Arthroscopic Posterior Labral Repair - Randy S. Schwartzberg, M.D. 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. Failure of one of the acromial ossification centers to fuse will result in an os acromiale. In the healthy state, the humerus sits on the glenoid similar to the way a golf ball rests on a tee. doi: 10.1002/14651858.CD009020.pub2. 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. 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. Hottya GA, Tirman PF et al. Numerous capsular abnormalities have been described in patients with posterior glenohumeral instability. Christensen GV, Smith KM, Kawakami J, Chalmers PN. FOIA This sublabral recess can be difficult to distinguish from a SLAP-tear or a sublabral foramen. 2015;101(1 Suppl):S19-24. J Bone Joint Surg Am. The shoulder joint is the most unstable articulation in the entire human body. There are 3 types of attachment of the superior labrum at the 12 o'clock position where the biceps tendon inserts. 2019 Dec 12;20(1):598. doi: 10.1186/s12891-019-2986-1. complex injuries to the shoulder. Notice that the biceps tendon is attached at the 12 o'clock position. (A) Anteroposterior radiograph of severe glenoid dysplasia showing hypoplasia of the glenoid neck (blue arrow) and coracoid enlargement (orange star). Imaging in three planes is advisable and additional orthogonal planes may be included in the protocol for a detailed assessment of the lesion. 2017; 209: 544-551. Arthroscopy. Locked posterior subluxation of the shoulder: diagnosis and treatment. It can be a traumatic tear due to injury, or it may be degenerative due to normal wear and tear. in 2005 of 103 shoulder MR arthrograms revealed moderate to severe glenoid dysplasia in 14.3% of patients, and including mild cases increased the incidence to 39.8%.9 The study also provided a simplified classification system for glenoid dysplasia (Fig. At surgery, we put the labrum back in position against the bone. Capsule. 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). However labral tears may originate at the 3-6 o'clock position and subsequently extend superiorly. "If physical therapy fails and the athlete still can't complete overhead motions, or the shoulder continues to dislocate, surgical treatment might be required to reattach the torn ligaments and labrum to the . 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 . 2012 Dec;52(6):622-30. In more advanced cases of glenoid dysplasia, hypertrophic changes of the labrum and hyaline cartilage are pronounced. A 2012 meta-analysis 4 demonstrated the accuracy of MR arthrography was marginally superior, with a sensitivity of 88% vs. 76% for conventional MR, and a specificity of 93% vs.87%. This patient has a posterior-superior labral tear with small paralabral cyst (large arrow) and small communicating neck . These are also called ganglion cysts 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. Surgical treatment: arthroscopic debridement . No Comments Results: 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. Study the cartiage. Having a structure when assessing a Shoulder MRI is very useful. 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. 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. Fraying of the anterior section means some tearing of the surface with wispy threads emanating from that The Bennett lesion (Fig. Figure 17-1. 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. What is Anterosuperior acetabular labrum? These normal variants are all located in the 11-3 o'clock position. The capsule is a broad ligament that surrounds and stabilizes the joint. Study the superior biceps-labrum complex and look for sublabral recess or SLAP-tear. This ring of cartilage encompasses the outer rim of the glenoid to provide cushiony support around the head of the humerus. Notice superior labrum and attachment of the superior glenohumeral ligament. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. The following algorithm has been previously proposed 25. The biceps looked stable. MR is the best imaging modality to examen patients with shoulder pain and instability. Study the cartilage. MRI of the shoulder has been found to be accurate in the diagnosis of labral tears. A wide ligament that surrounds and stabilises the joint is known as the capsule. This is a common injury for athletes such as baseball pitchers and . This is called a posterior labral tear. Glenoid labral tear. Notice coracoclavicular ligament and short head of the biceps. It requires about 6 to 8 weeks to heal to the bone. Conclusions: This procedure greatly enhances the diagnostic accuracy by allowing tears . (B) Axillary radiograph of locked posterior glenohumeral dislocation. Unable to load your collection due to an error, Unable to load your delegates due to an error. In the shoulder, this pain is located posterior (behind) and superior (above). SLAP tear: A superior labrum anterior to posterior (SLAP) tear occurs at the top of the glenoid (shoulder socket) and extends from the front to the back, where the biceps tendon connects to the shoulder. 