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MR Imaging of Glenohumeral Instability

¹ Department of Radiology and Nuclear Medicine, Wilford Hall United States Air Force Medical Center, 759th MDTS/MTRD, Ste. 1, 2200 Bergquist Dr., Lackland AFB, TX 78236-5300.
² Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814.
³ Present address: #611, 3711 Medical Dr., San Antonio, TX 78229.

Received July 17, 2002; accepted after revision December 17, 2002.

 
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or representing the views of the United States Air Force or the Department of Defense.

Address correspondence to J. Ly.

Introduction

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Glenohumeral instability is a common cause of shoulder pain and loss of shoulder function and refers to the symptomatic subluxation or dislocation of the humeral head in relation to the glenoid fossa and its abnormal sequelae. Anteroinferior instability is by far the most common type to involve the glenohumeral joint, occurring in 95% of all patients. The remaining 5% of patients have posterior (3%), inferior, superior, or multidirectional instability. Fractures of the osseous glenoid and humeral head and tears of the labroligamentous complex are frequently associated with glenohumeral instability, and MR imaging, in particular MR arthrography, provides excellent depiction of these intraarticular lesions. We review glenohumeral instability–related abnormalities as reported through a series of carefully chosen MR images from patients presenting with shoulder pain or loss of function or both.

Classification

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The cause of glenohumeral instability can be classified as atraumatic or congenital (e.g., displastic glenoid, capsular–ligamentous laxity, and far medial attachment of the anterior capsule) versus traumatic (e.g., acute injury in athletes or resulting from chronic repetitive microtrauma). Thomas and Matsen's [1] classification system for recurrent instability is widely used by orthopedic surgeons and classifies these patients into one of two categories on the basis of the mechanism, directionality, and preferred method of treatment. The first category, traumatic unidirectional Bankart surgery, is characterized by a history of trauma resulting in unidirectional instability and is commonly associated with a fibrous or osseous Bankart lesion. The mechanism for this injury typically involves a fall on the outstretched hand in a person younger than 35 years old. In the older patient, unidirectional instability may be related to rotator cuff tear as well as to labral–capsular injury [2].

The second category of recurrent instability is known as atraumatic multidirectional bilateral rehabilitation inferior capsular shift. This pattern of injury occurs in the absence of antecedent trauma and is characterized by multidirectional instability, usually involving both glenohumeral joints. This scenario is believed to be the result of atraumatic ligamentous and capsular laxity. The treatment of atraumatic multidirectional bilateral rehabilitation inferior capsular shift injuries is rehabilitation initially, followed by inferior capsular shift if indicated.

Injuries Associated with Glenohumeral Instability

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The inherently unstable glenohumeral joint is stabilized by a group of soft-tissue structures. These structures are the active stabilizers composed of the surrounding musculature, including the rotator cuff muscles and the static stabilizers—the glenoid fossa, hyaline cartilage, glenoid labrum, glenohumeral ligaments, and capsule. The loss of the integrity of any of these structures can lead to glenohumeral instability.

