MR diagnosis of superior labral anterior posterior (SLAP) injuries of the glenoid labrum: value of routine imaging without intraarticular injection of contrast material.

OBJECTIVE: Superior labral anterior posterior (SLAP) lesions are peculiar types of tears that involve the superior and anterior aspects of the glenoid labrum and extend posteriorly. The biceps tendon may also be involved in the injury. There have been conflicting reports in the literature about the value of MR imaging in depicting these injuries. Some authors have advocated imaging in special planes and, more recently, the use of intraarticular injection of contrast material to facilitate the diagnosis of SLAP injuries. Symptoms of SLAP injury of the glenoid labrum are nonspecific, and patients are often imaged according to routine imaging protocols that include images in axial, oblique coronal, and oblique sagittal planes using spin-echo pulse sequences. Intraarticular injection of contrast material is not part of routine MR imaging of the shoulder. We sought to determine the value of routine MR imaging without intraarticular contrast enhancement in the diagnosis of SLAP injuries of the glenoid labrum. MATERIALS AND METHODS: The MR images of eight patients with arthroscopically proved SLAP lesions were selected for this study. The MR imaging appearance of the glenoid labrum, biceps tendon attachment, and rotator cuff tendons were retrospectively evaluated in the axial, oblique coronal, and oblique sagittal planes in each case. The findings were correlated with the surgical observations. RESULTS: All eight patients showed an abnormal labrum on the coronal MR images, on 88% of the axial images, and on 50% of the sagittal images. An oblique or horizontal linear focus of increased signal was seen to traverse the labrum in 50% of the cases on sagittal images. Fifty percent of the cases also showed an intraarticular body, presumably representing the displaced fragment of a bucket-handle tear, on all imaging planes (the MR "Cheerio" sign). CONCLUSION: Routine MR imaging of the shoulder without intraarticular injection of contrast material is useful in the diagnosis of SLAP injuries of the glenoid labrum.

Arthroscopic categorization of intercarpal ligamentous injuries of the wrist.

Recent advances in our knowledge of wrist ligamentous anatomy, as well as improvements in arthroscopic techniques, permit the diagnosis and treatment of a wide variety of wrist injuries. The authors review current concepts in wrist ligamentous anatomy, patterns of instability, and the role of the arthroscope in the evaluation and treatment of such instability. Specifically, wrist portal anatomy and techniques of arthroscopic treatment of patients with partial and complete intercarpal ligament injuries are described. Chronic complete injuries are a contraindication of arthroscopic treatment. The authors conclude that wrist arthroscopy provides a valuable method of diagnosing and treating partial and complete intercarpal ligamentous injuries.

Use of the Herbert bone screw compression jig to reduce and stabilize a Bennett fracture.

This case report describes a new use for the compression jig from a Herbert bone screw set. The use of this device in stabilizing a Bennett fracture of the thumb metacarpal prevented extensive palmar exposure and facilitated reduction of the fracture.

Professional challenges in the coming decade.

Last month, as part of our observance of the 15th anniversary of Physician Assistant journal, members of our Editorial Board offered their views on turning points in the history of the PA profession. In this issue, we jump from the past to the future, with perspectives on the main crises or changes facing the profession in the coming decade. You may agree or disagree with these viewpoints. Diversity of opinion keeps the PA profession dynamic and strong--which is exactly why Physician Assistant journal provides an open forum for letters and guest editorials.

The landscape of meniscal injuries.

This article analyzes meniscal injuries seen in 10,117 knee arthroscopies. The information was compiled by a centralized data base at Surgical Data Management. The study suggests two patterns of meniscal injuries, degenerative and traumatic. Injuries to the menisci occurring with an associated anterior cruciate injury, radial tears, and tears within 3 mm of the meniscosynovial junction are associated with a younger and more active patient who is more likely to sustain a traumatic or sports-related injury. Tears described as complex, horizontal cleavage, and flap tears are associated with an older age group and follow a more degenerative pattern.