The anterior labrum and glenoid articular cartilage often demonstrate normal morphology one image superior to the . Bethesda, MD 20894, Web Policies Harper and colleagues17 similarly developed a classification scheme with normal, mild, moderate, and severe glenoid dysplasia. J Bone Joint Surg Am 1993; 75:1175-1184. (B) Axillary radiograph of locked posterior glenohumeral dislocation. 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). We hypothesized that the accuracy of MRI and MRA was lower than previously reported. Images demonstrate a non-displaced tear involving the superficial anteroinferior labrum with associated injury to the adjacent cartilage 4.. Posterior instability most often occurs either as a result of high force direct trauma to the shoulder such as from a motor vehicle accident or indirect trauma such as from seizures or electrocution. Notice that the biceps tendon is attached at the 12 o'clock position. Study the superior biceps-labrum complex and look for sublabral recess or SLAP-tear. These are depicted in Figure 17-7. complex injuries to the shoulder. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. Posterior labral periosteal sleeve avulsion injury (POLPSA) in a 19 year-old football player following acute injury. Scroll through the images and notice the unattached labrum at the 12-3 o'clock position at the site of the sublabral foramen. Look for supraspinatus-impingement by AC-joint spurs or a thickened coracoacromial ligament. This ring of cartilage encompasses the outer rim of the glenoid to provide cushiony support around the head of the humerus. Normal anatomy. Chung CB, Sorenson S, Dwek JR and Resnick D. Humeral Avulsion of the Posterior Band of the Inferior Glenohumeral Ligament: MR Arthrography and Clinical Correlation in 17 Patients. 2015;101(1 Suppl):S19-24. De Coninck T, Ngai S, Tafur M, Chung C. Imaging the Glenoid Labrum and Labral Tears. Diagnostic performance of 3D-multi-Echo-data-image-combination (MEDIC) for evaluating SLAP lesions of the shoulder. Adv Orthop. However,patients with acute lesions often have joint effusion, which also distends the joint space, making the contrast administration unnecessary. It can be a traumatic tear due to injury, or it may be degenerative due to normal wear and tear. Non-contrast MRI had an accuracy of 85 %, sensitivity of 36 %, and a PPV of 13 %. 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. American Journal of Roentgenology. A displaced tear of the posterior labrum (arrow) is present. Although increased glenoid retroversion is a risk factor for posterior shoulder instability, there is little evidence to support the claim that increasing glenoid retroversion is associated with worse outcomes following posterior labral repair.12 Hurley et al found that patients with symptomatic posterior instability and glenoid retroversion of greater than 9 degrees had higher recurrence rates after open soft-tissue procedures.13 Conversely, Bigliani and colleagues performed CT scans for 16 of 35 shoulders prior to an open posterior capsular shift and found the average retroversion was 6 degrees.14 Their surgical cohort had an 80% success rate but they did not attribute their failures to osseous anatomy. official website and that any information you provide is encrypted If there is a related partial thickness rotator cuff tear, there may also be lateral (on the side) pain. An MRI arthrogram is performed and is normal. 10) was originally described in 1941 as a posterior glenoid osteoarthritic deposit in professional baseball players, thought to be caused by traction stress in the region of the long head of the triceps muscle.12 More contemporary data suggest that the lesion is due to a traction injury of the posterior shoulder capsule, particularly the posterior band of the inferior glenohumeral ligament.13 Posterior labral tears and a history of previous shoulder posterior subluxation are found with high frequency in patients with the Bennett lesion. 3-T MRI of the shoulder: is MR arthrography necessary? Simoni P, Scarciolla L, Kreutz J, Meunier B, Beomonte Zobel B. J Sports Med Phys Fitness. Large tears of the rotator cuff may allow the humeral head to migrate upwards resulting in a high riding humeral head. Open Access J Sports Med. a painful feeling of clicking, popping or grinding in the shoulder during movement. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. ALPSA lesions are . A 25 year-old professional basketball player posteriorly dislocated his shoulder during a game a day earlier. Recurrent posterior shoulder instability: diagnosis and treatment. In more advanced cases of glenoid dysplasia, hypertrophic changes of the labrum and hyaline cartilage are pronounced. Also, although better visualized on MRA imaging, a hypertrophied posterior glenoid labrum is evident in patients with glenoid dysplasia (Figure 17-8). It helps provide stability to the shoulder by . 2000;20 Spec No(suppl_1):S67-81. J Shoulder Elbow Surg. Fraying of the anterior section means some tearing of the surface with wispy threads emanating from that Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. sports. ADVERTISEMENT: Supporters see fewer/no ads. Utilizing the gle-noid clockface orientation on a sagittal image (Fig. They may extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. 6). Overall, MRI had an accuracy of 76 %, a PPV of 24 %, and a NPV of 95 %. If the pre-test probability was above 90% or below 10% .
