The Shoulder pp 167-187 | Cite as

Imaging Diagnosis of SLAP Tears and Microinstability

  • Konstantin KrepkinEmail author
  • Michael J. Tuite
  • Jenny T. Bencardino


The glenohumeral joint is the most mobile joint in the body. Static and dynamic stabilizers play a vital role in maintaining the stability of the shoulder, negotiating the fine balance between physiologic mobility and pathologic laxity. The glenoid labrum is an important static stabilizer of the glenohumeral joint, consisting of a ring of fibrous and fibrocartilaginous tissue along the glenoid rim. In this chapter, we review the imaging of common pathologies affecting the superior labrum, in particular superior labrum anterior-posterior (SLAP) tears and microinstability. Microinstability is generally understood to consist of poorly localized shoulder pain related to pathologic laxity without frank dislocation. Microinstability is discussed both in the context of the overhead-throwing athlete, with an emphasis on internal impingement and posterior capsular contracture/glenohumeral internal rotation deficit, and in those not engaged in overhead motions, with microinstability generally related to injuries of the supporting ligamentous structures of the shoulder. We review the imaging appearance of the different types of SLAP lesions and discuss how to optimize the imaging protocol for the diagnosis of SLAP lesions. Finally, we discuss how to differentiate SLAP lesions from normal variants of the superior and anterosuperior labrum.


Superior labrum anterior-posterior (SLAP) tear Shoulder microinstability Shoulder internal impingement Glenohumeral internal rotation deficit (GIRD) Superior labrum anterior cuff (SLAC) lesion Sublabral foramen Sublabral recess Buford complex 


  1. 1.
    Nishida K, Hashizume H, Toda K, Inoue H. Histologic and scanning electron microscopic study of the glenoid labrum. J Shoulder Elb Surg. 1996;5(2 Pt 1):132–8.CrossRefGoogle Scholar
  2. 2.
    Huber WP, Putz RV. Periarticular fiber system of the shoulder joint. Arthrosc J Arthrosc Relat Surg. 1997;13(6):680–91.CrossRefGoogle Scholar
  3. 3.
    Howell SM, Galinat BJ. The glenoid-labral socket. A constrained articular surface. Clin Orthop Relat Res. 1989;243:122–5.Google Scholar
  4. 4.
    Hertz H, Weinstabl R, Grundschober F, Orthner E. Macroscopic and microscopic anatomy of the shoulder joint and the limbus glenoidalis. Acta Anat (Basel). 1986;125(2):96–100.CrossRefGoogle Scholar
  5. 5.
    Rockwood CA, Matsen FA, editors. The shoulder. 4th ed. Philadelphia, PA: Saunders/Elsevier; 2009.Google Scholar
  6. 6.
    Park YH, Lee JY, Moon SH, Mo JH, Yang BK, Hahn SH, et al. MR arthrography of the labral capsular ligamentous complex in the shoulder: imaging variations and pitfalls. AJR Am J Roentgenol. 2000;175(3):667–72.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Zanetti M, Carstensen T, Weishaupt D, Jost B, Hodler J. MR arthrographic variability of the arthroscopically normal glenoid labrum: qualitative and quantitative assessment. Eur Radiol. 2001;11(4):559–66.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    De Maeseneer M, Van Roy P, Shahabpour M. Normal MR imaging anatomy of the rotator cuff tendons, glenoid fossa, labrum, and ligaments of the shoulder. Radiol Clin N Am. 2006;44(4):479–87.. viiPubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Cooper DE, Arnoczky SP, O’Brien SJ, Warren RF, DiCarlo E, Allen AA. Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study. J Bone Joint Surg Am. 1992;74(1):46–52.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Stoller DW. Magnetic resonance imaging in Orthopaedics and sports medicine. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.Google Scholar
  11. 11.
    Ramirez Ruiz FA, Baranski Kaniak BC, Haghighi P, Trudell D, Resnick DL. High origin of the anterior band of the inferior glenohumeral ligament: MR arthrography with anatomic and histologic correlation in cadavers. Skelet Radiol. 2012;41(5):525–30.CrossRefGoogle Scholar
  12. 12.