Many osseous and labroligamentous injuries occur in association with shoulder instability. Fibrous and osseous Bankart lesions are characterized by avulsion of the anteroinferior capsulolabral complex with or without adjacent glenoid rim fractures (Figs. 1A, 1B, 1C, 1D, 1E). The Hill-Sachs deformity, or fracture involving the posterosuperior humeral head (Figs. 2A, 2B), often occurs in relation to both types of Bankart lesions. These lesions are associated with anterior instability, whereas the reverse Hill-Sachs (trough) and reverse Bankart lesions result from posterior dislocation (Figs. 3A, 3B, 3C). The potential findings on MR imaging of the patient with shoulder dysfunction cover a wide range of labral abnormalities, including a torn, avulsed, crushed, or frayed labrum (Figs. 1B, 1C, 1D, 1E, 4A, 4B, and 5A, 5B, 5C, 5D). Other possible injuries are pouch deformities, which are most often caused by general glenohumeral hyperlaxity or capsular injury or both. These injuries are more likely to be associated with clinically evident instability if they affect the anterior band of the inferior glenohumeral ligament (Figs. 6A, 6B, 6C, 6D, 6E, 6F) because this band is the single most important stabilizer of the glenohumeral joint and therefore should receive careful attention during MR imaging interpretation.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A. —Bankart lesion and variants. Axial gradient-echo MR image of 45-year-old man with osseous Bankart lesion (arrow), which was detected after anterior shoulder dislocation. Osseous Bankart lesion is fracture through anteroinferior labrum involving adjacent bony glenoid. Bankart lesions usually result from trauma to shoulder of sufficient force to anteriorly dislocate humeral head in relation to glenoid. One must identify the osseous Bankart lesion because it requires surgical repair (open or arthroscopic), whereas many defects caused by nontraumatic instability can be successfully treated with rehabilitation.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B. —Bankart lesion and variants. Axial fat-suppressed spin-echo T1-weighted MR image from MR arthrography in 36-year-old man shows fibrous Bankart lesion (arrow), which is avulsion of anteroinferior labrum with complete disruption of medial scapular periosteum that spares subjacent glenoid.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C. —Bankart lesion and variants. Axial gradient-echo MR image in 29-year-old man (C) and fat-suppressed spin-echo T1-weighted MR arthrographic image in abduction and external rotation position in 44-year-old man (D) show anterior labroligamentous periosteal sleeve avulsion lesion (arrow, C; arrows, D). In this variant of Bankart lesion, anteroinferior labrum is displaced medially but remains attached to scapula via anterior scapular periosteum. This variant is commonly referred to as "medialized Bankart." Treatment involves arthroscopic conversion to true Bankart lesion, followed by repair.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D. —Bankart lesion and variants. Axial gradient-echo MR image in 29-year-old man (C) and fat-suppressed spin-echo T1-weighted MR arthrographic image in abduction and external rotation position in 44-year-old man (D) show anterior labroligamentous periosteal sleeve avulsion lesion (arrow, C; arrows, D). In this variant of Bankart lesion, anteroinferior labrum is displaced medially but remains attached to scapula via anterior scapular periosteum. This variant is commonly referred to as "medialized Bankart." Treatment involves arthroscopic conversion to true Bankart lesion, followed by repair.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E. —Bankart lesion and variants. Axial fat-suppressed spin-echo T1-weighted image from MR arthrography in 42-year-old man shows nondisplaced Bankart lesion, otherwise known as Perthes' lesion (arrow). As is shown on this image, torn anteroinferior labrum is characteristically nondisplaced and is better visualized when large amount of joint fluid is present or when stress is applied, such as during abduction and external rotation. In this lesion, unlike in classic Bankart lesion, labrum remains attached to scapula by medial scapular periosteum.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A. —Hill-Sachs deformity. Coronal oblique fat-suppressed fast spin-echo T2-weighted MR image in 50-year-old man shows focal cortical defect (arrow) and subjacent marrow edema involving posterosuperior humeral head.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B. —Hill-Sachs deformity. Axial fat-suppressed proton density–weighted MR image in 36-year-old man shows Hill-Sachs fracture seen as irregular area of edema involving posterosuperior humeral head (arrow).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A. —Abnormalities associated with posterior dislocation. Axial fat-suppressed spin-echo T1-weighted image from MR arthrography in 58-year-old man shows fracture (arrow) through posterior glenoid, known as reverse Bankart lesion.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B. —Abnormalities associated with posterior dislocation. Axial fat-suppressed spin-echo T1-weighted image from MR arthrography in same patient as in A shows reverse Hill-Sachs defect (arrow) of anteromedial humeral head.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C. —Abnormalities associated with posterior dislocation. Sagittal oblique spin-echo T1-weighted MR image (anterior to left of image) in 49-year-old man shows irregular cortical defect with adjacent low-signal-intensity marrow edema of anteroinferior humeral head (arrow), consistent with reverse Hill-Sachs defect, which results when anterior aspect of humeral head impacts posterior glenoid during time of posterior dislocation.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A. —Labral degeneration and fraying. Coronal oblique gradient-echo MR image in 44-year-old woman shows intermediate signal involving blunted, mildly frayed, and moderately thickened superior labrum (arrow) that contains marked degenerative signal without evidence on corresponding T2-weighted image (not shown) of focal hyperintensity to indicate tear. This finding represents type 1 superior labral anteroposterior lesion.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B. —Labral degeneration and fraying. Coronal oblique fat-suppressed fast spin-echo T2-weighted MR image in 39-year-old man shows focal hyperintense signal in superior labrum (arrowhead), consistent with type 2 superior labral anteroposterior lesion.

View larger version (30K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A. —Superior labral anteroposterior lesions. Illustration shows frontal view of glenohumeral joint at level of long head of biceps tendon. Notice that proximal intraarticular portion of long head of biceps tendon attaches seamlessly to superior labrum, forming bicipital–labral complex.

