps tendon. Drawing shows glenolabral junction with normal sublabral hole (solid arrow) and sulcus (double arrow) between labrum (arrowhead) and biceps tendon (open arrow).

View larger version (11K): [in a new window]   Fig. 6B. —Sublabral hole and sulcus between labrum and biceps tendon. Drawing shows "double Oreo cookie configuration" with black (glenoid cortex), white (fluid in sublabral hole, single arrow), black (labrum), white (fluid in sulcus between labrum and biceps tendon, double arrow), and black (biceps tendon) areas.

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