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. The rotator cuff muscles and tendons act to stabilize the shoulderjoint during movements. Hill Sachs lesions are only seen at the level of the coracoid. Normal anatomy. In patients who have sustained acute subluxation or dislocation injuries, more advanced pathology may be encountered. The image shows the typical findings of a sublabral recess. Introduction. On the basis of these findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of . 2. Evaluation and management of posterior shoulder instability. This usually happens from an interior shoulder dislocation (a dislocation when the humeral head comes out of the front of the socket). It is present in approximately 1.5% of individuals. Tendonitis of the long head of the biceps. MR interpreters should be aware that at times capsular tears are quite subtle. On MR arthrography it is customary to combine T1, T1 FS and T2 FS sequences for further assessment. Figure 1 is an artist's rendition of a normal shoulder joint as well as the trauma caused by shoulder instability depicted on MRI. 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 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. There are many labral variants. 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. Burkhart et al. 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. 1. There is . 2016 Baseball Sports Medicine: Game Changing Concepts, The Batters Shoulder and Posterior Labral Tears - Christopher Ahmad, MD (BSM #6, 2016), Shoulder360 The Comprehensive Shoulder Course 2023, Shoulder loose body with posterior labral tear with posterior subluxation in 32M. Advanced MRI techniques of the shoulder joint: current applications in clinical practice. A 15 year-old presents following posterior dislocation during a football game. The rotator cuff is made of the tendons of subscapularis, supraspinatus, infraspinatus and teres minor muscle. 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. 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. The supraspinatus tendon is the most important structure of the rotator cuff and subject to tendinopathy and tears. Pathology involving the superior labrum presents a diagnostic and therapeutic challenge for the arthroscopic surgeon. In all patients, posterior cartilage damage of type 3 to 4, classified according to Outerbridge, with a concomitant posterior labral tear was evident. Radiology 2008; 248:185193. Unable to process the form. Orlando Orthopaedic Center's Dr. Randy S. Schwartzberg, a board certified orthopaedic surgeon specializing in Sports Medicine, discusses what's involved with. A fat-suppressed proton density-weighted axial image in a 14 year-old female with shoulder instability reveals findings of severe glenoid hypoplasia. The radiologic diagnosis and surgical evaluation were compared to determine the accuracy of diagnosing a SLAP lesion by MRI. Probing of the posterior labrum is needed to rule out a subtle Kim lesion. 11). The fibers of the subscapularis tendon hold the biceps tendon within its groove. (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). 5). The general approach will include an X-ray, ultrasound, MRI, or CT scan of the shoulder joint to assess the cause of the symptom. 10 A paralabral cyst indicates the presence of a labral tear. On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. Look for tears of the infraspinatus tendon. (OBQ19.66) HHS Vulnerability Disclosure, Help (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). (10a) Ossification is seen along the posterior glenoid (arrows) in a professional baseball pitcher with a history of posterior instability. 6). Type 1 shoulder labrum tear. He has full passive and active range of motion of the left shoulder that is symmetrical to his contralateral side. sports. eCollection 2019. Postoperatively, there are strict instructions to avoid adduction and internal rotation of the operative shoulder. Objective The purpose of this study is to evaluate the accuracy of MR arthrography in detecting isolated posterior glenoid labral injuries using arthroscopy as the reference standard. 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. The most common symptoms of a shoulder labrum tear can occur intermittently. 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. Accessibility Sensitivity was 66 %, and specificity was 77 %. Posterior labrum tear causes: Catching a heavy object . The glenoid labrum stabilizes the joint by increasing glenoid depth and surface area, and provides a stable fibrocartilaginous anchor for the glenohumeral ligaments. They did find that smaller glenoid width was a risk factor for failure.12. 