In the shoulder, this pain is located posterior (behind) and superior (above). It . Notice smooth undersurface of infraspinatus tendon and normal anterior labrum. A shoulder labral tear is an injury to this piece of cartilage, due to direct trauma, overuse, or instability. A posterior labral tear (reverse Bankart) is also present (arrowhead), and a bone bruise is seen within the anterior humeral head (asterisk). The biceps looked stable. (2c) Trough-like defects within both the humeral head (red arrows) and the glenoid (arrowheads) are visible on the fat-suppressed T2-weighted coronal image. MRI is well recognized as an effective means to diagnose internal impingement of the shoulder. Surgical treatment: arthroscopic debridement . Images demonstrate a non-displaced tear involving the superficial anteroinferior labrum with associated injury to the adjacent cartilage 4.. Measurement of Friedmans angle and posterior humeral head subluxation (yellow lines depict Friedmans angle; red line depicts percentage of posterior humeral head subluxation). Following plain radiographs, a CT scan is another useful imaging modality to evaluate the bony morphology of the glenoid including retroversion, glenoid dysplasia, and glenoid bone loss (GBL), and to further characterize the size and location of a reverse Hill-Sachs lesion. On MR arthrography it is customary to combine T1, T1 FS and T2 FS sequences for further assessment. The posterior labrum is enlarged to replace the deficient glenoid rim. If the patient is unable to abduct the arm, then a Velpeau view is an alternate orthogonal radiograph (Figure 17-4). Findings compatible with posterior shoulder subluxation with an intramuscular tear of the teres minor, a posterior labral tear, and posterior capsular disruption. (1a) Fat-suppressed proton density-weighted axial, (1b) sagittal T2-weighted, and (1c) fat-suppressed T2-weighted coronal MR images are provided. Notice coracoclavicular ligament and short head of the biceps. The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: comparison with arthroscopic findings. When we assess the shoulder labrum there are 7 areas to look at which have some association with labral tears. Often, muscle wasting is seen clearly on MRI, showing atrophy of the muscle and build-up of fat. (OBQ12.268) Notice rotator cuff muscles and look for atrophy. When you have a excessive posterior force on an adducted arm the resultant is a posterior labral tear. A SLAP tear may extend to the 1-3 o'clock position, but the attachment of the biceps tendon to the superior labrum should always be involved. In more advanced cases of glenoid dysplasia, hypertrophic changes of the labrum and hyaline cartilage are pronounced. In Shoulder MR-Part I we will focus on the normal anatomy and the many anatomical variants that may simulate pathology. Glenoid labral tear. It is present in approximately 1.5% of individuals. Insertion of the shoulder capsule onto the labrum or glenoid has been categorized previously according to a system by Mosley et al. Diagnostic arthroscopy revealed no significant glenohumeral articular defects. J Bone Joint Surg Am. Open Access J Sports Med. In a SLAP injury, the top (superior) part of the labrum is injured. Sports Health 2011 May, 3(3):253-263, Cooper A. Tendonitis of the long head of the biceps. McLaughlin, HL. The supraspinatus tendon is the most important structure of the rotator cuff and subject to tendinopathy and tears. Our data indicated that while MRI could exclude a SLAP lesion (NPV = 95 %), MRI alone was not an accurate clinical tool. 2019 Oct 31;2019:9013935. doi: 10.1155/2019/9013935. 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. 1998 Sep;171(3):763-8. 1994 May; 3(3):173-90. Baseball pitchers are shown to have a high prevalence. Occasionally, a SLAP (superior labrum, anterior and posterior) fracture, which represents a superior humeral head compression . At surgery, we put the labrum back in position against the bone. Clipboard, Search History, and several other advanced features are temporarily unavailable. The axillary radiograph is also helpful in the traumatic scenario for identifying a posterior glenoid rim fracture or a reverse Hill-Sachs lesion. While this certainly introduces vulnerability to injury, it also confers the advantage of broad range of motion. Orthop Traumatol Surg Res. coracoacromial arch and coracoacromial ligament, glenohumeral ligaments - SGHL, MGHL, IGHL (anterior band). Posterior labral periosteal sleeve avulsion injury (POLPSA) in a 19 year-old football player following acute injury. eCollection 2020 Aug. J Orthop. Arch Orthop Trauma Surg. Diagnosis . 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 . of this lesion is hypothesized to be secondary to either traction of the posterior band inferior glenohumeral ligament during the throwing deceleration phase, or impingement in the cocking phase. The glenoid cavity is the shallow socket of the scapula. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. A locked posterior shoulder dislocation is perhaps the most dramatic example of posterior glenohumeral instability. These terms are interchangeable because there is underdevelopment of the posterior inferior aspect of the glenoid. 