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B. —Superior labral anteroposterior lesions. Coronal oblique fat-suppressed fast spin-echo T2-weighted MR image in 40-year-old man shows focal hyperintensity (arrows) involving long head of biceps tendon and superior labrum. Type 2 superior labral anteroposterior lesion was confirmed at arthroscopy.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C. —Superior labral anteroposterior lesions. Coronal oblique fat-suppressed fast spin-echo T2-weighted MR image in 38-year-old man reveals focal high-signal tear delineating mildly inferiorly displaced superior labrum relative to adjacent long head of biceps tendon, producing bucket-handle appearance, which is best appreciated arthroscopically. This finding is classified as type 3 superior labral anteroposterior lesion (arrow).

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D. —Superior labral anteroposterior lesions. Coronal oblique fat-suppressed fast spin-echo T2-weighted MR image in 55-year-old man shows focal, linear high signal (arrow) involving superior labrum and extending into proximal long head of biceps tendon. This is example of type 4 superior labral anteroposterior lesion.

View larger version (32K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A. —Capsuloligamentous abnormalities of glenohumeral ligament associated with instability. Illustration shows normal anatomic relationships of glenohumeral ligaments. Superior glenohumeral ligament arises from anterosuperior glenoid rim to just superior to lesser tuberosity. Middle glenohumeral ligament courses from anterosuperior glenoid rim to lesser tuberosity. Anterior band of inferior glenohumeral ligament extends from anteroinferior glenoid rim to anteromedial humeral head.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B. —Capsuloligamentous abnormalities of glenohumeral ligament associated with instability. Axial fat-suppressed spin-echo T1-weighted image from MR arthrography in 42-year-old man shows irregular thickened superior glenohumeral ligament that contains abnormally increased signal (arrowhead). Superior glenohumeral ligament thickening can be associated with instability. Middle glenohumeral and superior glenohumeral ligaments are interconnected, and capsular thickening that occurs with instability also affects superior glenohumeral ligament.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C. —Capsuloligamentous abnormalities of glenohumeral ligament associated with instability. Sagittal oblique fat-suppressed spin-echo T1-weighted image from MR arthrography in 49-year-old man shows markedly thickened middle glenohumeral ligament (arrows), related to chronic instability.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D. —Capsuloligamentous abnormalities associated with instability. Coronal oblique fat-suppressed spin-echo T1-weighted image from MR arthrography in 31-year-old man shows laxity and irregularity of inferior glenohumeral ligament (arrows), which were caused by remote anterior dislocation and chronic shoulder instability.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6E. —Capsuloligamentous abnormalities associated with instability. Coronal oblique fat-suppressed spin-echo T1-weighted image from MR arthrography in 35-year-old man shows capsular tear (arrow) involving inferior glenohumeral ligament at location other than glenoid insertion; this tear is consistent with humeral avulsion of the glenohumeral ligament lesion.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6F. —Capsuloligamentous abnormalities associated with instability. Coronal oblique spin-echo T1-weighted MR image in 54-year-old man reveals avulsion of inferior glenohumeral ligament near humeral side and inferomedial retraction of anterior band of inferior glenohumeral ligament (arrow); this image shows another example of humeral avulsion of glenohumeral ligament lesion, which causes anterior instability and thus requires early and accurate detection and reattachment.

Labral Abnormalities

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MR arthrography is accurate in the detection of labral abnormalities. In a study of 121 subjects with surgically proven labral injuries, Palmer and Caslowitz [3] reported a sensitivity of 92% and a specificity of 92% for the MR arthrographic detection of labral tears. This advanced imaging technique is further improved by the addition to the routine protocol of stress views, using abduction and external rotation (Figs. 7A, 7B), which improves both sensitivity and specificity for anterior labral injury detection to greater than 95% [4]. Labral damage is usually traumatic in etiology and can occur in the form of crushed or frayed tissue, tears, and avulsions (Figs. 1B, 1C, 1D, 1E, 4A, 4B, and 5A, 5B, 5C, 5D). The most common sequences used for detection of labral injuries include a spin-echo T1-weighted fat-suppressed sequence during MR arthrography and T2-weighted spin-echo, fast spin-echo, or T2* gradient-recalled echo sequences during unenhanced MR imaging. The appearance of the normal labrum on MR imaging is one of uniform hypointensity, usually of triangular morphology, although normal morphology can vary from patient to patient. A diffuse increase in signal intensity (but less than fluid on T2-weighted images) suggests degeneration. A focal increase in signal (but less than fluid on T2-weighted images) may indicate prior injury. Conversely, linear signal changes are representative of a shearing injury to the fibrocartilage.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A. —Utility of images obtained during abduction and external rotation. Abduction and external rotation fat-suppressed spin-echo T1-weighted image from MR arthrography (anteroinferior is to left of image) in 28-year-old man shows thin taut band anterior to humeral head, which represents anterior band of inferior glenohumeral ligament (arrows). Note redundancy of posterosuperior rotator cuff (arrowheads).