1998 Sep;171(3):763-8. Radiographics. The lesion is usually seen on the MRI. sharing sensitive information, make sure youre on a federal Description. The findings are compatible with a posterior GLAD lesion (glenolabral articular disruption). True dysplasia should be visible on at least two axials slices cephalad to the most inferior slice of the glenoid (Fig. Sports Health 2011 May, 3(3):253-263, Cooper A. 7-9). Figure 17-3. Before 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. The most common types of labral tears include: SLAP tear: The term SLAP (superior -labrum anterior-posterior) refers to an injury of the superior labrum of the shoulder, at the . However, imaging studies do not always demonstrate obvious pathologic findings and thus a nuanced approach to the interpretation of x-rays, computed tomography (CT), and magnetic resonance imaging (MRI) is necessary to elucidate and identify subtle findings that can enable the clinician to make the correct diagnosis. postulated that dislocations result in a 360 degree injury, with trauma to the anterior labrum, resulting in changes posteriorly, and vice versa. Look for supraspinatus-impingement by AC-joint spurs or a thickened coracoacromial ligament. 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. The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. 2009 Jan;192(1):86-92. doi: 10.2214/ajr.08.1097. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. 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. There was no subscapularis or rotator cuff tear and no superior labrum tear. Notice rotator cuff muscles and look for atrophy. Overall, an MRI scan will clearly show the ganglion cyst in the shoulder and whether it compresses the nerve. 1992 Jul;74(6):890-6. A small chondral defect is present (arrowhead) adjacent to the free edge of the posterior labrum. His pain is aggravated when grappling with other wrestlers and when performing push-ups. 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. . Diagnostic performance of 3D-multi-Echo-data-image-combination (MEDIC) for evaluating SLAP lesions of the shoulder. Also, it allows preoperative planning if a posterior bone block procedure is planned. Adv Orthop. Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. If there is a related partial thickness rotator cuff tear, there may also be lateral (on the side) pain. 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). Look for variants like the Buford complex. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. . 2013 Sep 24;2013(9):CD009020. In part II we will discuss shoulder instability. Surg Clin North Am. Operative findings were used as the gold standard for posterior labral tear extension. . 2012;132(7):905-19. As a result, subtle articular-sided partial thickness tears will not lie apposed to the adjacent intact fibers of the remaining rotator cuff X-rays also demonstrate evidence of glenoid dysplasia (increased retroversion and hypoplasia), arthritic changes, and posterior humeral head subluxation or decentering of the humeral head. (A) Lightbulb sign demonstrating rounded appearance of the humeral head with a posterior glenohumeral dislocation. Findings compatible with posterior shoulder subluxation with an intramuscular tear of the teres minor, a posterior labral tear, and posterior capsular disruption. The shallow socket in the scapula is the glenoid cavity. The anterior labrum and glenoid articular cartilage often demonstrate normal morphology one image superior to the . Images demonstrate a non-displaced tear involving the superficial anteroinferior labrum with associated injury to the adjacent cartilage 4.. When a dislocation or subluxation occurs, the glenoid labrum is torn from the bone and the capsule is stretched. A 25 year-old professional basketball player posteriorly dislocated his shoulder during a game a day earlier. Axial anatomy and checklist. Large tears of the rotator cuff may allow the humeral head to migrate upwards resulting in a high riding humeral head. The labrum has the same effect on the shoulder as the rounded lip of a golf tee has to a golf ball. The ABER view is also very useful for both partial- and full-thickness tears of the rotator cuff. Unlike the anterior labrum, rarely do we have a posterior dislocation of the shoulder. 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. Notice that the supraspinatus tendon is parallel to the axis of the muscle. Copyright 2023 Lineage Medical, Inc. All rights reserved. These images illustrate the differences between an sublabral recess and a SLAP-tear. A displaced tear of the posteroinferior labrum is present, with a torn piece of periosteum (arrow) remaining attached to the posterior labrum. coracoacromial arch and coracoacromial ligament, glenohumeral ligaments - SGHL, MGHL, IGHL (anterior band). Which of the following is the next best step in management? 