MR arthrographic analysis of labral and tendinous lesions in patients with shoulder avulsion injury.

OBJECTIVES: This study aimed to evaluate the frequency and characteristics of specific labral lesions (SLAP and Bankart) and associated tendinous injuries in patients with avulsion fractures of the shoulder using magnetic resonance (MR) arthrography and to investigate their potential clinical implications. METHODS: A retrospective review was performed on 850 shoulder MR arthrograms retrieved from our institutional PACS database.The study comprised a total of 35 patients with confirmed avulsion fractures and 30 age- and sex-matched controls. . All patients received both conventional MR imaging and 3D volumetric MR arthrography sequences. The evaluation focused on labral lesions (SLAP, Bankart), rotator cuff injuries and biceps tendon pathology which were systematically evaluated by two experienced radiologists. RESULTS: The avulsion fracture of the greater tuberosity was the most commonly observed, accounting for 60% of cases. Labral pathology was considerably more prevalent among the patient cohort (51.4%) compared to the control group (23.3%) (p=0.039). Superior labrum anterior to posterior (SLAP) lesions were the most frequently identified labral abnormalities, and were significantly more common than both Bankart lesions (17.1%) and Bankart variant lesions (2.9%) (p=0.015). Patients presenting with fractures of the lesser tuberosity demonstrated a notably higher incidence of combined rotator cuff and biceps tendon pathology (77.8%) in contrast to those with greater tuberosity fractures (14.3%) (p=0.002). CONCLUSIONS: The research underscores a robust link between avulsion fractures and superior labral injuries, especially SLAP lesions. Moreover, there was a significant correlation between lesser tuberosity fractures and extensive tendinous pathology, indicating a greater degree of biomechanical compromise. These results highlight the critical role of MR arthrography in identifying concurrent labral and tendinous injuries that could affect clinical decision-making.