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Unlike Bankart lesions and ALPSA lesions, they are uncommonly (20%)associated with shoulder instability5. American Journal of Roentgenology. Variations in osseous anatomy at the glenoid can significantly affect shoulder stability. endobj
Mohana-Borges A, Chung C, Resnick D. Superior Labral Anteroposterior Tear: Classification and Diagnosis on MRI and MR Arthrography. The labrum serves to deepen the glenoid fossa and helps maintain glenohumeral alignment. (2001) ISBN: 0721690270 -. 2016;36(6):1628-47. Although it can be a slow process, following your surgeons guidelines and rehabilitation plan is vital to a successful outcome. 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. Bankart lesions are typically located in the 3-6 o'clock position because that's where the humeral head dislocates. WebA sublabral sulcus, also commonly referred to as sublabral recess, is a labral variant characterized by a gap between the superior labrum and the superior glenoid fossa anterior to the biceps anchor ( Fig. In the ABER-position it is obvious that there is a Perthes lesion (black arrow). Surgeons will usually conduct a physical exam and order MRI or X-ray imaging, if necessary, to determine the severity of the injury and the appropriate treatment. 13) of the posterior capsule. Magn Reson Imaging Clin N Am. There are two types of labral tears: SLAP tears and Bankart lesions. Journal of Bone and Joint Surgery 66A:169-74, 1984. They can extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. There is an ongoing debate on whether direct MR arthrography is superior to conventional MR in detecting labral tears. What are the findings? Mild glenoid hypoplasia results in a rounded contour of the posterior glenoid with normal or only mildly thickened posterior labral tissue. On MR-athrography the labrum is missing on the anterior glenoid and the labral fragment is displaced anteriorly (arrow). Direct trauma to the anterior shoulder, a posteriorly directed force on an adducted arm (fall on outstretched hand), and indirect muscle forces (seizure and electrical shock) are typical etiologies. (2010) ISBN: 9781441959720 -, 5. Posterior labral tearing was apparent on contiguous images (not shown).
The posterior labral and capsuloligamentous injuries that occur in posterior instability are often analogous to the classic anteroinferior injuries that are found in patients with anterior instability. Labral Tear( ) 93%, Labral detachment( ) 46%. An impaction fracture is also present at the posterior glenoid rim (blue arrow). The posterior capsule is torn at the humeral attachment (arrow). At the time the article was created Frank Gaillard had no recorded disclosures. A small chondral defect is present (arrowhead) adjacent to the free edge of the posterior labrum. The role of the rotator interval capsule in passive motion and stability of the shoulder. Numerous capsular abnormalities have been described in patients with posterior glenohumeral instability. 2005;184: 984-988. On images of the shoulder with the arm in a neutral position, the torn labrum may be held in its normal anatomic position by the intact scapular periosteum, which thereby prevents contrast media from entering the tear. Reading time: 18 minutes.
(2b) The T2-weighted sagittal image confirms posterior displacement of the humeral head (arrow) relative to the glenoid (asterisk). The shoulder joint is composed of the glenoid (the shallow shoulder "socket") and the head of the upper arm bone known as the humerus (the "ball"). Examples include the reverse Bankart lesion, the POLPSA lesion, and the posterior GLAD lesion (sometimes referred to as a PLAD lesion) (Figs. Your doctor will test your range of motion by having you move your arm in different directions. WebType 1: In this type of tear, your labrum shows signs of fraying or shredding but still functions. Transaxial T1-weighted MR image (779/12) shows posterior humeral translation of 10 mm. This top area is also where the biceps tendon attaches to the labrum. (4a) An axial fat-suppressed proton density weighted image demonstrates a severely retroverted glenoid (arrowheads) and posterior glenoid hypoplasia with a hypertrophied posterior labrum (arrow). Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum, and can often be confused with a sublabral sulcus on MRI. Notice the very large fracture of the glenoid rim with displacement. Radiology 2008; 248:185193. WebIt is associated with posterior labral tear, Circle is center of humeral head. Smith T, Drew B, Toms A. The simplest form is the isolated tear of the posterior glenoid labrum with normal glenoid morphology and no associated periosteal or capsular tears (Fig. Diagnosing a labrum tear involves a physical examination and most likely an Type 2: This is the most common SLAP tear type. an ALPSA-lesion (black arrow). Notice extention of the SLAP-tear further to posterior (red arrow). Bankart tears typically occur in younger patients who have dislocated their shoulder. The posterior labrum is avulsed, and stripped scapular periosteum remains attached to the posterior labrum (arrowhead). Because patients have varied health conditions, complete recovery time is different for everyone. Hottya GA, Tirman PF et al. Notice the distance between the humeral head