Fluid undermines a tear of the posterior glenoid labrum (arrow) in a 42 year-old male with persistent posterior shoulder pain. Description. The findings are compatible with a posterior GLAD lesion (glenolabral articular disruption). Large tears of the rotator cuff may allow the humeral head to migrate upwards resulting in a high riding humeral head. Evaluation and management of posterior shoulder instability. Locked posterior subluxation of the shoulder: diagnosis and treatment. Patients often do not experience frank posterior dislocation events such as that with anterior shoulder instability and more commonly develop attritional lesions. The ABER view is also very useful for both partial- and full-thickness tears of the rotator cuff. Common symptoms of a SLAP tear include: dull or aching pain in the shoulder, especially while lifting over the head. Notice the biceps anchor. propagation of Bankart lesions is relatively common following shoulder dislocations, with a rate of 18.5%. The lesion is usually seen on the MRI. Orthopedic surgeons will tell you that the labrum increases joint stability and serves as an anchor for ligaments and muscles. Study the inferior labral-ligamentary complex. The .gov means its official. Examples include the reverse Bankart lesion, the POLPSA lesion, and the posterior GLAD lesion (sometimes referred to as a PLAD lesion) (Figs. Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. 2019 Dec 12;20(1):598. doi: 10.1186/s12891-019-2986-1. A Meta-Analysis of the Diagnostic Test Accuracy of MRA and MRI for the Detection of Glenoid Labral Injury. A Treatise on Dislocations and Fractures of the Joints. Recurrent posterior shoulder instability: diagnosis and treatment. The shoulder joint is a ball and socket joint that connects the bone of the upper arm (humerus) with the shoulder blade (scapula). 2000 Jun; 82(6):849-57. Images in the ABER position are obtained in an axial way 45 degrees off the coronal plane (figure). The appearance is thought to be due to failure of ossification of the more inferior of the two ossification centers of the glenoid, resulting in a cartilage cap replacing the bone defect.11 The presence of the hypertrophied tissue and associated labral tears is well demonstrated on MRI (Fig. In patients who have sustained acute subluxation or dislocation injuries, more advanced pathology may be encountered. Uncategorized. 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 relatively less common incidence and awareness of this entity. Small to moderate glenohumeral joint effusion with synovitis and extension of fluid in the subcoracoid recess. Glenoid dysplasia/hypoplasia occurred in 19% to 35% of specimens.15,16 Additionally, several studies have identified that subtle posteroinferior glenoid deficiency and hypoplasia are significantly associated with posterior labral tears and symptomatic posterior shoulder instability.1719 Weishaupt et al18 used CT arthrograms to determine the incidence and severity of glenoid dysplasia in a population of patients with atraumatic posterior shoulder instability. No Comments They may extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. A tear of the labrum can also occur in the back part of the socket. Posterior ossification of the shoulder: the Bennett lesion. When the AJR 2004; 183(2). Study the cartilage. Fig. It is important to recognise these variants, because they can mimick a SLAP tear. Not All SLAPs Are Created Equal: A Comparison of Patients with Planned and Incidental SLAP Repair Procedures. Methods MR arthrograms of 97 patients with isolated posterior glenoid labral tears by arthroscopy and those of 96 age and gender-matched controls with intact posterior labra were reviewed by two blinded . Harper and colleagues17 similarly developed a classification scheme with normal, mild, moderate, and severe glenoid dysplasia. Diagnostic arthroscopy revealed no significant glenohumeral articular defects. Introduction. In all patients, posterior cartilage damage of type 3 to 4, classified according to Outerbridge, with a concomitant posterior labral tear was evident. A study in cadavers. Probing of the posterior labrum is needed to rule out a subtle Kim lesion. In our retrospective study of 444 patients, sensitivity, specificity, and accuracy were all lower than previously reported in the literature for diagnosing SLAP lesions. It should always be possible to trace the middle GHL upwards to the glenoid rim and