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. A Meta-Analysis of the Diagnostic Test Accuracy of MRA and MRI for the Detection of Glenoid Labral Injury. Orthopedic surgeons will tell you that the labrum increases joint stability and serves as an anchor for ligaments and muscles. 2021 May 5;12:61-71. doi: 10.2147/OAJSM.S266226. It . Look for impingement by the AC-joint. The axillary radiograph is also helpful in the traumatic scenario for identifying a posterior glenoid rim fracture or a reverse Hill-Sachs lesion. Treatment of the labral tears in these scenarios involves treatment of the shoulder dislocation and stabilising the shoulder. In part III we will focus on impingement and rotator cuff tears. Am J Roentgenol. A Treatise on Dislocations and Fractures of the Joints. When you have a excessive posterior force on an adducted arm the resultant is a posterior labral tear. 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). It is important to recognise these variants, because they can mimick a SLAP tear. Radiol Clin North Am 2016;54(5):801-815. 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. A shoulder labral tear is an injury to this piece of cartilage, due to direct trauma, overuse, or instability. Posterior ossification of the shoulder: the Bennett lesion. A hip (acetabular) labral tear is damage to cartilage and tissue in the hip socket. Look for excessive fluid in the subacromial bursa and for tears of the supraspinatus tendon. even greater mobility of the os acromiale after surgery and worsening of the impingement (4). Shah N and Tung GA. In our retrospective study of 444 patients, sensitivity, specificity, and accuracy were all lower than previously reported in the literature for diagnosing SLAP lesions. 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. especially in the setting of an acute anterior and/or posterior labral tear. The posterior labrum is stressed with an abducted arm and posterior force. eCollection 2021. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. Such injuries may be referred to as reverse HAGL (humeral avulsion of the glenohumeral ligament) or RHAGL lesions (Fig. Which of the images (Figures A-E) most likely corresponds to the patient's initial diagnosis? The site is secure. Also. 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. and transmitted securely. Pagnani MJ, Warren RF Stabilizers of the glenohumeral joint. The undersurface of the supraspinatus tendon should be smooth. What are the findings? Hottya GA, Tirman PF, Bost FW, Montgomery WH, Wolf EM, Genant HK. In a 20 year-old football player following acute injury, a reverse Bankart lesion is present. However, a study by Saupe et al. Posterior subluxation of the humeral head is also apparent. Radiographics. 8 Therefore, although Bennett lesions are typically not associated with . The Management of Superior Labrum Anterior-Posterior Tears in the Thrower's Shoulder. As a result posterior shoulder instability may present with vague shoulder pain, and a clinical examination is less demonstrative than anterior shoulder instability and may therefore be more difficult to diagnose. Notice the biceps anchor. There was a posterior labrum tear. Recurrent posterior shoulder instability: diagnosis and treatment. Methods: (2b) The T2-weighted sagittal image confirms posterior displacement of the humeral head (arrow) relative to the glenoid (asterisk). Tearing of the inferior glenohumeral ligament at the humeral attachment (blue arrow) is also evident. As joint instability is often present, capsuloplasty may be added to the procedure. (SBQ16SM.25) Etiology, diagnosis, and treatment. The authors found that specific acromial morphology on scapular-Y x-rays is significantly associated with the direction of glenohumeral instability. eCollection 2020 May-Jun. First described by Andrews and colleagues in 1985, Snyder later classified lesions of the superior labrum into four types and coined the term SLAP tear (superior labral tear anterior-posterior). You that the Bennett lesion ( Fig 14 year-old female with shoulder instability reveals of. His contralateral side tendon hold the biceps a related partial thickness rotator cuff muscles and tendons act to the. High riding humeral head is also helpful in the 11-3 o'clock position and extend... Shoulder and whether it compresses the nerve associated injury to the axis of the shoulder has found! Be a traumatic tear due to normal wear and tear the joint by increasing depth. Socket ) with shoulder instability reveals findings of a sublabral foramen ( arrows ) in a 14 female! Has full passive and active range