📌 Labral Calcification: The MRI Low-Signal Trap

https://youtu.be/hmhqWsh7Vuk

https://youtube.com/shorts/_UNZ5r3dH1M

 

Calcific Labritis (BCP Deposition in the Glenoid Labrum)

Why this matters

• Shoulder calcific tendinitis is common
• Labral calcification is rare
• Rare things get miscalled
• The common miscalls are expensive: infection or labral tear

---

 

What it is

• Basic Calcium Phosphate (BCP) crystal deposition
• Hydroxyapatite-type calcium
• Can deposit inside the glenohumeral joint
• Can be embedded in the glenoid labrum
• The painful presentation is often the acute inflammatory (resorptive) phase

---

 

Why pain can be extreme

• This is crystal-induced chemical synovitis
• Pain is often sudden
• Pain is often out of proportion
• ROM shuts down due to inflammation, not weakness

---

Imaging logic (the only workflow that works)

1) X-ray: detect the “type”

• BCP tends to look dense / amorphous / cloud-like
• CPPD tends to look thin / linear / punctate
• The diagnostic question becomes: where is it?

 

2) CT: prove the “location”

• Best modality to confirm intra-articular calcification
• Best modality to localize to labrum / biceps anchor / glenoid rim
• Also prevents the classic mistake: calling it a loose body or fracture

 

3) MRI: don’t chase calcium

• Calcium is low signal on essentially all sequences
• The labrum is low signal too
• So the deposit can “disappear” into the labrum

MRI diagnosis is pattern-based:

• Loss of normal labral contour
• Amorphous low-signal focus replacing the labral triangle
• Disproportionate inflammation
• Edema can make the lesion more conspicuous
• But edema also triggers misdiagnosis if you ignore X-ray/CT

---

 

Arthroscopy (what it explains)

• Hyperemic, inflamed labrum
• Incision can release chalky / toothpaste-like material
• Evacuation removes the inflammatory driver
• Repair depends on residual stability, not on the presence of calcium

---

 

Take-Home Message

• X-ray detects the suspicious calcification pattern
• CT localizes it to the labrum and confirms it is intra-articular
• MRI misleads unless you look for contour loss + disproportionate inflammation

If acute shoulder pain shows:

• focal amorphous calcification near the glenoid
• CT-proven intra-articular labral location
• MRI with labral contour loss and marked inflammatory reaction

Think: BCP deposition in the glenoid labrum — calcific labritis.
Call it early, and you avoid labeling it as infection or a confusing labral tear.

---

#DrSlothic #SlothicRadiology #MSKMRI #CalcificLabritis #BCP #Hydroxyapatite #ShoulderMRI #GlenoidLabrum #CrystalArthropathy #RadiologyPearls #MSKRadiology #OrthopedicImaging #CTCorrelation #XrayFirst #DontChaseEdema

---

Visualizing MSK Radiology: A Practical Guide to Radiology Mastery
© 2022 MSK MRI Jee Eun Lee All Rights Reserved.
No unauthorized reproduction, redistribution, or use for AI training.