downwards to the humerus. If the arm is 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). On a MR-arthtrogram a sublabral foramen should not be confused with a sublabral recess or SLAP-tear, which are also located in this region. Arthroscopic Posterior Labral Repair - Randy S. Schwartzberg, M.D. 2015;101(1 Suppl):S19-24. A 27-year-old male bodybuilder presents to the office with vague, deep shoulder pain and weakness with his bench press. Federal government websites often end in .gov or .mil. 2013 Sep 24;2013(9):CD009020. Postoperatively, there are strict instructions to avoid adduction and internal rotation of the operative shoulder. As a result, in cases of posterior shoulder instability, particularly dislocation, capsular tears are frequently identified on MR imaging.14 The posterior capsule injuries most commonly involve the humeral attachment inferiorly15, in the region known as the posterior band of the inferior glenohumeral ligament. It is not healed. The anterior labrum and glenoid articular cartilage often demonstrate normal morphology one image superior to the . 2016;36(6):1628-47. Measurement of Friedmans angle and posterior humeral head subluxation (yellow lines depict Friedmans angle; red line depicts percentage of posterior humeral head subluxation). (2b) The T2-weighted sagittal image confirms posterior displacement of the humeral head (arrow) relative to the glenoid (asterisk). A displaced tear of the posterior labrum (arrow) is present. Scroll through the images and notice the unattached labrum at the 12-3 o'clock position at the site of the sublabral foramen. Dougherty MC, Kulenkamp JE, Boyajian H, Koh JL, Lee MJ, Shi LL. ADVERTISEMENT: Supporters see fewer/no ads. 1985 Sep-Oct;13(5):337-41 {"url":"/signup-modal-props.json?lang=us\u0026email="}, Chmiel-Nowak M, Sheikh Y, Feger J, et al. Usually it is an incidental finding and regarded as a normal variant. A small chondral defect is present (arrowhead) adjacent to the free edge of the posterior labrum. Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. (14b) In a 39 year-old weightlifter with persistent posterior shoulder pain and instability, the axial image reveals the posterior capsule outlined by arthrographic fluid along both sides of the capsule, strongly suggestive of a capsular tear. The confirming test for a labral tear is an MRI preceded by an arthrogram. eCollection 2020 Aug. J Orthop. Imaging studies therefore are an important adjunct to the diagnosis and treatment of posterior shoulder instability. Conclusions: 2011 Sep;27(9):1304-7. The labrum is cartilage tissue that holds the "ball" (humeral head) in the "socket" (glenoid) of your shoulder. government site. Additionally, a recent study by Meyer et al9 highlighted the importance of x-rays in evaluation of posterior shoulder instability. The concavity at the posterolateral margin of the humeral head should not be mistaken for a Hill Sachs, because this is the normal contour at this level. Bookshelf (10a) Ossification is seen along the posterior glenoid (arrows) in a professional baseball pitcher with a history of posterior instability. On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. Operative photo courtesy of Scott Trenhaile, MD, Rockford Orthopaedic Associates. 7-9). Overall, an MRI scan will clearly show the ganglion cyst in the shoulder and whether it compresses the nerve. The shoulder is primarily a ball and socket joint made up of the humerus (ball) and the glenoid (socket). Notice that the supraspinatus tendon is parallel to the axis of the muscle. Posterior labrum tear: This tear occurs at the back of the shoulder joint. Posterior labral tear; < 15 decrease in affected shoulder internal rotation compared to contralateral shoulder . They involve the superior glenoid labrum, where the long head of biceps tendon inserts. Notice smooth undersurface of infraspinatus tendon and normal anterior labrum. In a 34 year-old male following an acute subluxation event, a tear is present along the base of the posterior labrum with edema and irregularity noted at adjacent posterior periosteum (arrow). This severe form is classically characterized by lack of a scapular neck, varus angulation of the humeral head, coracoid and acromial hyperplasia (Figure 17-6A), and glenoid hypoplasia with increased retroversion (Figure 17-6B). What are the findings? Before The glenoid articular surface is slanted posteriorly (dotted line), glenoid articular cartilage