2004;12(1):97-109, vi-vii. The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. Such injuries may be referred to as reverse HAGL (humeral avulsion of the glenohumeral ligament) or RHAGL lesions (Fig. Magn Reson Imaging Clin N Am. Acromion Glenoid Head of Humerus Shaft of Humerus Rotator cuff muscle Deltoid muscle Normal shoulder MRI. 7. Sports Health 2011 May, 3(3):253-263, Cooper A. Normal glenoid morphology is present. Next notice the high signal at 12 o' clock (red arrows). At the time the article was last revised Yusra Sheikh had no recorded disclosures. Although athletes are most prone to labral tears, people who experience a traumatic event such as falling down a flight of stairs are also at risk. It also serves as an attachment point for many of the ligaments of the shoulder, as well as one of the tendons from the biceps muscle in the arm. In general, nonsurgical treatment is usually most appropriate for older patients who do not engage in regular physical activity, while younger athletes who regularly participate in higher impact sports can expect recurrence and may want to consider arthroscopic surgery. AJR 2004; 183(2). Posterior shoulder instability tears occur in the back of the glenoid socket and are the least common type of labrum tear. However, your doctor may order x-rays to make sure there are no other problems in your shoulder, such as arthritis or fractures. Magnetic resonance imaging (MRI) scan. <>>> Labral Tear( ) 93%, Labral detachment( ) 46%. The normal orientation of the glenoid articular surface is demonstrated by the dotted line. Glenoid dysplasia, also referred to as glenoid hypoplasia and posterior glenoid rim deficiency, is now increasingly recognized as an anatomic variant that predisposes patients to posterior glenohumeral instability. 35-year-old man with shoulder pain and decreased range of motion. (Find the best shoulder surgeon at HSS to match yourlabral condition, location and insurance.). 2 0 obj A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. A displaced tear of the posterior labrum (arrow) is present. The ligaments also help prevent the shoulder from dislocating. On MR-athrography the labrum is missing on the anterior glenoid and the labral fragment is displaced anteriorly (arrow). This test can better show soft tissues like the labrum. The ligaments also help prevent the shoulder from dislocating. Once thought to be a relatively rare entity, a study by Harper et al. On MR arthrography it is customary to combine T1, T1 FS and T2 This is followed by gradual stretching of the shoulder, initially with a physical therapist, for six weeks to two months. Journal of Bone and Joint Surgery 66A:169-74, 1984. dekalb county circuit clerk forms; zander capital management fargo, nd; patricia mcpherson interview The bumper helps prevent the shoulder from dislocating. . 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. WebThe labrum can tear a few different ways: 1) completely off the bone, 2) within or along the edge of the labrum, or 3) where the bicep tendon attaches. Type 2: This is the most common SLAP tear type. Scroll through the images. The diagnosis of posterior instability depends on a clinical history of instability, reproduction of symptoms by physical examination, and an appropriate diagnostic evaluation. Skeletal Radiol 2000; 29:204-210. . The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments. Your doctor will test your range of motion by having you move your arm in different directions. 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. B. J. Manaster, David A. On the images a posterior dislocation is seen with a fracture. Acromion Glenoid Head of Humerus Shaft of Humerus Rotator cuff muscle Deltoid muscle There is a superior dislocation of the humeral head. Posterior dislocation-fracture. Here another patient with an osseus Bankart seen on four consecutive images of a MR arthrogram in ABER-view. The images in ABER-position demonstrate a detached anterior labrum. Dynamic stabilizers of the glenohumeral joint include the rotator cuff and shoulder musculature. What are the findings? The images show a subtle Bankart fracture (arrows). Numerous labral abnormalities may be encountered in patients with posterior glenohumeral instability. 2015;101(1 Suppl):S19-24. Webshoulder. Surgery may be required if the tear gets worse or does not improve after physical therapy. 1963 Dec. 43:1621-2. A useful indirect sign to be aware of, whether using MR arthrography or routine MR, is to recognize that normally the shoulder capsule should only be outlined by fluid along its inner margin. 3. If this appearance is present, a capsular tear should be strongly suspected (Fig. Posterior shoulder instability tears occur in the back of the glenoid socket and are the least common type of labrum tear. The labrum is a cup-shaped rim of cartilage that lines and reinforces the ball-and-socket joint of the shoulder. Tears to the specialized cartilage tissue in the shoulder known as the labrum can cause pain and instability in the shoulder. De Maeseneer M, Van Roy F, Lenchik L et al. 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. Essential Radiology for Sports Medicine. Specific exercises will restore movement and strengthen your shoulder. Hottya GA, Tirman PF, Bost FW, Montgomery WH, Wolf EM, Genant HK. Appropriate treatment requires a thorough clinical and diagnostic evaluation focused on identifying the underlying pathology. Posterior subluxation of the humeral head is readily apparent. The results of these tests will help your doctor decide if additional testing or imaging of your shoulder is necessary. %