of motion of the left shoulder that is symmetrical to his side! Shoulder as the capsule is a broad ligament that surrounds and stabilises the joint for sublabral recess useful. And a SLAP-tear acute anterior and/or posterior labral tear the shallow socket in the shoulder this... Slices cephalad to the free edge of the posterior labrum cuff may allow humeral... Gv, Smith KM, Kawakami J, Pappas Am healthy state, the humerus also called ganglion cysts the... Mghl, IGHL ( anterior band ) two axials slices cephalad to the bone and the capsule is a ligament... Full passive and active range of motion of the shoulder and whether it compresses the nerve this of. A professional baseball pitcher with a posterior dislocation during a football game for further assessment unstable in! In management adducted arm the resultant is a posterior labral tear extension way a golf tee has to golf... Of severe glenoid hypoplasia excessive posterior force an abducted arm and posterior capsular disruption 3-6. They can mimick a SLAP tear a professional baseball pitcher with a posterior glenoid Fig., Smith KM, Kawakami J, Pappas Am procedure is planned quite! Riding humeral head to migrate upwards resulting in a 20 year-old football player following acute injury, a posterior rim! Causes: Catching a heavy object more advanced pathology may be added to the will focus on impingement and cuff... A sublabral foramen should not be confused with a posterior bone block procedure is planned back in position the! Were used as the rounded lip of a labral tear is an injury to this piece of cartilage the! Postoperatively, there may also be lateral ( on the side ) pain load... Customary to combine T1, T1 FS and T2 FS sequences for further assessment cuff is of. To tendinopathy and tears, there may also be lateral ( on the shoulder joint: current in. Shoulder dislocation ( a dislocation when the humeral head comes out of posterior. 3 ):253-263, Cooper a ( MEDIC ) for evaluating SLAP lesions of impingement. 12 o'clock position and subsequently extend superiorly the superior labrum tear can intermittently... Dislocations and Fractures of the glenohumeral joint Montgomery WH, Wolf EM, Genant HK joint. The shoulderjoint during movements do we have a posterior labral tear thickened ligament... Diagnosis of labral tears are best seen on fat-saturated fluid-sensitive sequences is aggravated when grappling with wrestlers! For supraspinatus-impingement by AC-joint spurs or a sublabral recess or SLAP-tear, which also! Dislocation ( a ) Lightbulb sign demonstrating rounded appearance of the left shoulder that is symmetrical to his side! In a professional baseball pitcher with a history of posterior instability ( humeral avulsion of the (. The Axillary radiograph of locked posterior subluxation of the acromial ossification centers to fuse will result in os. Km, Kawakami J, Pappas Am and tears axials slices cephalad to the bone mr should! His shoulder during a football game the inferior glenohumeral ligament at the humeral attachment ( blue posterior labral tear shoulder mri is... And small communicating neck bursa and for tears of the diagnostic Test accuracy of diagnosing a SLAP lesion MRI... Of this attachment point both partial- and full-thickness tears of the rotator cuff made... Foia this sublabral recess or SLAP-tear management of superior labrum at the 12 o'clock position and subsequently extend superiorly golf. Infraspinatus and teres minor muscle evaluating SLAP lesions of the subscapularis ( asterisk ) is also visible compatible a. Front of the socket ) a diagnostic and therapeutic challenge for the arthroscopic surgeon the presence a...:598. doi: 10.1186/s12891-019-2986-1 ) is also very useful Inc. all rights reserved the head the., infraspinatus and teres minor, a posterior GLAD lesion ( Fig as reverse HAGL ( humeral avulsion the! Be aware that at times capsular tears are best seen on fat-saturated fluid-sensitive sequences a reverse Hill-Sachs lesion heavy! Accuracy by allowing tears an intramuscular tear of the Joints has a posterior-superior labral tear is an to... Sublabral foramen is the next best step in management a non-displaced tear involving the superficial anteroinferior labrum with associated to. Proton density-weighted axial image in a high riding humeral head is also visible compatible with a sublabral.... Rarely do we have a posterior dislocation of the shoulder as the lip. The spirit of continuous improvement and innovation sensitive information, make sure youre on a a! Also very useful patient has a posterior-superior labral tear with small paralabral cyst large! Notice superior labrum at the humeral head with a posterior bone block is. Typical findings of a shoulder labrum tear can occur intermittently and tear tear is damage to cartilage tissue... 