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B. —Utility of images obtained during abduction and external rotation. Abducted and externally rotated fat-suppressed spin-echo T1-weighted image from MR arthrography in 33-year-old man shows taut anterior band of inferior glenohumeral ligament, which increases conspicuity of minimally displaced anteroinferior labral tear (arrow).

The Bankart lesion is the most common injury associated with instability (Figs. 1A, 1B, 1C, 1D, 1E). Two variants of this lesion are the Perthes' (Fig. 1E) and the anterior labroligamentous periosteal sleeve avulsion lesions (Figs. 1C and 1D), which are alike in that both retain their attachment with the anterior scapular periosteum; this attachment is in direct contrast to the Bankart lesion. The Perthes' lesion is a nondisplaced Bankart lesion and can be difficult to identify on MR imaging unless an image obtained during stress such as the abducted and externally rotated position is used [5] (Figs. 7A, 7B). The torn anteroinferior labrum of the anterior labroligamentous periosteal sleeve avulsion lesion typically scars down in a medially displaced location.

Surgical repair of the anterior labroligamentous periosteal sleeve avulsion lesion involves its conversion to a Bankart lesion with subsequent Bankart repair, which involves surgical reduction of the avulsed fragment, followed by reconstruction of the supporting soft-tissue restraints of the anterior capsule [6]. Repair is necessary to prevent healing with deformity, which can result in persistent instability.

The glenolabral articular disruption lesion is an anteroinferior labral tear associated with an anteroinferior glenoid articular cartilage injury (Figs. 8A, 8B). This lesion results from impaction of the humeral head against the glenoid rather than from dislocation and thus is usually a stable lesion. Treatment consists of arthroscopic débridement of the labral and chrondral defects. The humeral avulsion of the glenohumeral ligament lesion is a lesion in which the anterior band of the inferior glenohumeral ligament is disrupted at or near its humeral attachment. Like the Bankart lesion, the humeral avulsion of the glenohumeral ligament lesion also results in glenohumeral instability, and treatment consists of repair of the injured ligaments (Figs. 6E and 6F).

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A. —Articular cartilage injury. Coronal oblique fat-suppressed fast spin-echo T2-weighted MR image in 57-year-old man shows focal chondral defect (arrow). This lesion was verified at arthroscopy to be full thickness (not shown).

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B. —Articular cartilage injury. Axial fat-suppressed spin-echo T1-weighted image from MR arthrography in 44-year-old man shows linear hyperintense defect (arrow) of anteroinferior articular cartilage, extending into adjacent labrum. This constellation of findings has been termed "glenolabral articular disruption lesion." Patients with this lesion present with persistent shoulder pain, but this lesion is typically stable because of nondisplaced labrum and intact anterior band of inferior glenohumeral ligament.

The superior labral anteroposterior lesion (Figs. 4A, 4B and 5A, 5B, 5C, 5D) was originally described by Snyder et al. [7] in 1990 as a lesion of the superior labrum that extends from anterior to posterior. Superior labral lesions most commonly result from repetitive traction to the biceps tendon, as seen in pitchers and other throwing athletes [8]. The original classification by Snyder et al. described four types of superior labral anteroposterior lesions, although several additional types have been subsequently described. Type 1 is characterized by superior labral degeneration and fraying. Type 2 is a separation of the superior labrum and biceps tendon from the adjacent glenoid rim. Type 3 is a bucket-handle tear of the superior labrum. Type 4 is similar to type 3 but with extension of the labral tear into the proximal portion of the long head of the biceps tendon.

Arthroscopic treatment is the standard of care, with débridement of types 1 and 3 and repair of types 2 and 4. Although MR arthrography is helpful in diagnosing superior labral anteroposterior lesions, it is considered by some to be inaccurate in its ability to differentiate the various types of superior labral anteroposterior lesions [9].