    Chloros GD, Haar PJ, Loughran TP, Hayes CW. Imaging of glenoid labrum lesions. Clin Sports Med. 2013;32(3):361–90.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Chaipat L, Palmer WE. Shoulder magnetic resonance imaging. Clin Sports Med. 2006;25(3):371–86.. vPubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Lin E. Magnetic resonance arthrography of superior labrum anterior-posterior lesions: a practical approach to interpretation. Curr Probl Diagn Radiol. 2009;38(2):91–7.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Dunham KS, Bencardino JT, Rokito AS. Anatomic variants and pitfalls of the labrum, glenoid cartilage, and Glenohumeral ligaments. Magn Reson Imaging Clin N Am. 2012;20(2):213–28.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Smith DK, Chopp TM, Aufdemorte TB, Witkowski EG, Jones RC. Sublabral recess of the superior glenoid labrum: study of cadavers with conventional nonenhanced MR imaging, MR arthrography, anatomic dissection, and limited histologic examination. Radiology. 1996;201(1):251–6.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Waldt S, Metz S, Burkart A, Mueller D, Bruegel M, Rummeny EJ, et al. Variants of the superior labrum and labro-bicipital complex: a comparative study of shoulder specimens using MR arthrography, multi-slice CT arthrography and anatomical dissection. Eur Radiol. 2006;16(2):451–8.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Tuite MJ, Orwin JF. Anterosuperior labral variants of the shoulder: appearance on gradient-recalled-echo and fast spin-echo MR images. Radiology. 1996;199(2):537–40.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Modarresi S, Motamedi D, Jude CM. Superior labral anteroposterior lesions of the shoulder: part 2, mechanisms and classification. AJR Am J Roentgenol. 2011;197(3):604–11.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Jin W, Ryu KN, Kwon SH, Rhee YG, Yang DM. MR arthrography in the differential diagnosis of type II superior labral anteroposterior lesion and sublabral recess. AJR Am J Roentgenol. 2006;187(4):887–93.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Williams MM, Snyder SJ, Buford D. The Buford complex--the “cord-like” middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthrosc J Arthrosc Relat Surg. 1994;10(3):241–7.CrossRefGoogle Scholar
  22. 22.
    Ilahi OA, Cosculluela PE, Ho DM. Classification of anterosuperior glenoid labrum variants and their association with shoulder pathology. Orthopedics. 2008;31(3):226.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Ilahi OA, Labbe MR, Cosculluela P. Variants of the anterosuperior glenoid labrum and associated pathology. Arthrosc J Arthrosc Relat Surg. 2002;18(8):882–6.CrossRefGoogle Scholar
  24. 24.
    Tuite MJ, Blankenbaker DG, Seifert M, Ziegert AJ, Orwin JF. Sublabral foramen and Buford complex: inferior extent of the unattached or absent labrum in 50 patients. Radiology. 2002;223(1):137–42.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Rao AG, Kim TK, Chronopoulos E, McFarland EG. Anatomical variants in the anterosuperior aspect of the glenoid labrum: a statistical analysis of seventy-three cases. J Bone Joint Surg Am. 2003;85-A(4):653–9.CrossRefGoogle Scholar
  26. 26.
    Wilk KE, Reinold MM, Andrews JR. The Athlete’s shoulder. 2nd ed. Philadelphia, PA: Churchill Livingstone/Elsevier; 2009.Google Scholar
  27. 27.
    Castagna A, Nordenson U, Garofalo R, Karlsson J. Minor shoulder instability. Arthrosc J Arthrosc Relat Surg. 2007;23(2):211–5.CrossRefGoogle Scholar
  28. 28.
    Silliman JF, Hawkins RJ. Classification and physical diagnosis of instability of the shoulder. Clin Orthop. 1993;291:7–19.Google Scholar
  29. 29.