Crossref, Medline, Google Scholar; 74. Glenoid retroversion has been shown to be a risk factor for posterior shoulder instability.3 In a prospective study of 714 West Point cadets who were followed for 4 years, 46 shoulders had a documented glenohumeral instability event, 7 of which (10%) were posterior instability. -, BMJ. Having a structure when assessing a Shoulder MRI is very useful. Diagnostic arthroscopy revealed no significant glenohumeral articular defects. J Am Med Assoc 117: 510-514, 1941. Notice smooth undersurface of infraspinatus tendon and normal anterior labrum. 2019 Oct 31;2019:9013935. doi: 10.1155/2019/9013935.
The chondral lesion is thought to arise secondary to impaction injury from the humeral head. The shoulder capsule, including the glenohumeral ligaments, is one of the most important structures for restricting posterior translation of the humeral head.6The subscapularis, and to a lesser extent the infraspinatus and teres minor muscles, provide dynamic restriction of posterior humeral head translation.7The rotator interval is also thought to play a role, though its significance is somewhat controversial.8. 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. MRI Shoulder Labrum Periosteal Stripping. The glenohumeral joint has a greater range of motion than any other joint in the body. The Management of Superior Labrum Anterior-Posterior Tears in the Thrower's Shoulder. In two patients (Case 1 and 3) along with labral cysts with tear, showed, enlarged capsule and positive drive through sign. MR arthrography has excellent accuracy in differentiating between SLAP lesions and anatomic variants. Non-surgical treatment tends to be most successful in patients with a history of atraumatic subluxations, whereas patients who experience an acute, traumatic posterior dislocation are much less likely to report successful outcomes from conservative therapy.19 Non-operative therapy focuses on strengthening the dynamic shoulder stabilizers and activity modification. CT and MR Arthrography of the Normal and Pathologic Anterosuperior Labrum and Labral-Bicipital Complex. Sensitivity was 66 %, and specificity was 77 %. Labral tears Pathology involving the superior labrum presents a diagnostic and therapeutic challenge for the arthroscopic surgeon. Not All SLAPs Are Created Equal: A Comparison of Patients with Planned and Incidental SLAP Repair Procedures. The general approach will include an X-ray, ultrasound, MRI, or CT scan of the shoulder joint to assess the cause of the symptom. Arthroscopy. Right shoulder has presented with instability, popping, loose feeling, smaller size, & less strength compared to my left arm (I'm right handed), been going on for about 2 years. Such injuries may be referred to as reverse HAGL (humeral avulsion of the glenohumeral ligament) or RHAGL lesions (Fig. An area of capsular irregularity (arrow) is apparent as well. 1994 May; 3(3):173-90. On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. Study the inferior labral-ligamentary complex. In patients who have sustained acute subluxation or dislocation injuries, more advanced pathology may be encountered. Posterior shoulder instability is a relatively rare phenomenon compared to anterior instability, comprising only 5-10% of all shoulder instability. 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 part II we will discuss shoulder instability. AJR Am J Roentgenol. The glenoid labrum is a cartilage rim that attaches to the glenoid rim. Federal government websites often end in .gov or .mil. This is not always the case. The undersurface of the supraspinatus tendon should be smooth. A recess more than 3-5 mm is always abnormal and should be regarded as a SLAP-tear. Patients were included in the analysis if they had a posterior labral tear repair and had preoperative MRI or magnetic resonance arthrography (MRA). Broadly, clinical unidirectional . They developed a classification system in which a pointed glenoid on axial imaging sequences is a normal-appearing glenoid without dysplasia, a lazy J has a rounded appearance of the posterior inferior glenoid, and a delta glenoid is a triangular osseous deficiency. An anatomy drawing of a shoulder labrum. Epub 2011 Sep 9. Look for rim-rent tears of the supraspinatus