Presentation
Tennis player with pain and functional difficulties in the shoulder in the form of “squeaking” and jamming movement.
Patient Data
Coronal oblique T1-weighted fat-saturated MR arthrogram images show linear contrast-intensity signal extending from the superior labrum into the biceps anchor, with bucket-handle fragment displaced from the superior glenoid. Rotator cuff, long head biceps tendon and glenohumeral ligaments are normal.
Double Oreo cookie configuration is characterized by fluid between labrum and glenoid cartilage and between two pieces of labrum.
Case Discussion
In type IV SLAP lesions there is a bucket handle tear from the labrum that extends through the biceps tendon. The bucket-handle fragment is composed of the superior labrum and a portion of the tendon that might be displaced from the superior glenoid. There is also a double "Oreo cookie" sign with fluid between labrum and glenoid cartilage and between two pieces of labrum.
Surgical treatment is indicated in all types of SLAP lesions except for type 1, which has no clinical relevance. Type 2 and 4 injuries impair the stabilizing function of biceps insertion with glenohumeral instability, secondary impingement, and rotator cuff injuries, are usually treated by refixation.
Case courtesy Dr.ssa Laura Braccaioli.
Radiographer: TSRM Fabio Imola.
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