and the glenoid on the AP-view, which is abnormally wide. If the injury is a minor Bankart tear with a dislocation, the physician (or even a team coach or patient themselves) can usually pop the shoulder back into place a process called reduction and then follow up with physical therapy to strengthen the muscles. The bumper helps prevent the shoulder from dislocating. The shoulder joint is a joint that connects the upper limb to the axial skeleton. To make a tear in the labrum show up more clearly on the MRI, a dye may be injected into your shoulder before the scan is taken. There is an osseus Bankart lesion (curved red arrow). The term SLAP stands for Superior Labrum Anterior and Posterior. Tears to the specialized cartilage tissue in the shoulder known as the labrum can cause pain and instability in the shoulder. On MR-arthrography it may be difficult to depict the osseus fragment. This exercise program can be continued anywhere from 3 to 6 months, and usually involves working with a qualified physical therapist. {"url":"/signup-modal-props.json?lang=us"}, Chmiel-Nowak M, Sheikh Y, Feger J, et al. Posterior dislocations account for 2-4% of all shoulder dislocations. It is above or at the level of the coracoid in the first 18 mm of the proximal humeral head. Journal of Bone and Joint Surgery 79A:433-40, 1997. Figure 2. CT-images in another patient show a reversed osseus Bankart in a patient with posterior dislocation. (16a) An axial image in a 17 year-old female following posterior subluxation during a basketball game demonstrates humeral sided avulsion of the capsule (arrow). Posterior labral periosteal sleeve avulsion injury (POLPSA) in a 19 year-old football player following acute injury. Posterior dislocations account for 2-4% of all shoulder dislocations. Recurrent posterior subluxation is the most common form of posterior instability and is being recognized with increasing frequency.
There is also a Hill-Sachs defect (red arrow). Lesions of the labrum, rotator cuff musculature, and glenoid may contribute to recurrent posterior glenohumeral subluxation. 1 0 obj
Other described types include 6: The investigation of choice is an MR arthrogram, which is variably reported as having accuracies of 75-90%, although distinguishing between subtypes can be difficult 2. 35-year-old man with shoulder pain and decreased range of motion. (2a) The posterior labrum (arrow) is torn from the posterior glenoid and displaced posteriorly. (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). Call for an appointment (03) 6231 2477. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. The yellow arrow points to the anterior glenoid rim. MRI . It is the most common normal variant of the superior labrum, having an incidence as high as 73% [ 19 ]. The importance of these structures is reviewed in the following: 1. 1 Acquired recurrent posterior subluxation makes up the largest subset of patients with posterior instability. The image on the right is rotated 90? Some SLAP injuries require cutting the biceps tendon attachment. Skeletal Radiol.
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. Alterations in function of the serratus anterior muscle may disrupt the scapulothoracic rhythm leading to loss of power and stability of the glenoid and variable amounts of scapular winging.6. The Bennett lesion (Fig. 3 0 obj
Posterior instability of the shoulder can vary from minor symptoms and findings to dramatic events resulting in extensive, complex injuries to the shoulder. Normal glenoid morphology is present. Notice how this high signal continues posteriorly, which means that it is a SLAP-lesion. 2020;49(Suppl 1):1-33. Numerous labral abnormalities may be encountered in patients with posterior glenohumeral instability. Figure 2. It is the most dislocated joint in the body. 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. Figure 1. The ligaments also help prevent the shoulder from dislocating. When the ball slips toward the back of the body, it leads to "posterior instability.". {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Jabaz D, Knipe H, et al. 2015;6(9):660-71.
xZ[oF~GxiWEi$zI)3PD97e./o]7,?8bqi&VP>}e SLAP is an acronym that stands for 'Superior Labral tear from Anterior to Posterior'. It is not clear whether the labrum is normal. . WebType 1: In this type of tear, your labrum shows signs of fraying or shredding but still functions.
This test can better show soft tissues like the labrum. (Left)An MRI image of a healthy shoulder.(Right)This MRI image shows a tear in the labrum. As healing progresses, exercises to strengthen the shoulder muscles and the rotator cuff will gradually be added to your program. Diagnosing a labrum tear involves a physical examination and most likely an What is your diagnosis? Clavert P. Glenoid Labrum Pathology. Images of a MR-arthrogram. Pain is usually limited to the time of subluxation. The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. AJR Am J Roentgenol.
The shoulder joint is a joint that connects the upper limb to the axial skeleton. The physiologic groove in the humerus or cysts and erosions at the attachment site of the infraspinatus tendon can simulate a Hill-Sachs, but usually this is not a diagnostic problem (figure). Arch Orthop Trauma Surg. AJR June 2000 vol. Etiology, diagnosis, and treatment.
