Physical examination findings consistent with labral tear. Next imaging study. MR Arthrography Shoulder MR arthrography has been reported to have a high sensitivity for detection of labral injury, ranging from 86% to 100% [20,59,62-65]; however, the issue of selection bias is inherent in the design of many of these retrospective MRI Shoulder MRI without contrast may be preferred to MR arthrography in the setting of acute shoulder dislocation when a post-traumatic joint effusion is typically present to provide sufficient visualization of soft-tissue structures. In the subacute or chronic setting, the glenohumeral joint effusion is usually too small to provide adequate joint distention to adequately assess soft-tissue structures. Noncontrast MRI has been shown to be inferior to MR arthrography in diagnosing labroligamentous and rotator cuff injuries [17,19]. CT Arthrography Shoulder CT arthrography provides comparable sensitivity and possibly improved specificity in detection of labral lesions compared to MR arthrography [12,67] and can provide improved visualization of the bones in cases of complex trauma. However, interobserver variability in reporting of labral lesions is low [13]. CT arthrography has also been shown to be inferior to MR arthrography in assessing partial-thickness rotator cuff tears [12], which makes CT arthrography less desirable in patients where rotator cuff tears may be suspected. However, CT arthrography may be considered in a patient with shoulder dislocation/instability and contraindication to MRI. CT Shoulder CT Shoulder Noncontrast CT is unable to assess rotator cuff and labroligamentous pathology. US Shoulder Although there have been efforts to use US in diagnosis of labral lesions, it currently has no defined role in this setting. FDG-PET/CT Skull Base to Mid-Thigh There is no role for FDG-PET/CT in assessment of suspected labral tear. Bone Scan Shoulder There is no role for bone scintigraphy in assessment of suspected labral tear.
Shoulder Pain Traumatic PCAs. Physical examination findings consistent with labral tear. Next imaging study. MR Arthrography Shoulder MR arthrography has been reported to have a high sensitivity for detection of labral injury, ranging from 86% to 100% [20,59,62-65]; however, the issue of selection bias is inherent in the design of many of these retrospective MRI Shoulder MRI without contrast may be preferred to MR arthrography in the setting of acute shoulder dislocation when a post-traumatic joint effusion is typically present to provide sufficient visualization of soft-tissue structures. In the subacute or chronic setting, the glenohumeral joint effusion is usually too small to provide adequate joint distention to adequately assess soft-tissue structures. Noncontrast MRI has been shown to be inferior to MR arthrography in diagnosing labroligamentous and rotator cuff injuries [17,19]. CT Arthrography Shoulder CT arthrography provides comparable sensitivity and possibly improved specificity in detection of labral lesions compared to MR arthrography [12,67] and can provide improved visualization of the bones in cases of complex trauma. However, interobserver variability in reporting of labral lesions is low [13]. CT arthrography has also been shown to be inferior to MR arthrography in assessing partial-thickness rotator cuff tears [12], which makes CT arthrography less desirable in patients where rotator cuff tears may be suspected. However, CT arthrography may be considered in a patient with shoulder dislocation/instability and contraindication to MRI. CT Shoulder CT Shoulder Noncontrast CT is unable to assess rotator cuff and labroligamentous pathology. US Shoulder Although there have been efforts to use US in diagnosis of labral lesions, it currently has no defined role in this setting. FDG-PET/CT Skull Base to Mid-Thigh There is no role for FDG-PET/CT in assessment of suspected labral tear. Bone Scan Shoulder There is no role for bone scintigraphy in assessment of suspected labral tear.