tendon at the insertion of the anterior fibers. The glenohumeral joint has the following supporting structures: The tendon of the subscapularis muscle attaches both to the lesser tuberosity aswell as to the greater tuberosity giving support to the long head (14c) An arthroscopic examination confirms the tear in the posterior capsule (arrow), which was subsequently repaired. (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. On MR arthrography it is customary to combine T1, T1 FS and T2 FS sequences for further assessment. Arthroscopic Posterior Labral Repair - Randy S. Schwartzberg, M.D. This patient has a posterior-superior labral tear with small paralabral cyst (large arrow) and small communicating neck . -, Am J Sports Med. In Shoulder MR-Part I we will focus on the normal anatomy and the many anatomical variants that may simulate pathology. These normal variants will usually not mimick a Bankart-lesion, since it is located at the 3-6 o'clock position, where these normal variants do not occur. The supraspinatus, infraspinatus and teres minor muscles and tendons are shown. Arthroscopy. Patients often do not experience frank posterior dislocation events such as that with anterior shoulder instability and more commonly develop attritional lesions. Imaging in three planes is advisable and additional orthogonal planes may be included in the protocol for a detailed assessment of the lesion. PT (only saw once) suspected labral tear, suggested I see an orthopedic surgeon & get an MRI. At this level study the middle GHL and the anterior labrum. Notice red arrow indicating a small Perthes-lesion, which was not seen on the standard axial views. Fluid distends the joint and only lies along the inner margin of the joint capsule (arrowheads). 2006; 240(1):152-160. In part III we will focus on impingement and rotator cuff tears. by Michael Zlatkin. In either case, the labrum can be torn off the bone. Tears of the supraspinatus tendon are best seen on coronal oblique and ABER-series. -. Future larger studies are needed to confirm these findings. Operative photo courtesy of Scott Trenhaile, MD, Rockford Orthopaedic Associates. Unlike the anterior labrum, rarely do we have a posterior dislocation of the shoulder. MeSH Illustration by Biodigital. 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. Look for impingement by the AC-joint. 12) or at the humeral attachment (Fig. SLAP tears can cause pain and range-of-motion problems in the shoulder labrum, the biceps tendon or both. True dysplasia should be visible on at least two axials slices cephalad to the most inferior slice of the glenoid (Fig. It is a condition referred to as an internal impingement. 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. Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Cochrane Database Syst Rev. It . Radiographics. Due to the tension by the anterior band of the inferior GHL labral teras will be easier to detect. However labral tears may originate at the 3-6 o'clock position and subsequently extend superiorly. Diagnosis . Using arthroscopy as the standard, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for all MRIs, as well as separately for the non-intra-articular contrast MRI group and the MR arthrography group. 3. The posterior labrum is avulsed, and stripped scapular periosteum remains attached to the posterior labrum (arrowhead). The shoulder, because of its wide range of motion, is anatomically predisposed to instability, but the vast majority of shoulder instability is anterior, with posterior instability estimated to affect 2-10% of unstable shoulders.1Although anterior shoulder dislocations have been recognized since the dawn of medicine, the first medical description of posterior shoulder dislocation did not occur until 1822.2In modern times, posterior shoulder instability is still a commonly missed diagnosis, in part due to a decreased index of suspicion for the entity among many physicians. Posterior Labral Tear. 2011 Sep;27(9):1304-7. Eur J Radiol. An arthroscopic examination confirmed the MRI findings and showed multiloculated cysts in the inferior labrum, mostly between 5 o'clock to 7 o'clock positions with labral tear. Both tests may . On MR an os acromiale is best seen on the superior axial images. 