Age / Sex : 21 / M

Chief complaint: Right shoulder pain for 8 months

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(답안은 한개만 보내주시고, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)

Courtesy: 지원희 (Won-Hee Jee, MD), 서울성모병원 (Seoul St. Mary’s Hospital)

Buford complex

Discussion

Findings: MR arthrogram with posterior approach at 3.0T. Axial fat-suppressed proton-weighted MR arthrogram shows absence of labrum at the anterosuperior portion of the glenoid. On oblique sagittal fat-suppressed T2-weighted MR arthrogram, the thick middle glenohumeral ligament parallels the anterior glenoid.

Diagnosis: Buford complex

Discussion: The anterior superior labrum is the most common site of normal anatomic labral-ligamentous variations. Detachment of the anterior superior labrum is known by sublabral recess and sublabral foramen. In addition, the middle glenohumeral ligament (MGHL) also has great deal of variability in the anatomy. It is usually thin and originates just below the superior glenohumeral ligament (SGHL). MGHL can have a conjoined attachment with SGHL or with the long head of the biceps tendon. MGHL may be doubled or absent. 

The Buford complex represents a combination of two normal variants: a markedly thickened, cord-like MGHL and congenital absence of the anterosuperior labrum. This normal variant is found in 1.5–2% of healthy subjects. The thickened MGHL attaches directly to the anterosuperior glenoid and can be mistaken for a detached labrum.

References

1. Tirman PF, Feller JF, Palmer WE, Carroll KW, Steinbach LS, Cox I. The Buford complex – a variation of normal shoulder anatomy: MR arthrographic imaging features. AJR 1996;166:869-73

2. Tuite MJ, Orwin JF. Anterosuperior labral variants of the shoulder: appearance on gradient-recalled-echo and fast spin-echo MR images. Radiology 1996;199:537-40