Assessment of Suspected Shoulder Labrum Tear
Initial Imaging Protocol
- The American College of Radiology recommends beginning with standard three-view radiographs, including anteroposterior in internal and external rotation plus an axillary or scapula-Y view, to exclude fractures and bony pathology, with a sensitivity of 86-100% for detecting labral tears 1, 2, 3
- Standard radiographs should be obtained first, with three mandatory views, to rule out fractures and other bony pathology before proceeding to advanced imaging 1, 2, 3
- Never rely on AP views alone, as they miss posterior dislocations in over 60% of cases 2, 3
Advanced Imaging Selection
- MR arthrography is the gold standard for suspected labral tears, with an appropriateness rating of 9/9 and a sensitivity of 86-100% for detecting labral injury 1, 2, 3
- For acute dislocations, non-contrast MRI may be preferred over MR arthrography, with an appropriateness rating of 7/9, to evaluate for labral tears, capsular injuries, and bone loss that predict recurrence 2, 4
- If MRI is contraindicated, CT arthrography is comparable to MR arthrography for Bankart and Hill-Sachs lesions, and should be reserved for patients with pacemakers or other MRI contraindications 1, 3
Age-Specific Considerations
- Younger patients (<35 years) have a higher likelihood of labroligamentous injury and persistent instability after dislocation, and may benefit from surgical stabilization if conservative management fails 2, 3
- Older patients (>40-60 years) are more likely to have concomitant rotator cuff tears, and may experience weakness in external rotation, abduction, or internal rotation 2, 4
Past Medical History Considerations
- Recurrent instability despite appropriate rehabilitation is an indication for surgical evaluation, and up to 10% of patients with recurrent instability develop progressive glenoid bone loss requiring specialized surgical procedures 2, 3