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. 2019 Dec 12;20(1):598. doi: 10.1186/s12891-019-2986-1. 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. Capsule. Injuries isolated to labrum and capsule can often be successfully repaired with arthroscopic techniques including capsulolabral repair, capsular shift, and capsular shrinkage. In the event of a shoulder dislocation, the . nor be effaced against the humeral head, and intra-articular contrast can enhance visualization of the tear (3). Locked posterior subluxation of the shoulder: diagnosis and treatment. Look for excessive fluid in the subacromial bursa and for tears of the supraspinatus tendon. 3. Figure 17-3. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. The authors found that specific acromial morphology on scapular-Y x-rays is significantly associated with the direction of glenohumeral instability. It is not healed. If the patient is unable to abduct the arm, then a Velpeau view is an alternate orthogonal radiograph (Figure 17-4). 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. These normal variants are all located in the 11-3 o'clock position. MRA for SLAP - Is the threshold for referral too low? In either case, the labrum can be torn off the bone. Saupe N, White LM, Bleakney R, et al. a painful feeling of clicking, popping or grinding in the shoulder during movement. Shoulder Labral Tear Repair Surgery. Treatment of the labral tears in these scenarios involves treatment of the shoulder dislocation and stabilising the shoulder. Clinical History: A 72 year-old male presents with severe left shoulder pain and limited motion following a fall 10 days earlier. The biceps looked stable. Appendicitis - Pitfalls in US and CT diagnosis, Acute Abdomen in Gynaecology - Ultrasound, Transvaginal Ultrasound for Non-Gynaecological Conditions, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, TI-RADS - Thyroid Imaging Reporting and Data System, The Abduction External Rotation (ABER) View for MRI of the Shoulder. They involve the superior glenoid labrum, where the long head of biceps tendon inserts. J Bone Joint Surg Am. What is your diagnosis? The fibers of the subscapularis tendon hold the biceps tendon within its groove. It . In type II there is a small recess. Orthop J Sports Med. Shah N and Tung GA. 2012 Jan;21(1):13-22 Labral tears, such as a SLAP tear that cause a paralabral cyst, can occur due to trauma (dislocation), repetitive movement . 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. The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. 1963 Dec. 43:1621-2. Study the cartiage. The ball of the shoulder can dislocate toward the front of the shoulder (an anterior dislocation), or it can go out the back of the shoulder (called a posterior dislocation). The vast majority of shoulder labral tears do not need surgery. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, Collateral Ligament Injuries of the Fingers, Tannenbaum E and Sekiya JK. Radiology. In cases of severe dysplasia, advanced rounding and posterior sloping of the posterior glenoid is seen, and pronounced thickening of the labrum and other adjacent posterior soft tissues is apparent. Baseball pitchers are shown to have a high prevalence. Recurrent posterior shoulder instability: diagnosis and treatment. In a 34 year-old male following an acute subluxation event, a tear is present along the base of the posterior labrum with edema and irregularity noted at adjacent posterior periosteum (arrow). (10a) Ossification is seen along the posterior glenoid (arrows) in a professional baseball pitcher with a history of posterior instability. In part II we will discuss shoulder instability. AJR 1998; 171:763-768. Figure 17-5. Imaging of superior labral anterior to posterior (SLAP) tears of the shoulder. When you plan the coronal oblique series, it is best to focus on the axis of the supraspinatus tendon. It is, however, becoming more frequently recognized, particularly in athletes such as football players and weightlifters, in which posterior glenohumeral instability has achieved increased awareness.3 As McLaughlin stated in 19634, the clinical diagnosis is clear-cut and unmistakable, but only when the posterior subluxation is suspected. official website and that any information you provide is encrypted Overall, MRI had an accuracy of 76 %, a PPV of 24 %, and a NPV of 95 %. However labral tears may originate at the 3-6 o'clock position and subsequently extend superiorly. Would you like email updates of new search results? (2b) The T2-weighted sagittal image confirms posterior displacement of the humeral head (arrow) relative to the glenoid (asterisk). Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. In this chapter we will review imaging findings of posterior instability on standard radiographs, CT scan, MRI, and magnetic resonance arthrogram (MRA), and 3-dimensional (3D) reconstruction CT and 3D MRI, which assist in the diagnosis and treatment of symptomatic posterior shoulder instability. Christensen GV, Smith KM, Kawakami J, Chalmers PN. 2008 Aug; 24(8):921-9. 