Now you know that you have to look for a Bankart or variant. Glenoid labral tears are the injuries of the glenoid labrum and a possible cause of shoulder pain. 2004;12(1):97-109, vi-vii. WebThe labrum of the shoulder is made of soft tissue so it will not show up on an x-ray. In atraumatic posterior instability there is no history of major trauma, however, there is almost always an element of repetitive microtrauma causing labral pathology and posterior capsular stretching. Clinical History: A 37 year-old male presents with shoulder discomfort, particularly in adduction and mild internal rotation. The example of shoulder plain x-ray shows bones very well. The glenoid labrum stabilizes the joint by increasing glenoid depth and surface area, and provides a stable fibrocartilaginous anchor for the glenohumeral ligaments. stream
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). The labrum is the attachment site for the shoulder ligaments and supports the ball-and-socket joint as well as the rotator cuff tendons and muscles. First notice the Hill-Sachs defect indicating a prior anterior dislocation (blue arrow).
An area of capsular irregularity (arrow) is apparent as well. 4. The example of shoulder MRI demonstrates the soft tissue around the bones and joints. Retracted end of the posterior glenoid and displaced posteriorly the osseus fragment slow process following... High as 73 % [ 19 ] an area of capsular irregularity ( arrow ) glenoid depth and area! That you have to look for a Bankart or variant an anterior as... Motion and stability of the rotator cuff will gradually be added to your.... Motion by having you move your arm in different directions well as the rotator cuff musculature and. Glenoid on the AP-view, which means that it is not clear whether the labrum, cuff!, Sheikh Y, Feger J, et al very large fracture of glenoid... ( ) 46 % condition, location and insurance. ) can contribute to recurrent posterior subluxation the. 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( curved red arrow ) is torn from the posterior labrum is avulsed and. Clear whether the labrum, rotator cuff musculature, and stripped scapular periosteum remains attached to the labrum in. Slap injury, the posterior labrum is normal 66A:169-74, 1984 a healthy shoulder in patient... '': '' /signup-modal-props.json? lang=us '' }, Chmiel-Nowak M, Sheikh Y, Feger,! Instability and is being recognized with increasing frequency customers and patients, in the spirit continuous..., following your surgeons guidelines and rehabilitation plan is vital to a successful outcome, your shows... Absent labrum - Buford complex and diagnosis on MRI and MR Arthrography where humeral. ) an MRI is above or at the level of the superior labrum having. Location and insurance. ) defect ( red arrow ) SLAP stands for superior labrum anterior and posterior joint!, Gaillard F, Jabaz D, Knipe H, et al this MRI image of a patient had! This type of tear, your labrum shows signs of fraying or but... 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Labral tear, your labrum shows signs of fraying or shredding but still.! Mri demonstrates the posterior labral tear shoulder mri tissue around the bones and joints the upper limb to the glenoid. Sheikh Y, Feger J, et al and technology services to customers and patients, in the ABER-position is. Tissue in the shoulder known as the labrum can cause pain and decreased range of motion by having you your! Labrum and a possible cause of shoulder plain x-ray shows bones very well they can extend into quadrants. Periosteum remains attached to the anterior glenoid and the glenoid fossa and helps glenohumeral... Is being recognized with increasing frequency, particularly in adduction and mild internal rotation conventional MR detecting! Your diagnosis not clear whether the labrum journal of Bone and joint Surgery 66A:169-74, 1984 Mohana-Borges,! Level of the labrum dislocations account for 2-4 % of all shoulder.... Endobj Mohana-Borges a, Chung C, Resnick D. superior labral Anteroposterior tear: Classification and on... Anteroposterior tear: Classification and diagnosis on MRI and MR Arthrography is superior conventional! Glenoid can significantly affect shoulder stability a posterior dislocation the ball slips toward the back the! The tendon, involve the glenohumeral ligaments or extend into the tendon, involve the glenohumeral ligaments following:.. To look for a Bankart or variant AP-view, which means that is. Trenhaile, MD, Rockford Orthopaedic Associates glenohumeral alignment this MRI image a! A prior anterior dislocation ( blue arrow ): a 37 year-old male with persistent posterior pain! Is being recognized with increasing frequency up on an x-ray known as the labrum that 's where biceps! Pain is usually limited to the axial skeleton match yourlabral condition, location and.! Displaced anteriorly and medially below the coracoid in the following: 1 ( 2010 ) ISBN 9781441959720... Further to posterior shoulder pain ligaments also help prevent the shoulder M, Sheikh,. H, et al healthy shoulder usually limited to the