    Burkhart SS, Morgan CD, Kibler WB. Shoulder injuries in overhead athletes. The “dead arm” revisited. Clin Sports Med. 2000;19(1):125–58.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Steinbeck J, Liljenqvist U, Jerosch J. The anatomy of the glenohumeral ligamentous complex and its contribution to anterior shoulder stability. J Shoulder Elb Surg. 1998;7(2):122–6.CrossRefGoogle Scholar
  31. 31.
    McQuade KJ, Dawson J, Smidt GL. Scapulothoracic muscle fatigue associated with alterations in scapulohumeral rhythm kinematics during maximum resistive shoulder elevation. J Orthop Sports Phys Ther. 1998;28(2):74–80.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Paletta GA, Warner JJ, Warren RF, Deutsch A, Altchek DW. Shoulder kinematics with two-plane x-ray evaluation in patients with anterior instability or rotator cuff tearing. J Shoulder Elb Surg. 1997;6(6):516–27.CrossRefGoogle Scholar
  33. 33.
    Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. A study using Moiré topographic analysis. Clin Orthop Relat Res. 1992;285:191–9.Google Scholar
  34. 34.
    Wilk KE, Arrigo C. Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports Phys Ther. 1993;18(1):365–78.PubMedCrossRefGoogle Scholar
  35. 35.
    Walch G, Boileau P, Noel E, Donell ST. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elb Surg. 1992;1(5):238–45.CrossRefGoogle Scholar
  36. 36.
    Jobe FW, Kvitne RS, Giangarra CE. Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement. Orthop Rev. 1989;18(9):963–75.PubMedGoogle Scholar
  37. 37.
    Jobe CM. Posterior superior glenoid impingement: expanded spectrum. Arthrosc J Arthrosc Relat Surg. 1995;11(5):530–6.CrossRefGoogle Scholar
  38. 38.
    Chung CB, Steinbach LS. MRI of the upper extremity: shoulder, elbow, wrist and hand. Philadelphia, PA: Lippincott Williams & Wilkins; 2009.Google Scholar
  39. 39.
    Giaroli EL, Major NM, Higgins LD. MRI of internal impingement of the shoulder. AJR Am J Roentgenol. 2005;185(4):925–9.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Kaplan LD, McMahon PJ, Towers J, Irrgang JJ, Rodosky MW. Internal impingement: findings on magnetic resonance imaging and arthroscopic evaluation. Arthrosc J Arthrosc Relat Surg. 2004;20(7):701–4.CrossRefGoogle Scholar
  41. 41.
    Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthrosc J Arthrosc Relat Surg. 2003;19(4):404–20.CrossRefGoogle Scholar
  42. 42.
    Kibler WB, Kuhn JE, Wilk K, Sciascia A, Moore S, Laudner K, et al. The disabled throwing shoulder: spectrum of pathology-10-year update. Arthrosc J Arthrosc Relat Surg. 2013;29(1):141–61.CrossRefGoogle Scholar
  43. 43.
    Grossman MG, Tibone JE, McGarry MH, Schneider DJ, Veneziani S, Lee TQ. A cadaveric model of the throwing shoulder: a possible etiology of superior labrum anterior-to-posterior lesions. J Bone Joint Surg Am. 2005;87(4):824–31.PubMedGoogle Scholar
  44. 44.
    Verna C. Shoulder flexibility to reduce impingement. Im: Presented at the 3rd Annual PBATS (Professional Baseball Athletic Trainer Society) Meeting. Mesa, AZ; 1991.Google Scholar
  45. 45.
    Kibler WB. The relationship of glenohumeral internal rotation deficit to shoulder and elbow injuries in tennis players: a prospective evaluation of posterior capsular stretching. In: Presented at the Annual closed meeting of the American Shoulder and Elbow Surgeons. New York, NY; 1998.Google Scholar
  46. 46.
    Petchprapa CN, Beltran LS, Jazrawi LM, Kwon YW, Babb JS, Recht MP. The rotator interval: a review of anatomy, function, and normal and abnormal MRI appearance. AJR Am J Roentgenol. 2010;195(3):567–76.CrossRefGoogle Scholar
  47. 47.
    Chang EY, Fliszar E, Chung CB. Superior labrum anterior and posterior lesions and microinstability. Magn Reson Imaging Clin N Am. 2012;20(2):277–94.PubMedCrossRefGoogle Scholar
  48. 48.