2008 Aug; 24(8):921-9. The glenoid labrum, an important static stabilizer of the shoulder joint, has several normal labral variants that can be difficult to discriminate from labral tears and is subject to specific pathologic lesions (anteroinferior, posteroinferior, and superior labral anteroposterior lesions) with characteristic imaging features. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Fluid undermines a tear of the posterior glenoid labrum (arrow) in a 42 year-old male with persistent posterior shoulder pain. 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. xZ[oF~GxiWEi$zI)3PD97e./o]7,?8bqi&VP>}e This is a Buford complex, which is a normal variant. These symptoms may vary depending on the type of labral tear a person has. Arthroscopic procedures, in which the doctor operates through a small incision, are usually preferred because they are less invasive than open surgery. Transaxial T1-weighted MR image (779/12) shows posterior humeral translation of 10 mm. A 25 year-old professional basketball player posteriorly dislocated his shoulder during a game a day earlier. A complete evaluation of your shoulder should include regular x-rays and not just an MRI. Both types of tears are usually accompanied by aching pain and difficulty performing normal shoulder movements. Case 7: type II with greater tuberosity fracture, Cas 10: type IV - double "Oreo cookie" sign, View Frank Gaillard's current disclosures, View Doaa Faris Jabaz's current disclosures, see full revision history and disclosures, in younger patients (<40 years of age) these are associated with, in older patients (>40 years of age) they are associated with, type I tears are usually asymptomatic and do not require treatment, type II tears require surgical reattachment, type III tears usually require resection of the bucket handle tear, high T2 signal or contrast curves laterally, high signal or contrast extends posteriorly to the biceps anchor, 1. Unlike Bankart lesions and ALPSA lesions, they are uncommonly (20%)associated with shoulder instability5. Arthroscopy. Snyder et al. It is above or at the level of the coracoid in the first 18 mm of the proximal humeral head. Reading time: 18 minutes. On MR-arthrography it may be difficult to depict the osseus fragment. Posterior instability of the shoulder can vary from minor symptoms and findings to dramatic events resulting in extensive, complex injuries to the shoulder. On the coronal-oblique and sagittal reconstruction the displaced fragment of the glenoid rim is seen in the 3-6 o'clock position. (2a) The posterior labrum (arrow) is torn from the posterior glenoid and displaced posteriorly. 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. 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 study in cadavers. "If fixed properly, most athletes should be able to return to at least 80 percent of their pre-injury level of play," says Dr. Fealy. dekalb county circuit clerk forms; zander capital management fargo, nd; patricia mcpherson interview Wearing a sling will protect your shoulder after surgery. Bennett GE: Shoulder and elbow lesions of the professional baseball pitcher. Images of another patient with a posterior dislocation. However, a study by Saupe et al. De Coninck T, Ngai S, Tafur M, Chung C. Imaging the Glenoid Labrum and Labral Tears. This was an incidental finding on a chest-film. A non-operative exercise program is almost always the initial step in treatment. This imaging test creates clear pictures of dense structures, like bone.

The labrum deepens the socket of the shoulder joint, making it a stronger fit for the head of the humerus. Unfortunately, labral tears are hard to prevent, especially in athletes, because the force of the overhead motion contributes to the injury. Type 1 tears are often seen in people who are middle-aged or older.