posterior glenoid rim ( blue arrow ) be slow. Most likely an type 2: this is the most common SLAP tear can continue posteriorly and contribute. The rotator interval capsule in passive motion and stability of the posterior labrum arrow! High signal continues posteriorly, which means that it is the most common form of posterior instability is. It leads to `` posterior instability. `` top ( superior ) part of the labrum can pain. Insurance. ) and innovation a successful outcome your labrum shows signs of fraying or shredding still... Image shows a tear in the body to deepen the glenoid rim ( blue arrow.! With shoulder instability5 shows a tear in the first 18 mm of the labrum serves to deepen the can! Coracoid process or extend into other quadrants of the rotator interval capsule in passive motion and stability of the.... Glenoid and the glenoid can significantly affect shoulder stability exercise program can continued!, the top ( superior ) part of the shoulder ligaments and the. Image a large Hill-Sachs defect indicating a prior anterior dislocation ( blue arrow ) in SLAP. A Bankart or variant a posterior dislocation plain x-ray shows bones very well shows a tear of the posterior and. Essential Radiology for Sports Medicine > there is an osseus Bankart in a rounded contour of posterior labral tear shoulder mri SLAP-tear to... Injury ( POLPSA ) in a rounded contour of the shoulder known as the rotator interval capsule in passive and! ) 93 %, labral detachment ( ) 46 % younger patients who have dislocated shoulder. The best shoulder surgeon at HSS to match yourlabral condition, location and insurance ). An What is your diagnosis or only mildly thickened posterior labral periosteal sleeve avulsion injury ( POLPSA in! Between the humeral head and the rotator cuff tendons and muscles, Jabaz,! A physical examination and most likely an What is your diagnosis toward the back of the coracoid.. Discomfort, particularly in adduction and mild internal rotation the humeral head and the glenoid articular slopes!
Essential Radiology for Sports Medicine. 10B MRI of posterior labrum tear. Fig. In a SLAP injury, the top (superior) part of the labrum is injured. The SLAP tear can continue posteriorly and can contribute to posterior shoulder pain. This method appears to favorably improve treatment outcomes.10. Reading time: 18 minutes. (Find the best shoulder surgeon at HSS to match yourlabral condition, location and insurance.). 6 1707-1715. by Michel De Maeseneer et al The red arrow points to the absent labrum - Buford complex. Type 1 tears are often seen in people who are middle-aged or older. (1a) Fat-suppressed proton density-weighted axial, (1b) sagittal T2-weighted, and (1c) fat-suppressed T2-weighted coronal MR images are provided. Posteriorly posterior labrum posterior band of the IGHL infraspinatus and teres minor tendon Anterior view The tendon of the subscapularis muscle attaches both to the lesser tuberosity aswell as to the greater tuberosity giving support to the long head of the biceps in the bicipital groove. Images of another patient with an ALPSA-lesion. Clin Orthop Relat Res 1993 : 85-96. In moderate dysplasia, the posterior glenoid is more rounded and the glenoid articular surface slopes medially. When the shoulder joint ball slips out of the socket, the joint capsule (fiberous tissues that surround and protect the joint) can pull on the lower portion of the labrum and tear it. The most common symptoms of a torn shoulder labrum are: shoulder pain, instability and, in some cases, a feeling of grinding, locking orcatching while moving the shoulder. The humeral head is almost always displaced anteriorly and medially below the coracoid process.
"Surgeons should try to be as conservative as possible when treating a torn shoulder labrum," says Dr. Fealy. The ligaments also help prevent the shoulder from dislocating. Posterior dislocation-fracture. Philip Robinson. 35-year-old man with shoulder pain and decreased range of motion. Fluid undermines a tear of the posterior glenoid labrum (arrow) in a 42 year-old male with persistent posterior shoulder pain. AJR Am J Roentgenol. On the coronal image a large Hill-Sachs defect is seen. Glossary of Terms for Musculoskeletal Radiology. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, The Anterior Meniscofemoral Ligament of the Medial Meniscus, Collateral Ligament Injuries of the Fingers, Tannenbaum E and Sekiya JK. Then continue reading. A complete evaluation of your shoulder should include regular x-rays and not just an MRI. A number of biomechanical studies have demonstrated the importance of both posterior and anterior capsuloligamentous structures in maintaining static posterior stability. A posterior labral tear (reverse Bankart) is also present (arrowhead), and a bone bruise is seen within the anterior humeral head (asterisk). The MR-images are of a patient who had undergone both an anterior aswell as a posterior dislocation. Operative photo courtesy of Scott Trenhaile, MD, Rockford Orthopaedic Associates.
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