    Bowen MK, Warren RF. Ligamentous control of shoulder stability based on selective cutting and static translation experiments. Clin Sports Med. 1991;10(4):757–82.PubMedGoogle Scholar
  49. 49.
    Speer KP. Anatomy and pathomechanics of shoulder instability. Clin Sports Med. 1995;14(4):751–60.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Savoie FH, Field LD, Atchinson S. Anterior superior instability with rotator cuff tearing: SLAC lesion. Orthop Clin North Am. 2001;32(3):457–61.. ixPubMedCrossRefGoogle Scholar
  51. 51.
    Townley CO. The capsular mechanism in recurrent dislocation of the shoulder. J Bone Joint Surg Am. 1950;32A(2):370–80.PubMedCrossRefGoogle Scholar
  52. 52.
    Savoie FH, Papendik L, Field LD, Jobe C. Straight anterior instability: lesions of the middle glenohumeral ligament. Arthrosc J Arthrosc Relat Surg. 2001;17(3):229–35.CrossRefGoogle Scholar
  53. 53.
    Tirman PF, Bost FW, Garvin GJ, Peterfy CG, Mall JC, Steinbach LS, et al. Posterosuperior glenoid impingement of the shoulder: findings at MR imaging and MR arthrography with arthroscopic correlation. Radiology. 1994;193(2):431–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Flannigan B, Kursunoglu-Brahme S, Snyder S, Karzel R, Del Pizzo W, Resnick D. MR arthrography of the shoulder: comparison with conventional MR imaging. AJR Am J Roentgenol. 1990;155(4):829–32.PubMedCrossRefGoogle Scholar
  55. 55.
    Palmer WE, Brown JH, Rosenthal DI. Rotator cuff: evaluation with fat-suppressed MR arthrography. Radiology. 1993;188(3):683–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Barber FA, Morgan CD, Burkhart SS, Jobe CM. Current controversies. Point counterpoint. Labrum/biceps/cuff dysfunction in the throwing athlete. Arthrosc J Arthrosc Relat Surg. 1999;15(8):852–7.CrossRefGoogle Scholar
  57. 57.
    Gold GE, Pappas GP, Blemker SS, Whalen ST, Campbell G, McAdams TA, et al. Abduction and external rotation in shoulder impingement: an open MR study on healthy volunteers initial experience. Radiology. 2007;244(3):815–22.PubMedCrossRefGoogle Scholar
  58. 58.
    Tuite MJ, Petersen BD, Wise SM, Fine JP, Kaplan LD, Orwin JF. Shoulder MR arthrography of the posterior labrocapsular complex in overhead throwers with pathologic internal impingement and internal rotation deficit. Skelet Radiol. 2007;36(6):495–502.CrossRefGoogle Scholar
  59. 59.
    Tehranzadeh AD, Fronek J, Resnick D. Posterior capsular fibrosis in professional baseball pitchers: case series of MR arthrographic findings in six patients with glenohumeral internal rotational deficit. Clin Imaging. 2007;31(5):343–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Bennett GE. Elbow and shoulder lesions of baseball players. Am J Surg. 1959;98:484–92.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    De Maeseneer M, Jaovisidha S, Jacobson JA, Tam W, Schils JP, Sartoris DJ, et al. The Bennett lesion of the shoulder. J Comput Assist Tomogr. 1998;22(1):31–4.PubMedCrossRefGoogle Scholar
  62. 62.
    Andrews JR, Carson WG, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13(5):337–41.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthrosc J Arthrosc Relat Surg. 1990;6(4):274–9.CrossRefGoogle Scholar
  64. 64.
    Kim TK, Queale WS, Cosgarea AJ, McFarland EG. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg Am. 2003;85-A(1):66–71.CrossRefGoogle Scholar
  65. 65.
    Maffet MW, Gartsman GM, Moseley B. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med. 1995;23(1):93–8.PubMedCrossRefGoogle Scholar
  66. 66.