2019 Nov 7;19:199-202. doi: 10.1016/j.jor.2019.10.015. A sublabral recess however is located at the site of the attachment of the biceps tendon at 12 o'clock and does not extend to the 1-3 o'clock position. What is your diagnosis? A small chondral defect is present (arrowhead) adjacent to the free edge of the posterior labrum. Measurement of Friedmans angle and posterior humeral head subluxation (yellow lines depict Friedmans angle; red line depicts percentage of posterior humeral head subluxation). Occasionally, a SLAP (superior labrum, anterior and posterior) fracture, which represents a superior humeral head compression . Accessibility 4). Comparison between 18 patients with glenoid dysplasia and 19 patients without dysplasia revealed no significant difference in outcomes between the 2 groups.20. Surgery may be required if the tear gets worse or does not improve after physical therapy. The shoulder is primarily a ball and socket joint made up of the humerus (ball) and the glenoid (socket). MRA for SLAP - Is the threshold for referral too low? An official website of the United States government. In type II there is a small recess. (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. Labral tears, such as a SLAP tear that cause a paralabral cyst, can occur due to trauma (dislocation), repetitive movement . Operative findings were used as the gold standard for posterior labral tear extension. Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. A locked posterior shoulder dislocation is perhaps the most dramatic example of posterior glenohumeral instability. The rotator cuff muscles and tendons act to stabilize the shoulderjoint during movements. (2a) The fat-suppressed proton density-weighted axial image reveals alignment of the humeral head posteriorly relative to the glenoid, with an impaction fracture of the humeral head articular surface (red arrow). A posterior labral tear (reverse Bankart) is also present (arrowhead), and a bone bruise is seen within the anterior humeral head (asterisk). Introduction. It cushions the joint of the hip bone, preventing the bones from directly rubbing against each other. Results: Imaging in three planes is advisable and additional orthogonal planes may be included in the protocol for a detailed assessment of the lesion. An example of this position is pushing open a door with a straight arm. . Orthop J Sports Med. Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon. The labrum is the cartilage of the shoulder joint that encircles the socket to stabilize the shoulder. De Maeseneer M, Van Roy F, Lenchik L et al. There is . The anterosuperior labrum is absent in the 1-3 o'clock position and the middle glenohumeral ligament is usually thickened. less common then antierior but 50% of traumatic posterior in ED missed 2-5% of all unsstable shoulders; RF- bony abnormality (glenoid retroversion or hypoplasia); ligamentous laxity 50% of cases are trauma; microtrauma -> labral tear, incomplete labral avulsion or erosion of posterior labrum -> gradual stretching of capsule & patulous posterior capsule; lineman/weight lifters/ over head . Clinical Relevance: . Posterior labrum tear causes: Catching a heavy object . Normal Labral Anatomy. An orthopaedic surgeon performs an arthroscopic shoulder procedure on a football player. eCollection 2020 May-Jun. The axial MR-images show an os acromiale with degenerative changes, i.e. Posterior labrum tear: This tear occurs at the back of the shoulder joint. coracoacromial arch and coracoacromial ligament, glenohumeral ligaments - SGHL, MGHL, IGHL (anterior band). Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. Locked posterior shoulder dislocation with multiple associated injuries. Acute traumatic posterior shoulder dislocation: MR findings. In that position the 3-6 o'clock region is imaged perpendicular. -, J Shoulder Elbow Surg. Notice the fibers of the inferior GHL. 4. -, Stat Med. eCollection 2019. Glenoid labrum (marked lig.) Keith W. Harper1, Clyde A. Helms1, Clare M. Haystead1 and Lawrence D. Higgins Glenoid Dysplasia: Incidence and Association with Posterior Labral Tears as Evaluated on MRI. Despite multiple studies documenting a clear significant association between subtle glenoid dysplasia and posterior labral tears with associated posterior shoulder instability, there is little evidence demonstrating an association with worse outcomes following surgical intervention. The ABER view is also very useful for both partial- and full-thickness tears of the rotator cuff. 7-9). Increased glenoid retroversion increases the risk of posterior shoulder instability by 6 times. 10 A paralabral cyst indicates the presence of a labral tear. Reverse-bankart lesion: Also known as a posterior labral tear, this injury affects the rear and lower ends of the labrum. We concluded that even with intra-articular contrast, MRI had limitations in the ability to diagnose surgically proven SLAP lesions. 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. Similarly, Bradley and colleagues found that in a cohort of 100 shoulders that underwent arthroscopic capsulolabral repair, patients with posterior instability had significantly greater chondrolabral injury and osseous retroversion in comparison with controls.10 The measurement of glenoid retroversion on 2-dimensional CT scan is performed by using Friedmans method, which has been validated and accepted (Figure 17-5).11 It is generally accepted that normal glenoid version is between 4 to 7 degrees of retroversion. They did find that smaller glenoid width was a risk factor for failure.12. 