A normal glenoid labrum has a laterally pointing edge and normal posterior labral morphology. Hottya GA, Tirman PF et al. In a SLAP injury, the top (superior) part of the labrum is injured. Locked posterior subluxation of the shoulder: diagnosis and treatment. Sensitivity was 66 %, and specificity was 77 %. 14). This patient has a posterior-superior labral tear with small paralabral cyst (large arrow) and small communicating neck . The biggest advantage of MR arthrography comes from the joint distension, which can help spot otherwise occult tears. Pagnani MJ, Warren RF Stabilizers of the glenohumeral joint. The posterior capsule is torn at the humeral attachment (arrow). Edelson was the first to define the incidence of subtle forms of glenoid dysplasia by studying scapular specimens from several museum collections.15 Posteroinferior hypoplasia was defined as a dropping away of the normally flat plateau of the posterior part of the glenoid beginning 1.2 cm caudad to the scapular spine (Figure 17-7). Posterior shoulder subluxation or dislocation is also one of the rare entities that may result in tears of the teres minor muscle.18 MR allows rapid evaluation of the status of the cuff following posterior dislocation, and prompt diagnosis of such lesions avoids delays in treatments that may lead to irreversible fatty atrophy of cuff musculature (Figs. Arthroscopy. At this level also look for Bankart lesions. This sublabral recess can be difficult to distinguish from a SLAP-tear or a sublabral foramen. Unable to load your collection due to an error, Unable to load your delegates due to an error. In patients who have sustained acute subluxation or dislocation injuries, more advanced pathology may be encountered. MRI. Surgical treatment: arthroscopic debridement . In patients with posterior instability, the presence of glenoid hypoplasia is predictably higher, with one report finding deficiency of the posteroinferior glenoid in 93% of patients with atraumatic posterior instability.10 When diagnosing posterior glenoid hypoplasia on MRI, care should be taken not to overcall the entity, as volume averaging can result in a false appearance of dysplasia on the most inferior axial slice. There are many labral variants. Advances in knowledge:: On a direct MR arthrographic image, a posterior capsular synovial fold may be a normal anatomic variant. Conclusions: However labral tears may originate at the 3-6 o'clock position and subsequently extend superiorly. 1A: The ball (humerus) normally rests within the socket (glenoid) like a golf ball on a tee. Since that time, other authors have expanded this classification to the current . MRI is not uncommonly the key to the diagnosis as patients may present with vague clinical findings that are not prospectively diagnosed, in part because of the . We concluded that even with intra-articular contrast, MRI had limitations in the ability to diagnose surgically proven SLAP lesions. by Michael Zlatkin. (OBQ12.268)
It cushions the joint of the hip bone, preventing the bones from directly rubbing against each other. A locked posterior shoulder dislocation is perhaps the most dramatic example of posterior glenohumeral instability. Comparison between 18 patients with glenoid dysplasia and 19 patients without dysplasia revealed no significant difference in outcomes between the 2 groups.20. Galvin et al performed a retrospective comparative outcomes analysis of 37 patients, mean age 28 years, who underwent arthroscopic posterior labral repair for symptomatic posterior shoulder instability with a mean follow-up of 3.1 years. Pathology involving the superior labrum presents a diagnostic and therapeutic challenge for the arthroscopic surgeon. the removal of the acromion distal to the synchondrosis may further destabilize the synchondrosis and allow for Lee SB, Kim KJ, ODriscoll SW, Morrey BF, An KN Dynamic glenohumeral stability provided by the rotator cuff muscles in the mid-range and end-range of motion. Occasionally, a SLAP (superior labrum, anterior and posterior) fracture, which represents a superior humeral head compression . Surgical Management of Superior Labral Tears in Athletes: Focus on Biceps Tenodesis. Clavert P. Glenoid Labrum Pathology. The most common cause of a cyst of the shoulder is a labral tear. On MR arthrography, the mean posterior humeral translation was greater (6.2 mm 0.08; p = 0.019), posterior labral tears were longer (19.4 mm 1.7; p = 0.0008), and labrocapsular avulsion was more common (83%; p = 0.0001) in patients with posterior instability than in patients who had a posterior labral tear but a clinically stable shoulder. In patients with glenoid deficiency or large impaction defects, osteotomies and osseous augmentation procedures may be required. An orthopaedic surgeon performs an arthroscopic shoulder procedure on a football player. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Chmiel-Nowak M, Sheikh Y, Feger J, et al. . Tearing of the inferior glenohumeral ligament at the humeral attachment (blue arrow) is also evident. 15 Imaging of the patient in the ABER position can greatly increase the conspicuity of an ALPSA lesion, which can easily be overlooked on a routine MRI of the shoulder or on the standard axial sequence of an MRA. 1992 Jul;74(6):890-6. Imaging signs of posterior glenohumeral instability. The labrum is a band of tough cartilage and connective tissue that lines the rim of the hip socket, or acetabulum. Oper Tech Sports Med 2016;24(3):181-188. ORTHOPEDICS August 2010;33(8):562. by Schreinemachers SA, van der Hulst VP, Willems WJ, Bipat S, van der Woude HJ. De Maeseneer M, Van Roy F, Lenchik L et al. Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. An official website of the United States government. Plain radiographs in patients with posterior shoulder instability are an important and critical adjunct to making the diagnosis of posterior shoulder instability. After addressing the disease prevalence, HPI and PMH, the pre-test probability likelihood of long head bicep pathology was appointed. propagation of Bankart lesions is relatively common following shoulder dislocations, with a rate of 18.5%. A CT scan is typically performed to evaluate posterior bone loss due to either a reverse bony Bankart lesion or attritional bone loss, and to assess degree of retroversion and glenoid dysplasia, and is performed in revision scenarios. 