Case 5 - Buford complex of the shoulder

Summary

Imaging description

A Buford complex, found in 1.5% of individuals, is the absence of the anterior superior labrum in conjunction with a thickened cord-like middle glenohumeral ligament. The thick middle glenohumeral ligament attaches directly to the anterosuperior glenoid. In cases of Buford complex, axial MR images at the level of the superior half of the glenoid cavity show a thickened middle glenohumeral ligament close to the glenoid margin with an absent labrum (Figure 5.1), simulating labral tear.

Importance

If the Buford complex is mistakenly surgically reattached to the neck of the glenoid cartilage, severe painful restriction of humeral rotation and elevation can occur.

Typical clinical scenario

Buford complex can be identified in patients who were examined by MR imaging, MR arthrography, or arthroscopy to evaluate shoulder instability.

Differential diagnosis

A Buford complex can be confused with a sublabral foramen or pathologic labral detachment.

Teaching point

Identification of a thick middle glenohumeral ligament on oblique sagittal MR images helps one avoid this pitfall. The Buford complex should be suspected if the contiguous superior labrum and anterior inferior labrum appear normal.