Diagnosis and Management of Chronic Labral Tear with Secondary Adhesive Capsulitis

Clinical Presentation and Diagnosis

The American College of Radiology suggests that clicking with circumduction is highly suggestive of labral pathology, as the torn labral fragment mechanically catches during shoulder rotation 1, 3
A mechanism of direct impact from a significant fall creates sufficient force to cause labroligamentous injury, which is a common post-traumatic soft-tissue injury 1, 2, 4
Labral tears frequently persist chronically if untreated, continuing to cause mechanical symptoms and pain years after the initial injury 3
The American College of Radiology recommends obtaining standard shoulder radiographs to exclude fracture, dislocation, or significant osteoarthritis 4
Radiographs can also identify bony Bankart lesions or Hill-Sachs deformities from the original trauma 3

The American College of Radiology states that MR arthrography is the gold standard for diagnosing labral tears and is superior to noncontrast MRI for detecting labroligamentous injuries 1, 2, 4
In chronic cases, MR arthrography is preferred over noncontrast MRI because there will be no acute joint effusion to outline the labral tear 1, 2

The American College of Radiology suggests performing O'Brien's test or crank test to provoke labral symptoms and clicking 3
Assessing for painful arc and impingement signs can help evaluate for concurrent rotator cuff pathology 1, 3
It is critical not to assume that chronicity means the condition is stable or benign, as chronic labral tears can cause progressive cartilage damage and secondary osteoarthritis 3
The American College of Radiology advises against ordering noncontrast MRI as the initial advanced imaging in chronic cases, as MR arthrography provides superior visualization of labral pathology 1, 2, 4