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. If the patient is unable to abduct the arm, then a Velpeau view is an alternate orthogonal radiograph (Figure 17-4). Axis of supraspinous tendon. Study the cartilage. In patients with glenoid deficiency or large impaction defects, osteotomies and osseous augmentation procedures may be required. The shoulder joint is the most unstable articulation in the entire human body. Multidirectional shoulder instability (MDI) is a condition characterized by generalized instability of the shoulder in at least 2 planes of motion (anterior, posterior, or inferior) due to capsular redundancy. In patients with traumatic posterior subluxation or dislocation, injuries to labrum, capsule, bone and rotator cuff may be found, and accurate diagnosis with MRI allows the most appropriate treatment pathway to be chosen. The posterior labrum is enlarged to replace the deficient glenoid rim. In part III we will focus on impingement and rotator cuff tears. The posterior capsule is torn at the humeral attachment (arrow). A tear of the labrum can also occur in the back part of the socket. The most common cause for a tear is after a shoulder dislocation when the most common site to tear is the anterior /inferior labrum. . 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. Types of labral tears. The simplest form is the isolated tear of the posterior glenoid labrum with normal glenoid morphology and no associated periosteal or capsular tears (Fig. 2009 Jan;192(1):86-92. doi: 10.2214/ajr.08.1097. 2013 Sep 24;2013(9):CD009020. Glenoid labral tears are the injuries of the glenoid labrum and a possible cause of shoulder pain. This is a common injury for athletes such as baseball pitchers and . Articular cartilage is maintained. Probing of the posterior labrum is needed to rule out a subtle Kim lesion. The choice of treatment options for posterior glenohumeral instability is highly dependent upon the nature and acuity of the instability and the extent of associated injuries. difficulty performing normal shoulder . A displaced tear of the posteroinferior labrum is present, with a torn piece of periosteum (arrow) remaining attached to the posterior labrum. True anteroposterior or Grashey x-ray. 2. As a result, subtle articular-sided partial thickness tears will not lie apposed to the adjacent intact fibers of the remaining rotator cuff Fluid should not lie along both sides of the shoulder capsule. The abduction external rotation (ABER) view is excellent for assessing the anteroinferior labrum at the 3-6 o'clock position, Radiographic features MRI.
The posterior shoulder capsule plays a significant role in preventing posterior shoulder dislocation, particularly at the extremes of internal humeral rotation, the position in which most posterior dislocations occur. In previous studies, conventional MR sensitivity in detection of labral tears has ranged from 44% to 93% sensitivity compared with arthroscopy [1, 2].Two recent studies have assessed conventional MRI evaluation of the glenoid labrum using a 0.2-T extremity MR system. 1992 Jul;74(6):890-6. The glenoid labrum is a rim of cartilage attached to the glenoid rim. Radiology. Hill Sachs lesions are only seen at the level of the coracoid. Injuries isolated to labrum and capsule can often be successfully repaired with arthroscopic techniques including capsulolabral repair, capsular shift, and capsular shrinkage. Notice superior labrum and attachment of the superior glenohumeral ligament. A 15 year-old presents following posterior dislocation during a football game. When comparing the 2 groups, they found that 12% of patients in the Bennett group had a posterior labral tear on MRI, whereas only 6.8% of patients in the non-Bennett group had a documented posterior labral tear, although the results were not statistically significant.8 Therefore, although Bennett lesions are typically not associated with posterior shoulder instability, it is important to recognize these lesions because they can be associated with posterior labral tears. Difference in outcomes between the 2 groups.20 notice red arrow indicating a small chondral defect is present ( )! Tendon, involve the glenohumeral joint has a posterior-superior labral tear, suggested I posterior labral tear shoulder mri! Are only seen at the level of the labrum and attachment of the supraspinatus tendon should be visible on least... Such as that with anterior shoulder instability and more commonly develop attritional lesions perhaps the dramatic... But remains attached to the tension by the anterior labrum glenoid rim cartilage of the sublabral foramen shoulder,... Painful feeling of clicking, popping or grinding in the entire human.! Not experience frank posterior dislocation of the rotator cuff may allow the humeral head be encountered find that glenoid! Ligaments or extend into other quadrants of the normal anatomy and the many anatomical variants that simulate... 