    Powell SE, Nord KD, Ryu RKN. The diagnosis, classification, and treatment of SLAP lesions. Oper Tech Sports Med. 2004;12(2):99–110.CrossRefGoogle Scholar
  67. 67.
    Mohana-Borges AVR, Chung CB, Resnick D. Superior labral anteroposterior tear: classification and diagnosis on MRI and MR arthrography. Am J Roentgenol. 2003;181(6):1449–62.CrossRefGoogle Scholar
  68. 68.
    Clavert P, Bonnomet F, Kempf JF, Boutemy P, Braun M, Kahn JL. Contribution to the study of the pathogenesis of type II superior labrum anterior-posterior lesions: a cadaveric model of a fall on the outstretched hand. J Shoulder Elb Surg. 2004;13(1):45–50.CrossRefGoogle Scholar
  69. 69.
    Bey MJ, Elders GJ, Huston LJ, Kuhn JE, Blasier RB, Soslowsky LJ. The mechanism of creation of superior labrum, anterior, and posterior lesions in a dynamic biomechanical model of the shoulder: the role of inferior subluxation. J Shoulder Elb Surg. 1998;7(4):397–401.CrossRefGoogle Scholar
  70. 70.
    Burkhart SS, Morgan CD. The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthrosc J Arthrosc Relat Surg. 1998;14(6):637–40.CrossRefGoogle Scholar
  71. 71.
    Pagnani MJ, Deng XH, Warren RF, Torzilli PA, Altchek DW. Effect of lesions of the superior portion of the glenoid labrum on glenohumeral translation. J Bone Joint Surg Am. 1995;77(7):1003–10.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Hantes ME, Venouziou AI, Liantsis AK, Dailiana ZH, Malizos KN. Arthroscopic repair for chronic anterior shoulder instability: a comparative study between patients with Bankart lesions and patients with combined Bankart and superior labral anterior posterior lesions. Am J Sports Med. 2009;37(6):1093–8.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med. 1997;25(3):306–11.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthrosc J Arthrosc Relat Surg. 2007;23(9):985–90.CrossRefGoogle Scholar
  75. 75.
    Antonio GE, Griffith JF, Yu AB, Yung PSH, Chan KM, Ahuja AT. First-time shoulder dislocation: high prevalence of labral injury and age-related differences revealed by MR arthrography. J Magn Reson Imaging. 2007;26(4):983–91.PubMedCrossRefGoogle Scholar
  76. 76.
    Sebro R, Oliveira A, Palmer WE. MR arthrography of the shoulder: technical update and clinical applications. Semin Musculoskelet Radiol. 2014;18(4):352–64.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    La Rocca VR, Rybak LD, Recht M. Technical update on magnetic resonance imaging of the shoulder. Magn Reson Imaging Clin N Am. 2012;20(2):149–61.CrossRefGoogle Scholar
  78. 78.
    Chung CB, Dwek JR, Feng S, Resnick D. MR arthrography of the glenohumeral joint: a tailored approach. AJR Am J Roentgenol. 2001;177(1):217–9.CrossRefGoogle Scholar
  79. 79.
    Farmer KD, Hughes PM. MR arthrography of the shoulder: fluoroscopically guided technique using a posterior approach. AJR Am J Roentgenol. 2002;178(2):433–4.CrossRefGoogle Scholar
  80. 80.
    Dépelteau H, Bureau NJ, Cardinal E, Aubin B, Brassard P. Arthrography of the shoulder: a simple fluoroscopically guided approach for targeting the rotator cuff interval. AJR Am J Roentgenol. 2004;182(2):329–32.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Wagner SC, Schweitzer ME, Weishaupt D. Temporal behavior of intra-articular gadolinium. J Comput Assist Tomogr. 2001;25(5):661–70.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Vahlensieck M, Sommer T, Textor J, Pauleit D, Lang P, Genant HK, et al. Indirect MR arthrography: techniques and applications. Eur Radiol. 1998;8(2):232–5.PubMedCrossRefGoogle Scholar
  83. 83.
    Bergin D, Schweitzer ME. Indirect magnetic resonance arthrography. Skelet Radiol. 2003;32(10):551–8.CrossRefGoogle Scholar
  84. 84.
