Buford Complex-Normal Variant

 An absent anterior superior labrum and an associated cordl like middIe glenohumeral ligament represent the normal variation that is known as the Buford complex rather than an avulsed labrum. This normal variation may be mistaken for a detached labrum.

MR Arthrography Shoulder

Teaching points 

Usually done under fluoroscopy /ultrasonography/CT guidance to avoid labral cartilage injury. By Dr MGK Murthy and Dr Sudheer Kunkunuru

·        Indications

1.   Primarily for Rotator cuff tear suspicion or evaluation

2.   Cartilage evaluation

3.   All the internal structures including glenohumeral ligaments

·        Technique

PreArthrography  Xray shoulder AP with external and internal rotation views to look for presence of hydroxyl apatite crystals/calcification (which could be confused with rotator cuff  tear producing contrast leak)

-Supine and external rotation

-Mark the joint lateral to humeral head cortex

-20 to 22gauge LP needle perpendicular to fluoroscopy beam. Testing the safe INJOINT position with local anaesthetic after aspiration to test for blood vessels

-Confirm position with iodinated  contrast

- Dilute gadolinium injected to the comfort level usually

10 to 16 ml (Cocktail made of 0.1 ml Gadolinium+10ml Iohexol+10ml 0.9%saline+0.3ml of epinephrine of 1:1000 in 20 ml syringe )