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. 1, 2 The potential for more extensive injury patterns is also supported by recent biomechanical data demonstrating increased strain in the posterior labrum following an anterior . This is not always the case. If this appearance is present, a capsular tear should be strongly suspected (Fig. Diagnosis of a locked posterior humeral dislocation can be avoided by recognizing on the AP Grashey radiograph the presence of the lightbulb sign (Figure 17-3A), which is the humeral head taking on a rounded appearance similar to the shape of a lightbulb because of fixed internal rotation secondary to a posterior glenohumeral dislocation.4 In addition to recognizing the lightbulb sign on an AP Grashey radiograph, an axillary x-ray will confirm the diagnosis of a locked posterior dislocation (Figure 17-3B). 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. Large tears of the rotator cuff may allow the humeral head to migrate upwards resulting in a high riding humeral head. If the arm is When we assess the shoulder labrum there are 7 areas to look at which have some association with labral tears. The glenoid cavity is the shallow socket of the scapula. The axillary radiograph is also helpful in the traumatic scenario for identifying a posterior glenoid rim fracture or a reverse Hill-Sachs lesion. The confirming test for a labral tear is an MRI preceded by an arthrogram. Apart from that, CT is superior to MR in assessing bony structures, so this modality is helpful in detecting co-existing small glenoid rim fractures. Which of the following nerves was most likely injured during the procedure? 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. A 20-year-old college football offensive lineman undergoes arthroscopic right shoulder surgery for the injury shown in Figure A. Post-operatively he complains of burning pain in the region marked in yellow on Figure B. Bethesda, MD 20894, Web Policies Adv Orthop. 2011 May;196(5):1139-44. doi: 10.2214/AJR.08.1734. 12) or at the humeral attachment (Fig. Posterior shoulder subluxation or dislocation is also one of the rare entities that may result in tears of the teres minor muscle.18 MR allows rapid evaluation of the status of the cuff following posterior dislocation, and prompt diagnosis of such lesions avoids delays in treatments that may lead to irreversible fatty atrophy of cuff musculature (Figs. Crossref, Google Scholar; 73. Study the superior biceps-labrum complex and look for sublabral recess or SLAP-tear. FOIA The posterior labrum is avulsed, and stripped scapular periosteum remains attached to the posterior labrum (arrowhead). 4). It is a condition referred to as an internal impingement. A displaced tear of the posterior labrum (arrow) is present. CT and MR Arthrography of the Normal and Pathologic Anterosuperior Labrum and Labral-Bicipital Complex. J Bone Joint Surg Am 1993; 75:1175-1184. Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. Glenoid labral tear. Often, muscle wasting is seen clearly on MRI, showing atrophy of the muscle and build-up of fat. On plain radiography of the shoulder, an anteroposterior (AP) view of the shoulder in internal and external rotation, outlet, and axillary views should be obtained. When the Posterior instability of the shoulder can vary from minor symptoms and findings to dramatic events resulting in extensive, complex injuries to the shoulder. At this level study the middle GHL and the anterior labrum. Notice the fibers of the inferior GHL. CT arthrography has been reported to have 97.3% accuracy for detecting Bankart lesions and 86.3% for SLAP lesions 4, which makes it comparable with MR arthrography and gives the possibility to examine the patients with contraindications to an MR examination. The rotator cuff is made of the tendons of subscapularis, supraspinatus, infraspinatus and teres minor muscle. Notice MGHL, which has an oblique course through the joint and study the relation to the subscapularis tendon. Notice the smooth borders unlike the margins of a SLAP-tear. (1a) Fat-suppressed proton density-weighted axial, (1b) sagittal T2-weighted, and (1c) fat-suppressed T2-weighted coronal MR images are provided. True anteroposterior or Grashey x-ray. 2009; 38(10):967-975. by Herold T, Bachthaler M, Hamer OW, et al. 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Fracture or a reverse Hill-Sachs lesion oblique series, it is best to focus on axis... ; 196 ( 5 ):1139-44. doi: 10.1186/s12891-019-2986-1, which has an oblique course through the joint and the... And the anterior labrum male presents with severe left shoulder pain and limited motion following a fall days!
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