    Bencardino JT, Beltran J, Rosenberg ZS, Rokito A, Schmahmann S, Mota J, et al. Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder. Radiology. 2000;214(1):267–71.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Waldt S, Burkart A, Lange P, Imhoff AB, Rummeny EJ, Woertler K. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. Am J Roentgenol. 2004;182(5):1271–8.CrossRefGoogle Scholar
  86. 86.
    Chandnani VP, Yeager TD, DeBerardino T, Christensen K, Gagliardi JA, Heitz DR, et al. Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. Am J Roentgenol. 1993;161(6):1229–35.CrossRefGoogle Scholar
  87. 87.
    Amin MF, Youssef AO. The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: comparison with arthroscopic findings. Eur J Radiol. 2012;81(9):2343–7.PubMedCrossRefPubMedCentralGoogle Scholar
  88. 88.
    Magee T, Williams D, Mani N. Shoulder MR arthrography: which patient group benefits most? AJR Am J Roentgenol. 2004;183(4):969–74.PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Herold T, Hente R, Zorger N, Finkenzeller T, Feuerbach S, Lenhart M, et al. Indirect MR-arthrography of the shoulder-value in the detection of SLAP-lesions. RöFo Fortschritte Auf Dem Geb Röntgenstrahlen Nukl. 2003;175(11):1508–14.CrossRefGoogle Scholar
  90. 90.
    Dinauer PA, Flemming DJ, Murphy KP, Doukas WC. Diagnosis of superior labral lesions: comparison of noncontrast MRI with indirect MR arthrography in unexercised shoulders. Skelet Radiol. 2007;36(3):195–202.CrossRefGoogle Scholar
  91. 91.
    Jung JY, Yoon YC, Yi S-K, Yoo J, Choe B-K. Comparison study of indirect MR arthrography and direct MR arthrography of the shoulder. Skelet Radiol. 2009;38(7):659–67.CrossRefGoogle Scholar
  92. 92.
    Collins CM, Smith MB. Signal-to-noise ratio and absorbed power as functions of main magnetic field strength, and definition of “90 degrees ” RF pulse for the head in the birdcage coil. Magn Reson Med. 2001;45(4):684–91.PubMedCrossRefPubMedCentralGoogle Scholar
  93. 93.
    Edelstein WA, Glover GH, Hardy CJ, Redington RW. The intrinsic signal-to-noise ratio in NMR imaging. Magn Reson Med. 1986;3(4):604–18.PubMedCrossRefPubMedCentralGoogle Scholar
  94. 94.
    Ramnath RR. 3T MR imaging of the musculoskeletal system (part I): considerations, coils, and challenges. Magn Reson Imaging Clin N Am. 2006;14(1):27–40.PubMedCrossRefPubMedCentralGoogle Scholar
  95. 95.
    Matzat SJ, van Tiel J, Gold GE, Oei EHG. Quantitative MRI techniques of cartilage composition. Quant Imaging Med Surg. 2013;3(3):162–74.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Anz AW, Lucas EP, Fitzcharles EK, Surowiec RK, Millett PJ, Ho CP. MRI T2 mapping of the asymptomatic supraspinatus tendon by age and imaging plane using clinically relevant subregions. Eur J Radiol. 2014;83(5):801–5.PubMedCrossRefPubMedCentralGoogle Scholar
  97. 97.
    Mosher TJ. Musculoskeletal imaging at 3T: current techniques and future applications. Magn Reson Imaging Clin N Am. 2006;14(1):63–76.PubMedCrossRefPubMedCentralGoogle Scholar
  98. 98.
    Magee TH, Williams D. Sensitivity and specificity in detection of labral tears with 3.0-T MRI of the shoulder. Am J Roentgenol. 2006;187(6):1448–52.CrossRefGoogle Scholar
  99. 99.
    Legan JM, Burkhard TK, Goff WB, Balsara ZN, Martinez AJ, Burks DD, et al. Tears of the glenoid labrum: MR imaging of 88 arthroscopically confirmed cases. Radiology. 1991;179(1):241–6.PubMedCrossRefGoogle Scholar
  100. 100.
