MRI Shoulder - Slap tear

Transcription

1 MRI Shoulder - Slap tear Poster No.: C-1149 Congress: ECR 2015 Type: Educational Exhibit Authors: F. Abubacker Sulaiman, R. Ravi; Chennai/IN Keywords: Musculoskeletal joint, Musculoskeletal soft tissue, MR, Education, Decision analysis, Diagnostic procedure, Education and training, Infection DOI: /ecr2015/C-1149 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 21

2 Learning objectives To determine the sensitivity and specificity of Superior Labral Anterior Posterior (SLAP) tear. To learn usefullness of MRI in SLAP abnormalities and establishing the type of SLAP tears before surgery, thereby permitting better operative planning. Background SLAP tear injury is tear of superior part of glenoid labrum in the region of the [1, 2] insertion of the biceps tendon. The tears are clinically significant causing pain, clicking of the shoulder occasionally. Clockwise approach to the labrum is the easiest way to diagnose and to [3] differentiate it from normal. SLAP tears typically extend from the 10 to 2 o'clock position, either on posterior or anterior aspect extending into the biceps tendon. There are four types of SLAP tears Type I tear has fraying of the articulating surfaces of the superior portion of the glenoid labrum. [4] Page 2 of 21

3 Fig. 1: Type 1 SLAP tear References: Radiology and Imaging Sciences, Chettinad Hospital and Research Institute, Chettinad Hospital and Research Institute - Chennai/IN Type II tear has superior labral fraying with stripping of the superior part of the glenoid labrum and attached biceps off the underlying glenoid fossa. Page 3 of 21

4 Fig. 2: Type II SLAP tear References: Radiology and Imaging Sciences, Chettinad Hospital and Research Institute, Chettinad Hospital and Research Institute - Chennai/IN Type III tear has a bucket-handle tear of the superior portion of the glenoid labrum with the central portion of the tear often displaced into the joint. [5] Page 4 of 21

5 Fig. 3: Type III SLAP tear References: Radiology and Imaging Sciences, Chettinad Hospital and Research Institute, Chettinad Hospital and Research Institute - Chennai/IN Type IV tear has a bucket-handle tear of the superior portion of the glenoid labrum similar to type Ill with the extension of the tear into the biceps tendon. The biceps tendon has an attached partial tear that frequently is found to migrate into the joint space. Page 5 of 21

6 Fig. 4: Type IV SLAP tear References: Radiology and Imaging Sciences, Chettinad Hospital and Research Institute, Chettinad Hospital and Research Institute - Chennai/IN Images for this section: Page 6 of 21

7 Fig. 2: Type II SLAP tear Page 7 of 21

8 Fig. 3: Type III SLAP tear Page 8 of 21

9 Fig. 4: Type IV SLAP tear Page 9 of 21

10 Fig. 1: Type 1 SLAP tear Page 10 of 21

11 Findings and procedure details MRI Protocol: The images were obtained on a 1.5-Tesla scanner using a phased-array shoulder coil. Patients were scanned with the arm adducted at the side and, [6] wih possible mild external rotation. Conventional MR images obtained included oblique coronal fat suppressed fast spin-echo T2-weighted images [7] with a 4-mm section thickness and a 1-mm interslice gap. The Axial images were fat-suppressed fast spin-echo intermediate-weighted images with a 3-mm section thickness with 1-mm interslice gap with a 14-cm field of view and a matrix. Image Findings: Type I- Minimal irregularity of the articulating labral contours with a slight increase in signal intensity images. The biceps tendon and the labral-biceps anchor were intact and had normal signal intensity. [8,9] Page 11 of 21

12 Fig. 5: Coronal PD Weighted MRI shows Type I SLAP tear References: Radiology and Imaging Sciences, Chettinad Hospital and Research Institute, Chettinad Hospital and Research Institute - Chennai/IN Type II - Globular high signal interposed between the superior part of the glenoid labrum and the superior part of the glenoid fossa, high signal in the region of the labral-biceps anchor was seen with/without paired cleavages were seen in the superior and inferior aspects of the superior section of the labrum at the labral-biceps anchor. [10,11] Fig. 6: Coronal PD Weighted MRI shows Type II SLAP tear References: Radiology and Imaging Sciences, Chettinad Hospital and Research Institute, Chettinad Hospital and Research Institute - Chennai/IN Type III - normal signal intensity and contour of the biceps tendon and labral-biceps anchor were seen. Superior labral tears were identified as areas of high signal intensity within the superior section of the labrum separate from the normal superior part of the labral recess. [12,13] Page 12 of 21

13 Fig. 7: Coronal PD Weighted MRI shows Type III SLAP tear References: Radiology and Imaging Sciences, Chettinad Hospital and Research Institute, Chettinad Hospital and Research Institute - Chennai/IN Type IV -diffuse high signal intensity within the glenoid labrum with marked abnormal high signal intensity extending into the proximal biceps tendons. [14,15] Page 13 of 21

14 Fig. 8: Coronal PD Weighted MRI shows Type IV SLAP tear References: Radiology and Imaging Sciences, Chettinad Hospital and Research Institute, Chettinad Hospital and Research Institute - Chennai/IN Images for this section: Page 14 of 21

15 Fig. 5: Coronal PD Weighted MRI shows Type I SLAP tear Page 15 of 21

16 Fig. 6: Coronal PD Weighted MRI shows Type II SLAP tear Page 16 of 21

17 Fig. 7: Coronal PD Weighted MRI shows Type III SLAP tear Page 17 of 21

18 Fig. 8: Coronal PD Weighted MRI shows Type IV SLAP tear Page 18 of 21

19 Conclusion Laterally curved and posterior high signal intensities are specific signs for distinguishing a SLAP tear from a normal-variant superior sublabral recess. MR Imaging modality is superior in diagnosing SLAP Tear. Personal information Dr.F.Abuabacker Sulaiman, MD.RD Associate Professor Department of Radiology and Imaging Sciences Chettinad Hospital and Research Institute Kelambakkam Kanchipuram District Tamilnadu India R.Rajesh M.Sc. AHS Final Year Student Department of Radiology and Imaging Sciences Chettinad Hospital and Research Institute Kelambakkam Kanchipuram District Tamilnadu India Page 19 of 21

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21 13. Legan JM, Burkhard TK, Goff WB, et al.tears of the glenoid labrum: MR imaging of 88 arthroscopically confirmed cases.radiology 1991; 179: Gusmer PB, Potter HG, Schatz JA, et al.labral injuries: accuracy of detection with unenhanced MR imaging of the shoulder.radiology 1996; 200: Connell D, Potter H, Wickiewicz T, et al.noncontrast magnetic resonance imagingof superior labral lesions: 102 cases confirmed at arthroscopic surgery. Sports Med 1999; 27: Helgason JW, Chandnani VP, Yu JS. MR arthrography: a review of current technique and applications. AJR Am J Roentgenol 1997; 168: Chandnani VP, Yeager TD, DeBerardino T,et al. Glenoid labral tears: prospective evaluation with MRI imaging,mrarthrography,and CT arthrography. AJR Am J Roentgenol 1993; 161: Palmer WE, Brown JH, Rosenthal DI. Labral-ligamentous complex of the shoulder:evaluation with MR arthrography.radiology 1994; 190: Hunter JC, Blatz DJ, Escobedo EM. SLAP lesions of the glenoid labrum: CT arthrographic and arthroscopic correlation. Radiology 1992; 184: Page 21 of 21