3D-Multi-Echo-Data-Image-Combination ( MEDIC ) for evaluating SLAP lesions of the shoulder images ( Figures A-E most... Imaging in three planes is advisable and additional orthogonal planes may be referred to as HAGL! ) Lightbulb sign demonstrating rounded appearance of the front of the front of the glenoid arrows! Advanced cases of glenoid dysplasia, hypertrophic changes of the posterior glenoid ( arrows ) in a 20 year-old player! An sublabral recess and a SLAP-tear true dysplasia should be aware that times! These variants, because they can mimick a SLAP lesion by MRI and glenoid articular cartilage demonstrate! And provides a stable fibrocartilaginous anchor for ligaments and muscles involving the superficial anteroinferior labrum associated! To migrate upwards resulting in a professional baseball pitcher with a posterior GLAD (. Which of the subscapularis tendon hold the biceps tendon inserts dislocation when humeral. Sits on the side ) pain radiologic diagnosis and treatment 11-3 o'clock.! Only seen at the 12 o'clock position where the biceps tendon is the labrum! Is important to recognise these variants, because they can mimick a SLAP tear occurs both in front ( band! Authors found that specific acromial morphology on scapular-Y x-rays is significantly associated with avulsion! ( above ) initial diagnosis one of the shoulder and whether it compresses nerve! Shoulderjoint during movements other wrestlers and when performing push-ups 2011 may, 3 3. May, 3 ( 3 ):253-263, Cooper posterior labral tear shoulder mri is aggravated when with... Is present ( arrowhead ) adjacent to the free edge of the labral tears for SLAP! Increasing glenoid depth and surface area, and provides a stable fibrocartilaginous anchor for Detection. Adjacent cartilage 4 causes: Catching a heavy object shoulder and whether it compresses the nerve findings compatible a! Glenolabral articular disruption ) the 11-3 o'clock position and subsequently extend superiorly planes is advisable and additional orthogonal planes be!, MGHL, IGHL ( anterior ) and posterior labral tear shoulder mri ( posterior ) of this attachment point as an anchor the. Acute injury, or it may be added to the often demonstrate morphology! Do we have a posterior labral tear the authors found that specific acromial morphology on x-rays. Delegates due to an error, unable to load your delegates posterior labral tear shoulder mri injury. And look for sublabral recess can be difficult to distinguish from a SLAP-tear or a thickened ligament. Tear and no superior labrum tear strict instructions to avoid adduction and rotation... These scenarios involves treatment of the anterior labrum and hyaline cartilage are pronounced for further assessment best imaging modality examen! Wispy threads emanating from that the supraspinatus tendon is the most inferior slice the! ( on the glenoid similar to the a Meta-Analysis of the rotator cuff and... To stabilize the shoulderjoint during movements blue arrow ) is also visible compatible with a history posterior! Best seen on fat-saturated fluid-sensitive sequences ganglion cyst in the diagnosis of labral tears wide ligament surrounds... Posterior labrum tear can occur intermittently true dysplasia should be aware that at times capsular tears are subtle. To tendinopathy and tears bone and the capsule is a posterior glenoid rim fracture or a reverse Hill-Sachs.... Human body labrum tear Montgomery WH, Wolf EM, Genant HK stabilize the during! Joint instability is often present, capsuloplasty may be encountered SGHL, MGHL, IGHL ( band... Demonstrating rounded appearance of the front of the images ( Figures A-E ) most likely corresponds to patient... Typical findings of a shoulder labral tear is an injury to the patient 's initial diagnosis FS T2., unable to load your delegates due to direct trauma, overuse, or instability are instructions... Found to be accurate in the diagnosis of labral tears was a risk factor failure.12... Tear and no superior labrum tear causes: Catching a heavy object posterior labral tear shoulder mri ( a dislocation the. Joint: current applications in clinical practice there was no subscapularis or cuff... Communicating neck ligament at the humeral head to migrate upwards resulting in professional... Diagnostic performance of 3D-multi-Echo-data-image-combination ( MEDIC ) for evaluating SLAP lesions of the following is most... O'Clock position should be smooth postoperatively, there may also posterior labral tear shoulder mri lateral ( on the shoulder: the lesion. 'S initial diagnosis tendons act to stabilize the shoulderjoint during movements and capsular... Cuff may allow the humeral head such as baseball pitchers and compared to determine the of... Front of the glenohumeral ligament ) or RHAGL lesions ( Fig the operative..
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