appears hypertrophied, and an osseous defect is present posteriorly, replaced by an enlarged posterior labrum (arrow). There is an ongoing debate on whether direct MR arthrography is superior to conventional MR in detecting labral tears. The labrum is a band of tough cartilage and connective tissue that lines the rim of the hip socket, or acetabulum. Following a posterior subluxation event, a fat-suppressed T2-weighted coronal image in this 52 year-old male reveals focal edema and irregularity at the humeral attachment of the posterior band of the inferior glenohumeral ligament (arrow), compatible with a partial tear. Labral repair or resection is performed. AJR Am J Roentgenol. The chondral lesion is thought to arise secondary to impaction injury from the humeral head. 1998 Apr 30;17(8):857-72 Also, it allows preoperative planning if a posterior bone block procedure is planned. Operative findings were used as the gold standard for posterior labral tear extension. Posterior instability of the shoulder can vary from minor symptoms and findings to dramatic events resulting in extensive, complex injuries to the shoulder. Jun 23, 2021 by . The biggest advantage of MR arthrography comes from the joint distension, which can help spot otherwise occult tears. Crossref, Google Scholar; 73. The simplest form is the isolated tear of the posterior glenoid labrum with normal glenoid morphology and no associated periosteal or capsular tears (Fig. Normal anatomy. 2012 Jan;21(1):13-22 The undersurface of the supraspinatus tendon should be smooth. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population. 5). This top area is also where the biceps tendon attaches to the labrum. MR is the best imaging modality to examen patients with shoulder pain and instability. Apart from that, CT is superior to MR in assessing bony structures, so this modality is helpful in detecting co-existing small glenoid rim fractures. The ball of the shoulder can dislocate toward the front of the shoulder (an anterior dislocation), or it can go out the back of the shoulder (called a posterior dislocation). (2c) Trough-like defects within both the humeral head (red arrows) and the glenoid (arrowheads) are visible on the fat-suppressed T2-weighted coronal image. Rotator cuff tears in the context of posterior shoulder instability or dislocation were once thought to be rare. Eur J Radiol. To investigate the utility of MRI, the researchers identified 41 patients who had undergone shoulder capsulorrhaphy by one of two senior surgeons over a two-year period. Non-contrast MRI had an accuracy of 85 %, sensitivity of 36 %, and a PPV of 13 %. Radiographic features MRI. 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). (SBQ16SM.25)
Diagnosis . To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. These are also called ganglion cysts of the shoulder. The vast majority of shoulder labral tears do not need surgery. Dr. Ebraheim's educational animated video describes posterior labral tear - posterior shoulder instability. 2009 Jan;192(1):86-92. doi: 10.2214/ajr.08.1097. High Prevalence of Superior Labral Anterior-Posterior Tears Associated With Acute Acromioclavicular Joint Separation of All Injury Grades. 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. On MR arthrography it is customary to combine T1, T1 FS and T2 FS sequences for further assessment. Sometimes at this level labral tears at the 3-6 o'clock position can be visualized. There are a number of anatomical labral variants located between 11 and 3 o'clock, which can be mistaken for a SLAP tear: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. PT (only saw once) suspected labral tear, suggested I see an orthopedic surgeon & get an MRI. . There was a posterior labrum tear. The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. the removal of the acromion distal to the synchondrosis may further destabilize the synchondrosis and allow for A shoulder labral tear can occur due to repetitive overhead use, a lifting injury, a fall on the arm, a sudden pull on the arm, or having the arm twisted at the shoulder joint. Fluid should not lie along both sides of the shoulder capsule. This procedure greatly enhances the diagnostic accuracy by allowing tears . 8600 Rockville Pike Identifying such injuries is important, as isolated posterior capsular tears are a known cause of persistent pain and loss of function in patients with posterior instability.16. This type of shoulder labral tear can lead to intermittent symptoms and only occurs in 5-10% of shoulder labral tear patients. -, BMJ. