Although diagnosing recurrent labral tears after prior labral repair is challenging, MR arthrography is particularly helpful in this scenario in which discrete fluid or gadolinium signal within or underlying the labrum, absent labrum, and paralabral cyst are all highly suggestive of recurrent tear [94], with a greater sensitivity than seen with conventional MRI [73]. MRI Shoulder Without and With IV Contrast IV injection of gadolinium can be used to enhance the highly vascular synovium producing an indirect arthrogram effect [34]. Indirect arthrography has been found to have a sensitivity of 74% and a specificity of 67% for SLAP tear, which is lower than for direct MR arthrography [89]. Although the accuracy of indirect MR arthrography has been described in the literature, it is not commonly used in clinical practice. MRI Shoulder Without IV Contrast Conventional MRI with 3T imaging is highly accurate for the detection of a labral tear, with a sensitivity of 83% and a specificity of 99% to 100% for a labral tear [90]. MR arthrography adds additional benefit to conventional shoulder MRI because it may identify some labral tears that are not seen with conventional MRI [95]. The increased accuracy with MR arthrography should be balanced against the need for an invasive arthrogram procedure. Although evaluation of glenoid bony integrity is typically better with CT imaging, some practitioners have used ultrashort or zero echo time sequences [96-98], 3-D sequences [99], or conventional MRI sequences [100] to measure glenoid bone loss with a high concordance to CT images. Radiography Shoulder Additional Views There are several options for additional radiographic views in patients with suspected instability [1]. The West Point and Garth views can demonstrate the anterior inferior glenoid at a better advantage in patients with a suspected Bankart fracture. A Stryker notch view can sometimes demonstrate a Hill-Sachs lesion that is difficult to see on conventional projections.
Chronic Shoulder Pain PCAs. Although diagnosing recurrent labral tears after prior labral repair is challenging, MR arthrography is particularly helpful in this scenario in which discrete fluid or gadolinium signal within or underlying the labrum, absent labrum, and paralabral cyst are all highly suggestive of recurrent tear [94], with a greater sensitivity than seen with conventional MRI [73]. MRI Shoulder Without and With IV Contrast IV injection of gadolinium can be used to enhance the highly vascular synovium producing an indirect arthrogram effect [34]. Indirect arthrography has been found to have a sensitivity of 74% and a specificity of 67% for SLAP tear, which is lower than for direct MR arthrography [89]. Although the accuracy of indirect MR arthrography has been described in the literature, it is not commonly used in clinical practice. MRI Shoulder Without IV Contrast Conventional MRI with 3T imaging is highly accurate for the detection of a labral tear, with a sensitivity of 83% and a specificity of 99% to 100% for a labral tear [90]. MR arthrography adds additional benefit to conventional shoulder MRI because it may identify some labral tears that are not seen with conventional MRI [95]. The increased accuracy with MR arthrography should be balanced against the need for an invasive arthrogram procedure. Although evaluation of glenoid bony integrity is typically better with CT imaging, some practitioners have used ultrashort or zero echo time sequences [96-98], 3-D sequences [99], or conventional MRI sequences [100] to measure glenoid bone loss with a high concordance to CT images. Radiography Shoulder Additional Views There are several options for additional radiographic views in patients with suspected instability [1]. The West Point and Garth views can demonstrate the anterior inferior glenoid at a better advantage in patients with a suspected Bankart fracture. A Stryker notch view can sometimes demonstrate a Hill-Sachs lesion that is difficult to see on conventional projections.