Shoulder labral tear is partial or complete detachment of the fibrocartilaginous structure of the glenoid labrum. The labrum deepens the glenoid cavity contributing 50% to glenohumeral stability. Tears are classified by location: Bankart lesion (anteroinferior — associated with anterior instability/dislocation), SLAP lesion (superior — at biceps tendon origin area, in overhead athletes), posterior labral tear (rare, posterior instability). MRI and especially MR arthrography (intra-articular gadolinium injection) are the gold standard — dilute gadolinium highlights tear by penetrating into labral tear. Paralabral cysts are indirect findings of labral tear. HAGL lesion (Humeral Avulsion of Glenohumeral Ligament) is an important variant that may be seen instead of or with labral tear in anterior instability.
Age Range
15-45
Peak Age
25
Gender
Male predominant
Prevalence
Common
The glenoid labrum is a fibrocartilaginous structure attached to the glenoid bone rim. The labrum's primary function is deepening the glenoid cavity by 50% contributing to humeral head stability. Additionally, glenohumeral ligaments and biceps tendon attach to the labrum — these structural connections enhance stability. Bankart lesion most commonly occurs during anterior shoulder dislocation: as the humeral head displaces anteriorly, the anteroinferior labrum avulses from the glenoid rim. In bony Bankart, the anterior bone fragment of glenoid rim is also avulsed — stability loss is more severe. Hill-Sachs lesion (humeral head posterosuperior compression fracture) is the contralateral impaction finding of anterior dislocation. SLAP lesion is separation of superior labrum anterior to posterior at the biceps origin region. Most commonly occurs in overhead athletes (baseball, tennis) from repetitive traction and compression forces or from fall on outstretched hand mechanism. Paralabral cysts form from synovial fluid seeping through the labral tear line behind the labrum — cysts at suprascapular notch location can compress the suprascapular nerve causing infraspinatus muscle atrophy. Gadolinium penetrating into the labral tear space on MR arthrography proves the tear is open-ended and communicates with the joint. Normal labral sulcus (sublabral recess) must be differentiated from tear — sulcus extends medially, tear extends laterally.
On MR arthrography T1 fat-sat axial images, high-signal gadolinium line penetrating between labrum and glenoid rim. This finding proves the labral tear communicates with the joint and is diagnostic. Differentiation from normal sublabral recess: tear line extends laterally, recess extends medially.
On axial T1 fat-sat images on MR arthrography, gadolinium-penetrating tear line in anteroinferior labrum is seen. Labrum is detached from glenoid rim with contrast filling between labrum and glenoid. In bony Bankart, anterior glenoid bone defect is also seen. Periosteal stripping (ALPSA lesion) shows medialized labrum as Bankart variant.
Report Sentence
Gadolinium-penetrating tear line with detachment from glenoid rim in anteroinferior labrum is seen, consistent with Bankart lesion.
On T2 fat-sat coronal-oblique images, labral irregularity, signal increase, and labral detachment at biceps origin region of superior labrum is seen. SLAP classification: Type I — degeneration; Type II — labral detachment (most common, 40%); Type III — bucket-handle; Type IV — tear extending into biceps tendon. Differentiation from sublabral recess is important — recess has smooth margins and extends medially.
Report Sentence
Labral detachment and signal increase at biceps origin level of the superior labrum is seen, consistent with SLAP Type ___ lesion.
On T2 fat-sat axial or coronal images, T2 hyperintense cystic lesion behind labrum or within glenoid bone is seen. Paralabral cysts form from synovial fluid seeping through labral tear line outside the labrum and are indirect findings of underlying labral tear. Cysts at suprascapular notch location can compress suprascapular nerve causing infraspinatus muscle denervation and atrophy — surgical intervention is required in this case.
Report Sentence
A paralabral cyst measuring approximately ___ mm behind the posterior/superior labrum is seen, suggesting underlying labral tear.
On T2 fat-sat axial images, impaction defect with surrounding bone marrow edema in posterosuperior region of humeral head is seen. Hill-Sachs lesion is the classic contralateral finding of anterior shoulder dislocation — during anterior dislocation, humeral head impacts anterior glenoid rim creating posterosuperior compression fracture. Engaging Hill-Sachs (matching glenoid defect) requires surgical intervention.
Report Sentence
An impaction defect and bone marrow edema consistent with Hill-Sachs lesion is seen in the posterosuperior humeral head.
On MR arthrography, contrast penetration with avulsion at humeral attachment of inferior glenohumeral ligament is seen. In HAGL lesion, labrum may be intact — instability source is ligament avulsion not labral tear. On axial T1 fat-sat images, contrast accumulation and periosteal irregularity at ligament detachment site at humeral medial metaphysis is seen.
Report Sentence
Avulsion and contrast penetration at humeral attachment of inferior glenohumeral ligament is seen, consistent with HAGL lesion.
Criteria
Anteroinferior labrum avulsed from glenoid
Distinct Features
Associated with anterior dislocation, Hill-Sachs accompanies, recurrent instability, surgical repair (Bankart repair)
Criteria
Superior labrum anterior-posterior detachment (biceps origin)
Distinct Features
Common in overhead athletes, Type II most frequent, biceps tendon instability may accompany, SLAP repair or biceps tenodesis
Criteria
Posterior labrum detachment from glenoid
Distinct Features
Rare (5-10%), posterior instability, Kim lesion (paralabral cyst + posterior labral tear), in offensive linemen athletes
Distinguishing Feature
Rotator cuff tear is tendon pathology, labral tear is labrum pathology — different anatomy, different clinical presentation (instability vs strength loss)
Distinguishing Feature
Biceps tendon pathology is seen in bicipital groove; in SLAP lesion superior labral tear at biceps origin — both may coexist
Distinguishing Feature
Subacromial bursitis is bursal pathology, labral tear is labrum pathology — completely different anatomic region and mechanism
Urgency
urgentManagement
surgicalBiopsy
Not NeededFollow-up
specialist-referralLabral tear treatment is planned based on tear type, patient age, activity level, and instability pattern, requiring multidisciplinary evaluation. Bankart lesion: arthroscopic Bankart repair (labral refixation with suture anchors) is standard in young patients with recurrent anterior instability — success rate 85-95%, recurrence 5-15%. Bony Bankart or engaging Hill-Sachs with glenoid bone loss >25% may require Latarjet procedure (coracoid transfer — coracoid process fixed to anterior glenoid, bone stock augmented + conjoined tendon sling effect) — success rate 95%+, recurrence 2-5%. SLAP lesion: SLAP repair preferred in young overhead athletes (<35 years) with Type II tears but return-to-sport rate is variable; biceps tenodesis (biceps tendon fixed to humerus + SLAP debridement) offers more predictable outcomes in >40 years and low-demand profiles. Posterior labral tears: arthroscopic posterior labral repair — posterior instability is rarer and more subtle than anterior (positional pain and subluxation). If paralabral cyst with suprascapular nerve compression exists, surgical decompression + labral repair must be performed together — infraspinatus atrophy may be irreversible requiring early intervention. MR arthrography is the gold standard for preoperative planning — evaluating tear type, location, bone loss amount, and accompanying pathologies (Hill-Sachs, HAGL, rotator cuff).
Bankart lesions are the most important cause of recurrent shoulder dislocation and require surgical repair (arthroscopic Bankart repair). SLAP lesions cause performance loss in overhead athletes. Large bone defects (engaging Hill-Sachs, glenoid bone loss >20%) may require open surgery (Latarjet procedure).