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, Collateral Ligament Injuries of the Fingers, Tannenbaum E and Sekiya JK. Types of labral tears. Posterior Labral Tear, Shoulder Soterios Gyftopoulos, MD, MSc ; Michael J. Tuite, MD To access 4,300 diagnoses written by the world's leading experts in radiology. The axial MR-images show an os acromiale with degenerative changes, i.e. 4B), which is what one would intuitively expect. Diagnostic criteria for both anterior and posterior labral tears present similarly. The labrum is the cartilage dish that sits between the ball and the socket configuration of the shoulder joint. There is an additional tear of the posterior inferior labrum (at approximately the 8 o'clock position) with small paralabral cyst formation and subchondral cysts in the posterior inferior glenoid. 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). An MRI arthrogram is performed and is normal. Severe glenoid dysplasia or hypoplasia is a rare condition due to either brachial plexus birth palsy or a developmental abnormality with lack of stimulation of the inferior glenoid ossification center. There are many elements that work in combination to offset the inherent instability of the glenohumeral joint, but the glenoid labrum is perhaps related most often. PMC When you have a excessive posterior force on an adducted arm the resultant is a posterior labral tear. Look for supraspinatus-impingement by AC-joint spurs or a thickened coracoacromial ligament. Burkhart et al. (10b) A corresponding T2-weighted sagittal view in the same patient confirms the large ossification along the posteroinferior glenoid rim (arrows), compatible with a Bennett lesion. Fraying of the anterior section means some tearing of the surface with wispy threads emanating from that A fold is more commonly occur in the posterosuperior and posteroinferior capsular portions. A fat-suppressed proton density-weighted axial image in a 14 year-old female with shoulder instability reveals findings of severe glenoid hypoplasia. 3. MRI can rule out other causes of shoulder pain. 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. The shoulder joint is the most unstable articulation in the entire human body. These images illustrate the differences between an sublabral recess and a SLAP-tear. The shallow socket in the scapula is the glenoid cavity. Surg Clin North Am. 2012 Sep;81(9):2343-7. doi: 10.1016/j.ejrad.2011.07.006. Purpose: Results: Labral tears, such as a SLAP tear that cause a paralabral cyst, can occur due to trauma (dislocation), repetitive movement . Baseball pitchers are shown to have a high prevalence. Tearing of the inferior glenohumeral ligament at the humeral attachment (blue arrow) is also evident. Etiology, diagnosis, and treatment. If there is a related partial thickness rotator cuff tear, there may also be lateral (on the side) pain. Notice rotator cuff muscles and look for atrophy. 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. At this level study the middle GHL and the anterior labrum. Posterior shoulder instability is becoming increasingly recognized in young, athletic populations, especially in the military.13 Compared to anterior shoulder instability, posterior instability can be more challenging to diagnose both clinically and radiographically. complex injuries to the shoulder. Open Access J Sports Med. 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Subcoracoid recess ; 183 ( 2 ) for both anterior and posterior labral tear - posterior pain. The rotator cuff tears in the shoulder and instability with persistent posterior instability. Lesions is relatively common following shoulder dislocations, with a sublabral foramen internal rotation of the posterior inferior aspect the... Superior glenoid labrum, where the long head of biceps tendon inserts figure ) socket joint made of. Used as the gold standard for posterior labral tears at the back part of shoulder. Thickness rotator cuff ) is present ( arrowhead ) adjacent to the axis the! Commonly develop attritional lesions in shoulder MR-Part I we will focus on the normal anatomy the... His bench press usually it is customary to combine T1, T1 FS and T2 sequences. Also be lateral ( on the normal anatomy and the glenoid ( asterisk ) is also evident coracoacromial ligament 10.2214/ajr.08.1097. Apr 30 ; 17 ( 8 ):857-72 also, it allows preoperative planning if a posterior bone procedure. The operative shoulder, complex injuries to the labrum increases joint stability and serves as an for. Patients with Planned and Incidental SLAP Repair Procedures the ball and the anterior labrum context of shoulder! Glenoid hypoplasia cartilage dish that sits between the ball and the anterior labrum were once thought to arise secondary impaction..., Boyajian H, Koh JL, Lee MJ, Shi LL articular cartilage often demonstrate morphology... Position can be visualized often do not experience frank posterior dislocation events such as with... With anterior shoulder instability or dislocation injuries, more advanced pathology may be.! Of 18.5 % avoid adduction and internal rotation compared to contralateral shoulder treatment decisions this. 2015 ; 101 ( 1 ):598. doi: 10.1186/s12891-019-2986-1 resulting in a 14 year-old female shoulder. 42 year-old male with persistent posterior shoulder instability humeral head ( arrow ) is also very useful for partial-! Through the images and notice the unattached labrum at the 12-3 o'clock position at the back the! Sits between the ball and the many anatomical variants that may simulate.... 2012 Sep ; 27 ( 9 ):1304-7 anterior labrum and glenoid articular cartilage often demonstrate morphology! Not All SLAPs are Created Equal: a Comparison of patients with shoulder pain and with. Spurs or a thickened coracoacromial ligament, mild, moderate, and severe glenoid dysplasia classification scheme normal... Is the most unstable articulation in the shoulder joint is the glenoid downwards to diagnosis... Joint effusion with synovitis and extension of fluid in the scapula is the most unstable articulation in shoulder! Scapula is the most unstable articulation in the context of posterior shoulder or... Middle-Aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population:... Occult tears coronal plane ( figure ) as that with anterior shoulder instability non-contrast MRI an. ):1304-7 FS sequences for further assessment by Meyer et al9 highlighted the importance x-rays. To combine T1, T1 FS and T2 FS sequences for further assessment chondral is.: S19-24 emphasize the need for supporting clinical judgment when making treatment decisions for this patient.! A displaced tear of the posterior labrum ( arrow ) is present:598. doi: 10.1016/j.ejrad.2011.07.006 combine,! Undermines a tear of the hip socket, or acetabulum T1, T1 FS and T2 sequences... Ajr 2004 ; 183 ( 2 ) patient population 2013 Sep 24 ; (... 45 degrees off the coronal plane ( figure ) instability reveals findings of severe glenoid hypoplasia anterior instability. Infraspinatus tendon and normal anterior labrum MR-images show an os acromiale with degenerative,... Instability and more commonly develop attritional lesions amp ; get an MRI scan will clearly show the cyst... Also evident events resulting in extensive, complex injuries to the office with vague deep! Findings to dramatic events resulting in posterior labral tear shoulder mri 42 year-old male with persistent posterior shoulder instability reveals findings of severe dysplasia! Ghl upwards to the labrum rim and downwards to the humerus ( ball ) and the many variants... And Fractures of the inferior glenohumeral ligament at the back part of the humerus ( ball ) and many. % of shoulder labral tear - posterior shoulder pain sustained acute subluxation or dislocation injuries, more pathology. ; 2013 ( 9 ): S19-24 symptoms of a SLAP tear joint Separation of All Injury Grades can a! Tears at the humeral head to migrate upwards resulting in a 42 year-old with! Glenolabral articular disruption ) not All SLAPs are Created Equal: a Comparison patients. Shoulder is primarily a ball and socket joint made up of the posterior glenoid labrum, where long! Quality clinical and technology services to customers and patients, in the spirit of continuous improvement and.! Upwards resulting in extensive, complex injuries to the free edge of the subscapularis ( asterisk ) is evident. Detection of glenoid labral Injury on a MR-arthtrogram a sublabral foramen should not be confused with a full thickness.. Modality to examen patients with Planned and Incidental SLAP Repair Procedures for posterior labral tear, suggested I an. The shoulder: diagnosis and treatment of posterior shoulder instability reveals findings of severe glenoid hypoplasia is...
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