Paralabral cysts (Figs. 9A, 9B) are lobulated fluid collections that occur adjacent to labral tears and are frequently associated with glenohumeral instability. These cysts may be analogous to meniscal cysts of the knee.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A. —Paralabral cyst. Axial gradient-echo MR image in 33-year-old man shows hyperintense rounded lesion at posterosuperior paralabral area consistent with paralabral cyst (arrowhead). Notice communication with posterior labral tear (arrow). Paralabral cysts are nearly always associated with labral tears and often with glenohumeral instability.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B. —Paralabral cyst. Sagittal oblique fat-suppressed fast spin-echo T2-weighted MR image in 49-year-old woman confirms posterior location of paralabral cyst (arrow).

Caution should be taken not to mistake certain congenital labral variants with true labral abnormalities. Most variants occur in the anterior-to-superior portion of the labrum and include the sublabral recess, sublabral foramen, and Buford complex (Figs. 10A, 10B, 10C, 10D, 10E, 10F).

View larger version (40K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A. —Congenital labral variants. Illustration shows two normal variants of anterosuperior labrum: sublabral foramen (left) and Buford complex (right). Sublabral foramen represents normal detachment of labrum from glenoid in anterosuperior quadrant. Buford complex is composed of absent anterosuperior labrum in association with thickened middle glenohumeral ligament. P = posterior, A = anterior.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B. —Congenital labral variants. Axial fat-suppressed spin-echo T1-weighted image from MR arthrography in 51-year-old man shows surgically proven sublabral foramen. Contrast agent extends through gap (arrow), which results from detachment of anterosuperior labrum from anterosuperior glenoid rim.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10C. —Congenital labral variants. Coronal oblique fat-suppressed spin-echo T1-weighted image from MR arthrography in 39-year-old man shows sublabral recess (arrowheads). Contrast agent extends beneath undersurface of superior labrum. This recess can be differentiated from superior labral anteroposterior tear because contrast agent is smooth and tapering and extends in medial direction toward glenoid attachment of superior labrum rather than in lateral direction. In addition, superior labrum maintains its normal triangular configuration and contains no abnormal signal within its substance.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10D. —Congenital labral variants. Axial fat-suppressed spin-echo T1-weighted image from MR arthrography in 36-year-old man shows normal middle glenohumeral ligament (arrow) and anterior labrum.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10E. —Congenital labral variants. Normal finding in D is contrasted with Buford complex (E) in 33-year-old man as seen on this axial fat-suppressed spin-echo T1-weighted image from MR arthrography, in which congenital absence of anterior superior labrum (straight arrow) is associated with thick middle glenohumeral ligament (curved arrow). Buford complex should not be mistaken for avulsed anterior labrum (not shown).

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10F. —Congenital labral variants. Sagittal oblique fat-suppressed spin-echo T1-weighted image from MR arthrography in 46-year-old man shows thickened middle glenohumeral ligament (arrow) associated with Buford complex.

References

Top Introduction Classification Injuries Associated with... Labral Abnormalities References

 

1. Thomas SC, Matsen FA III. An approach to the re pair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral in stability. J Bone Joint Surg Am1989; 71:506 –513[Abstract/Free Full Text]
2. Sanders TG, Morrison WB, Miller MD. Imaging techniques for the evaluation of glenohumeral in stability. Am J Sports Med 2000;28:414 –434[Abstract/Free Full Text]
3. Palmer WE, Caslowitz PL. Anterior shoulder in stability: diagnostic criteria determined from pro spective analysis of 121 MR arthrograms. Radiology1995; 197:819 –825[Abstract/Free Full Text]
4. Cvitanic O, Tirman PFJ, 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 glenoid labrum. AJR1997; 169:837 –844[Abstract/Free Full Text]
5. Sanders TG, Tirman PFJ, Linares R, Feller JF, Ri chardson R. The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation. AJR1999; 172:171 –175[Abstract/Free Full Text]
6. Neviaser TJ. The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior in stability of the shoulder. Arthroscopy1993; 9:17 –21[Medline]
7. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy1990; 6:274 –279[Medline]
8. Andrews JR, Carson WG Jr, McLeod WD. Glenoid labral tears related to the long head of the biceps. Am J Sports Med1985; 13:337 –341[Abstract/Free Full Text]
9. Smith AM, McCauley TR, Jokl P. SLAP lesions of the glenoid labrum diagnosed with MR imaging. Skeletal Radiol1993; 22:507 –510[Medline]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ly, J. Q. Articles by Sanders, T. G. Search for Related Content PubMed PubMed Citation Articles by Ly, J. Q. Articles by Sanders, T. G. Social Bookmarking                      What's this?