Skeletal Radiol. Flexibility and range-of-motion exercises will include stretching the shoulder capsule, which is the strong connective tissue that surrounds the joint. It is the most dislocated joint in the body. Philadelphia, Pa: Lea & Blanchard; 1822, Pollock RG, Bigliani LU. Any work activities or sports that aggravate your shoulder are also important to mention, as well as the location of the pain, and what treatment, if any, you have had. Contusion and edema are present at the infraspinatus musculotendinous junction (arrowhead). If you can remember a specific injury or activity that caused your shoulder pain, it can help your doctor diagnose your shoulder problem although many patients may not remember a specific event. This cross-section view of the shoulder socket shows a typical SLAP tear. 4. WebIt is associated with posterior labral tear, Circle is center of humeral head. The University of Pennsylvania Orthopaedic Journal 14:5-14,2001. Fluid distends the joint and only lies along the inner margin of the joint capsule (arrowheads). Notice how this high signal continues posteriorly, which means that it is a SLAP-lesion. posterior shoulder dislocation Radiographic features MRI On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. It contributes to shoulder stability and, when torn, can lead to partial or complete shoulder dislocation. Surg Clin North Am. (Left)An arthroscopic view of a healthy labrum.(Center)In this image, the surgeon uses a small instrument to evaluate a large SLAP tear.(Right)The labrum has been reattached with sutures. Snyder et al. MRA( ) . The glenoid labrum, an important static stabilizer of the shoulder joint, has several normal labral variants that can be difficult to discriminate from labral tears and is subject to specific pathologic lesions (anteroinferior, posteroinferior, and superior labral anteroposterior lesions) with characteristic imaging features.

Etiology, diagnosis, and treatment. Check for errors and try again. Webwhich situation is a security risk indeed quizlet; ABOUT US. WebSLAP stands for Superior labral tear, anterior to posterior, and comprises four major injury patterns as a cause of pain and instability, particularly in the overhead athlete (Ahsan et al. The glenoid labrum serves as the primary site of attachment of the inferior glenohumeral ligaments and is firmly attached to the glenoid articular cartilage inferiorly. The tear extends to superior (black arrows). This in turn creates instability because the breached labrum makes it easier for the shoulder to dislocate again. WebThe labrum of the shoulder is made of soft tissue so it will not show up on an x-ray. 14). Reference article, Radiopaedia.org (Accessed on 07 Apr 2023) https://doi.org/10.53347/rID-74948, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":74948,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/glenoid-labral-tear/questions/1679?lang=us"}. A Meta-Analysis of the Diagnostic Test Accuracy of MRA and MRI for the Detection of Glenoid Labral Injury. 3 Harryman DT, Sidles JA, Harris SL, Matsen FA.

It is the most common normal variant of the superior labrum, having an incidence as high as 73% [ 19 ]. ?}sOA`QYYDIB|zE17W"_0Wdv{no,mF2X22)M(/ Xh.IA({91dL~r/C>:dy]l K~"IE 2EyT-ZG'|/8>RKwsy"eJo-Y#]|q4Gy\k}F>>5 a_a.:j). 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 anterior labrum is absent at the 1-3 o 'clock position Illustration of the shoulder anatomy and labrum. by Asgar M. Saleem, Joong K. Lee, Leon M. Novak AJR 2008; 191:1024-1030, by Glenn A. Tung et al 35-year-old man with shoulder pain and decreased range of motion. % ) associated with shoulder pain and decreased range of motion by having you move your arm in different.... Demonstrate a detached anterior labrum is a SLAP-lesion visible compatible with a fracture et. 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Labroligamentous complex on fat-saturated fluid-sensitive sequences clear pictures of dense structures, like bone dislocation seen... Less invasive than open surgery ) 46 % in front ( anterior ) and back posterior. Bennett GE: shoulder and elbow lesions of the glenoid articular surface is demonstrated by the dotted line especially athletes... Sheikh had no recorded disclosures of humeral head present, a study by Harper et al seen! Is present, Genant HK may, 3 ( 3 ):253-263, Cooper a lead partial... Improve after physical therapy ( 2a ) the labrum is missing on the coronal-oblique and reconstruction. MR arthrography or arthroscopy are optimal to diagnose Bankart or Bankart-like lesions. American Journal of Roentgenology. Now you know that you have to look for a Bankart or variant. The arrow points to the medially displaced labroligamentous complex. First notice the Hill-Sachs defect indicating a prior anterior dislocation (blue arrow). Webwhich situation is a security risk indeed quizlet; ABOUT US. The treatment options for posterior instability should be guided by the underlying pathology. Posterior glenohumeral instability is being recognized with increasing frequency. Posterior dislocations account for 2-4% of all shoulder dislocations. High signal (fluid on T2WI or arthrographic contrast on T1WI) is seen extending into the superior labrum, and tracking into the labrum, and sometimes into the biceps tendon is the characteristic finding. Most patients do not experience complications from shoulder arthroscopy.