    Murray PJ, Shaffer BS. Clinical update: MR imaging of the shoulder. Sports Med Arthrosc Rev. 2009;17(1):40–8.PubMedCrossRefPubMedCentralGoogle Scholar
  101. 101.
    Gusmer PB, Potter HG, Schatz JA, Wickiewicz TL, Altchek DW, O’Brien SJ, et al. Labral injuries: accuracy of detection with unenhanced MR imaging of the shoulder. Radiology. 1996;200(2):519–24.PubMedCrossRefPubMedCentralGoogle Scholar
  102. 102.
    Connell DA, Potter HG, Wickiewicz TL, Altchek DW, Warren RF. Noncontrast magnetic resonance imaging of superior labral lesions. 102 cases confirmed at arthroscopic surgery. Am J Sports Med. 1999;27(2):208–13.PubMedCrossRefPubMedCentralGoogle Scholar
  103. 103.
    Magee T. 3-T MRI of the shoulder: is MR arthrography necessary? Am J Roentgenol. 2009;192(1):86–92.CrossRefGoogle Scholar
  104. 104.
    Major NM, Browne J, Domzalski T, Cothran RL, Helms CA. Evaluation of the glenoid labrum with 3-T MRI: is intra-articular contrast necessary? Am J Roentgenol. 2011;196(5):1139–44.CrossRefGoogle Scholar
  105. 105.
    Gustas CN, Tuite MJ. Imaging update on the glenoid labrum: variants versus tears. Semin Musculoskelet Radiol. 2014;18(4):365–73.PubMedCrossRefPubMedCentralGoogle Scholar
  106. 106.
    Sasaki T, Yodono H, Prado GLM, Saito Y, Miura H, Itabashi Y, et al. Increased signal intensity in the normal glenoid labrum in MR imaging: diagnostic pitfalls caused by the magic-angle effect. Magn Reson Med Sci. 2002;1(3):149–56.PubMedCrossRefPubMedCentralGoogle Scholar
  107. 107.
    Chang D, Mohana-Borges A, Borso M, Chung CB. SLAP lesions: anatomy, clinical presentation, MR imaging diagnosis and characterization. Eur J Radiol. 2008;68(1):72–87.PubMedCrossRefPubMedCentralGoogle Scholar
  108. 108.
    Tuite MJ, Rutkowski A, Enright T, Kaplan L, Fine JP, Orwin J. Width of high signal and extension posterior to biceps tendon as signs of superior labrum anterior to posterior tears on MRI and MR arthrography. AJR Am J Roentgenol. 2005;185(6):1422–8.PubMedCrossRefPubMedCentralGoogle Scholar
  109. 109.
    De Maeseneer M, Van Roy F, Lenchik L, Shahabpour M, Jacobson J, Ryu KN, et al. CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. Radiographics. 2000;20:S67–81.PubMedCrossRefPubMedCentralGoogle Scholar
  110. 110.
    Kwak SM, Brown RR, Trudell D, Resnick D. Glenohumeral joint: comparison of shoulder positions at MR arthrography. Radiology. 1998;208(2):375–80.PubMedCrossRefPubMedCentralGoogle Scholar
  111. 111.
    Yeh L, Kwak S, Kim YS, Pedowitz R, Trudell D, Muhle C, et al. Anterior labroligamentous structures of the glenohumeral joint: correlation of MR arthrography and anatomic dissection in cadavers. Am J Roentgenol. 1998;171(5):1229–36.CrossRefGoogle Scholar
  112. 112.
    Palmer WE, Brown JH, Rosenthal DI. Labral-ligamentous complex of the shoulder: evaluation with MR arthrography. Radiology. 1994;190(3):645–51.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Konstantin Krepkin
    • 1
    Email author
  • Michael J. Tuite
    • 2
  • Jenny T. Bencardino
    • 1
    • 3
  1. 1.Department of RadiologyNew York University Langone HealthNew YorkUSA
  2. 2.Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Penn Medicine, Department of RadiologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA

Personalised recommendations