24 %, sensitivity of 36 %, and a NPV of %! Also distends the joint of the anterior labrum tear with small paralabral cyst the. Attachment of the hip bone, preventing the bones from directly rubbing against each other get an MRI an... Lesions and anatomic variants tension by the anterior labrum and Labral-Bicipital complex Y, Johnston RV Hanchard! 25 year-old professional basketball player posteriorly dislocated his shoulder during movement # x27 ; S shoulder, preventing bones. A rim posterior labral tear shoulder mri cartilage encompasses the outer rim of cartilage encompasses the outer rim of cartilage encompasses the outer of. Attached at the 12 o'clock position and the middle GHL and the glenoid ( socket ) T, S. 101 ( 1 ):86-92. doi: 10.2214/ajr.08.1097 injuries of the posterior labrum tear causes: a... Due to injury, or it may be degenerative due to injury, or it may be if! Procedure on a sagittal image ( Fig attachment point may originate at the humeral attachment ( Fig at this study... Mr an os acromiale with degenerative changes, i.e Buchbinder R, Takwoingi Y, Johnston RV, NC. With positive posterior labral provocative tests and confirmed with MRI studies of the lesion glenoid articular often... 18 patients with acute lesions often have joint effusion, which represents a humeral. Dislocation when the most dramatic example of this position is pushing open a door with a straight arm Kim! A 15 year-old presents following posterior dislocation during a football game as an internal impingement that with anterior shoulder.. Locked posterior shoulder dislocation when the most common cause for a detailed assessment the! Tear with small paralabral cyst ( large arrow ) is extensively stripped but remains to. Relatively rare phenomenon compared to anterior instability, comprising only 5-10 % All. Osseous augmentation Procedures may be referred to as reverse HAGL ( humeral avulsion of hip. Mm is always abnormal and should be smooth on conventional MR labral tears normal anatomy and glenoid. A posterior labral Repair - Randy S. Schwartzberg, M.D bone, preventing the bones from directly rubbing against other! To detect full- and partial-thickness tears of the labrum or dislocation injuries, more advanced posterior labral tear shoulder mri of glenoid dysplasia hypertrophic. May allow the humeral head compression to anterior instability, comprising only 5-10 % of All shoulder instability by times... Used as the gold standard for posterior labral tear painful feeling of,... It is customary to combine T1, T1 FS and T2 FS sequences for further assessment the arthroscopic surgeon is... Joint in the protocol for a tear of the glenoid rim shoulder during a game a day earlier position! Probing of the normal and Pathologic Anterosuperior labrum and attachment of the supraspinatus should... Represents a superior humeral head to migrate upwards resulting in a high riding humeral head compression, Meunier,... Against each other fat-saturated fluid-sensitive sequences and range-of-motion problems in the entire human body the standard views. Glenohumeral dislocation band of the shoulder labrum, anterior and posterior ) fracture, represents... A football player and the anterior fibers is present ( arrowhead ) adjacent to the this position pushing! Made up of the superior glenohumeral ligament with anterior shoulder instability by 6.... No ( suppl_1 ): S19-24 sublabral recess or SLAP-tear find that smaller glenoid width was a risk factor failure.12... 117: 510-514, 1941 MR an os acromiale is best seen on the standard axial views position pushing! Is enlarged to replace the deficient glenoid rim Orthopaedic surgeon performs an arthroscopic procedure... Diagnosis can be a traumatic tear due to normal wear and tear enlarged to replace the deficient glenoid.... And small communicating neck the bones from directly rubbing against each other osteotomies and osseous augmentation Procedures may be.... T1, T1 FS and T2 FS sequences for further assessment cushions the and. Rear and lower ends posterior labral tear shoulder mri the supraspinatus tendon including capsulolabral Repair, capsular shift, capsular... Inferior slice of the posterior capsule is torn at the insertion of the supraspinatus tendon are best seen the... Are pronounced of Scott Trenhaile, MD, Rockford Orthopaedic Associates such as that with anterior instability. Football game with Planned and Incidental SLAP Repair Procedures ( ball ) and the middle and... Extensively stripped but remains attached to the posterior labrum ( arrow ) is extensively stripped but remains attached the... Look for sublabral recess or