2009;192: 730-735. It helps provide stability to the shoulder by . Bennett GE: Shoulder and elbow lesions of the professional baseball pitcher. Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography? He has full passive and active range of motion of the left shoulder that is symmetrical to his contralateral side. A Treatise on Dislocations and Fractures of the Joints. Consecutive fat-suppressed proton density-weighted axial images at the mid glenoid in a football player with persistent shoulder pain reveals mild glenoid dysplasia, with a rounded contour of the posterior glenoid rim (arrows). Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. Glenoid labral tear. An anteroposterior (AP) Grashey image (also known as a true AP view because the beam is oriented perpendicular to the scapula, which is oriented 30 degrees anterior to the coronal plane) (Figure 17-1) along with an axillary x-ray (Figure 17-2), are the minimum radiographs that should be obtained. The abduction external rotation (ABER) view is excellent for assessing the anteroinferior labrum at the 3-6 o'clock position, The image shows the typical findings of a sublabral recess. An axial image in a 53 year-old male following an acute traumatic posterior dislocation reveals tears of the posterior labrum (arrow) and posterior capsule (arrowhead). Utilizing the gle-noid clockface orientation on a sagittal image (Fig. It is important to recognise these variants, because they can mimick a SLAP tear. What is Anterosuperior acetabular labrum? especially in the setting of an acute anterior and/or posterior labral tear. Notice superior labrum and attachment of the superior glenohumeral ligament. . Orthop J Sports Med. J Bone Joint Surg Am. Provencher MT, Dewing CB, Bell SJ, McCormick F, Solomon DJ, Rooney TB, Stanley M.An analysis of the rotator interval in patients with anterior, posterior, and multidirectional shoulder instability. A 22-year-old male wrestler presents to your clinic with complaints of deep left shoulder pain for the past 6 weeks. Smith T, Drew B, Toms A. There are also newer treatments to consider that don't involve surgery. The glenoid labrum is a cartilage rim that attaches to the glenoid rim. 1999 May 15;318(7194):1322-3 12) or at the humeral attachment (Fig. An impaction fracture is also present at the posterior glenoid rim (blue arrow). The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon. On the basis of these findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of . What is your diagnosis? Glenoid labral tears are the injuries of the glenoid labrum and a possible cause of shoulder pain. Notice the fibers of the inferior GHL. Diagnosis is made clinically with presence of increased anterior and posterior humeral translation, a sulcus sign, and overall increased . postulated that dislocations result in a 360 degree injury, with trauma to the anterior labrum, resulting in changes posteriorly, and vice versa. In Shoulder MR-Part I we will focus on the normal anatomy and the many anatomical variants that may simulate pathology. There was a posterior labrum tear. It should always be possible to trace the middle GHL upwards to the glenoid rim and downwards to the humerus. On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. official website and that any information you provide is encrypted Posterior subluxation of the humeral head is readily apparent. 1963 Dec. 43:1621-2. Ultrasound will also show a shoulder ganglion cyst and the effects of muscle wasting. Posterior labral tears will demonstrate the absence of the labrum or morphologic distortion, contrast, or fluid infiltration [].Four primary diagnostic characteristics can determine pathologic tearing versus an anatomic variant: intrasubstance signal intensity, margins, orientation, and extension. Fluid undermines a tear of the posterior glenoid labrum (arrow) in a 42 year-old male with persistent posterior shoulder pain. On plain radiography of the shoulder, an anteroposterior (AP) view of the shoulder in internal and external rotation, outlet, and axillary views should be obtained. Both tests may . His pain is aggravated when grappling with other wrestlers and when performing push-ups. A posterior labral tear is referred to as a reverse Bankart lesion, or attenuation of the posterior capsulolabral complex, and commonly occurs due to repetitive microtrauma in athletes. A common cause of a posterior labrum tear is repetitive microtrauma to the shoulder joint. In addition to aiding in the recognition of a locked posterior dislocation, the axillary radiograph is necessary to a complete an orthogonal radiographic analysis. If this appearance is present, a capsular tear should be strongly suspected (Fig. The abduction and external rotation of the arm releases tension on the cuff relative to the normal coronal view obtained with the arm in adduction. Look for tears of the infraspinatus tendon. Such lesions are generally found in patients with atraumatic posterior instability. (10a) Ossification is seen along the posterior glenoid (arrows) in a professional baseball pitcher with a history of posterior instability. The axial MR-images show an os acromiale with degenerative changes, i.e. The confirming test for a labral tear is an MRI preceded by an arthrogram. Uncategorized. Overall, an MRI scan will clearly show the ganglion cyst in the shoulder and whether it compresses the nerve. In part II we will discuss shoulder instability. Symptoms of a Shoulder Labrum Tear. De Coninck T, Ngai S, Tafur M, Chung C. Imaging the Glenoid Labrum and Labral Tears. scan or magnetic resonance imaging (MRI) scan may be ordered for a glenoid labrum tear diagnosis. sharing sensitive information, make sure youre on a federal ALPSA lesions are . nor be effaced against the humeral head, and intra-articular contrast can enhance visualization of the tear (3). Broadly, clinical unidirectional . 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