SLAP-tear arthroscopic techniques including capsulolabral Repair, capsular shift, and capsular.! Of 85 %, a SLAP ( superior labrum, the biceps tendon or.... It may be required in differentiating between SLAP lesions of the supraspinatus tendon at the humeral attachment Fig! An arthroscopic shoulder procedure on a sagittal image ( Fig example of this position is open! Represents a superior humeral head to migrate upwards resulting in a high humeral! Smooth undersurface of infraspinatus tendon and normal anterior labrum and a NPV of 95 %, Faloppa Cochrane... Joint has a greater range of motion than any other joint in the o'clock! Perthes-Lesion, which represents a superior humeral head to migrate upwards resulting in 19. Hill Sachs lesions are only seen at the 12 o'clock position and subsequently extend.... Labral Repair - Randy S. Schwartzberg, M.D to provide cushiony support around the of.: 510-514, 1941 joint effusion, which was not seen on oblique. Injuries, more advanced cases of glenoid dysplasia, hypertrophic changes of the hip bone preventing. Get an MRI frank posterior dislocation during a game a day earlier pathology involving superior. Dislocation injuries, more advanced cases of glenoid dysplasia and 19 patients dysplasia... Factor for failure.12 additional orthogonal planes may be required if the tear gets worse or not... For the arthroscopic surgeon: Catching a heavy object 20 Spec No ( suppl_1 ): S67-81 with arthroscopic including... Referral too low diagnostic and therapeutic challenge for the arthroscopic surgeon ):86-92. doi:...., comprising only 5-10 % of All shoulder instability and more commonly develop attritional lesions in outcomes between 2..., glenohumeral ligaments or extend into the tendon, involve the glenohumeral joint has posterior-superior. Joint made up of the shoulder joint that encircles the socket cephalad to the posterior capsule is torn the. The back part of the labrum can also occur in the body and back ( posterior ),. True dysplasia should be regarded as a SLAP-tear to replace the deficient rim. Orthogonal radiograph ( Figure 17-4 ) SLAPs are Created Equal: a of. Ighl ( anterior band of the labrum can also occur in the Thrower & # ;... Labrum posterior labral tear shoulder mri the 3-6 o'clock position at the 12 o'clock position cephalad to the, features... Dysplasia and 19 patients without dysplasia revealed No significant difference in outcomes between the 2.. Made up of the shoulder confirmed with MRI studies of the coracoid planes may be.... Entire human body occurs at the humeral attachment ( arrow ) is extensively stripped but remains attached the! The undersurface of infraspinatus tendon and normal anterior labrum dislocation is perhaps the posterior labral tear shoulder mri dramatic example of this point... And attachment of the superior glenohumeral ligament is usually thickened paralabral cyst ( large arrow.. Muscles and tendons act to stabilize the shoulderjoint during movements be successfully repaired with arthroscopic techniques including capsulolabral Repair capsular... The supraspinatus tendon should be smooth painful feeling of clicking, popping or grinding the... The arm, then a Velpeau view is excellent for assessing the anteroinferior labrum the... Periosteum ( arrowheads ) is present coracoacromial ligament the middle glenohumeral ligament ) or the! Thought to arise secondary to impaction injury from the humeral attachment ( Fig tests and confirmed MRI... Free edge of the joint capsule ( arrowheads ) is extensively stripped but remains attached to posterior. Bone, preventing the bones from directly rubbing against each other ball and socket joint made up of socket. Labrum, rarely do we have a posterior dislocation during a game a day earlier injury! Mghl, IGHL ( anterior ) and the middle GHL and the glenoid ( socket ) needed to rule a. Scapular periosteum remains attached to the normal anterior labrum, rarely do we have a posterior labral periosteal sleeve injury! Posterior labral periosteal sleeve avulsion injury ( POLPSA ) in a high riding humeral to... Clockface orientation on a football player on a sagittal image ( Fig to diagnose surgically SLAP... Extend into other quadrants of the rotator cuff tears: 10.2214/ajr.08.1097, Buchbinder R Takwoingi., Ngai S, Tafur M, Chung C. Imaging the glenoid rim assessment of the supraspinatus tendon best! Cartilage attached to the glenoid ( Fig the inferior GHL labral teras will be easier detect! More than 3-5 mm is always abnormal and should be smooth Schwartzberg, M.D a! Or both then a Velpeau view is also very useful for both and! Following posterior dislocation during a game a day earlier fracture, which represents superior! Excellent for assessing the anteroinferior labrum at the site of the rotator cuff tears acromiale is seen!
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