2005;184: 984-988. Glenoid labrum (marked lig.) the removal of the acromion distal to the synchondrosis may further destabilize the synchondrosis and allow for Posterior subluxation of the humeral head is also apparent. The vast majority of shoulder labral tears do not need surgery. There was a fair amount of synovitis and thickening of the capsule posteriorly and inferiorly, suggesting a reactive change. This sublabral recess can be difficult to distinguish from a SLAP-tear or a sublabral foramen. The shoulder joint is a ball and socket joint that connects the bone of the upper arm (humerus) with the shoulder blade (scapula). American Journal of Sports Medicine 1994, 22:2:171-176. There is an additional tear of the posterior inferior labrum (at approximately the 8 o'clock position) with small paralabral cyst formation and subchondral cysts in the posterior inferior glenoid. A posterior labral tear is referred to as a reverse Bankart lesion, or attenuation of the posterior capsulolabral complex, and commonly occurs due to repetitive microtrauma in athletes. A shoulder labral tear can occur due to repetitive overhead use, a lifting injury, a fall on the arm, a sudden pull on the arm, or having the arm twisted at the shoulder joint. Although x-ray findings are typically normal, they must be scrutinized to avoid errors of diagnosis such as missed posterior dislocations. 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. Scroll through the images and notice the unattached labrum at the 12-3 o'clock position at the site of the sublabral foramen. Axis of supraspinous tendon. An example of this position is pushing open a door with a straight arm. eCollection 2019. 4). 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. 2012 Dec;52(6):622-30. If the arm is 2017; 209: 544-551. This is a common injury for athletes such as baseball pitchers and . 2000 Jan;214(1):267-71 J Bone Joint Surg Am. De Coninck T, Ngai S, Tafur M, Chung C. Imaging the Glenoid Labrum and Labral Tears. This usually happens from an interior shoulder dislocation (a dislocation when the humeral head comes out of the front of the socket). Follow me on twitter:https://twitter.com/#!/DrEbr. This can result in the damage to the anterior or front part of the labrum. Fig. 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). There are 3 types of attachment of the superior labrum at the 12 o'clock position where the biceps tendon inserts. Notice that the biceps tendon is attached at the 12 o'clock position. Fraying of the anterior section means some tearing of the surface with wispy threads emanating from that SLAP tears can cause pain and range-of-motion problems in the shoulder labrum, the biceps tendon or both. 15,16). American Journal of Roentgenology. Disclaimer, National Library of Medicine 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. An MRI arthrogram is performed and is normal. The posterior capsule is torn at the humeral attachment (arrow). Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. Diagnostic criteria for both anterior and posterior labral tears present similarly. The capsule is a broad ligament that surrounds and stabilizes the joint. When there is an avulsion of the posterior inferior labrum, and the lesion is incomplete, concealed, or occult, it is called a Kim lesion. Failure of one of the acromial ossification centers to fuse will result in an os acromiale. posterior labral tear surgery. Injuries isolated to labrum and capsule can often be successfully repaired with arthroscopic techniques including capsulolabral repair, capsular shift, and capsular shrinkage. Study the attachment of the IGHL at the humerus. A study in cadavers. A recess more than 3-5 mm is always abnormal and should be regarded as a SLAP-tear. It can be a traumatic tear due to injury, or it may be degenerative due to normal wear and tear. Broadly, clinical unidirectional . The shallow socket in the scapula is the glenoid cavity. 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. 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. 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. The os acromiale may cause impingement because if it is unstable, it may be pulled inferiorly during abduction by the deltoid, which attaches here. 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%. Bennett lesions are more commonly found in overhead athletes, typically baseball players, and can be visualized on axillary radiographs.5 The development of this lesion is hypothesized to be secondary to either traction of the posterior band inferior glenohumeral ligament during the throwing deceleration phase, or impingement in the cocking phase.6,7 Park et al examined a population of 388 baseball pitchers, 125 of whom (32.2%) had Bennett lesions. In the event of a shoulder dislocation, the . 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. These are also called ganglion cysts of the shoulder. J Shoulder Elbow Surg. Large tears of the rotator cuff may allow the humeral head to migrate upwards resulting in a high riding humeral head. 12) or at the humeral attachment (Fig. It helps provide stability to the shoulder by . MRI is not uncommonly the key to the diagnosis as patients may present with vague clinical findings that are not prospectively diagnosed, in part because of the . Arthroscopic Posterior Labral Repair - Randy S. Schwartzberg, M.D. 8 Therefore, although Bennett lesions are typically not associated with . 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. (A) Anteroposterior radiograph of severe glenoid dysplasia showing hypoplasia of the glenoid neck (blue arrow) and coracoid enlargement (orange star). Comparison between 18 patients with glenoid dysplasia and 19 patients without dysplasia revealed no significant difference in outcomes between the 2 groups.20. 2008 Aug; 24(8):921-9. Shoulder Labral Tear Repair Surgery. Diagnostic performance of 3D-multi-Echo-data-image-combination (MEDIC) for evaluating SLAP lesions of the shoulder. A fat-suppressed proton density-weighted axial image in a 14 year-old female with shoulder instability reveals findings of severe glenoid hypoplasia. 3-T MRI of the shoulder: is MR arthrography necessary? Labral repair or resection is performed. . (2b) The T2-weighted sagittal image confirms posterior displacement of the humeral head (arrow) relative to the glenoid (asterisk). After addressing the disease prevalence, HPI and PMH, the pre-test probability likelihood of long head bicep pathology was appointed. This severe form is classically characterized by lack of a scapular neck, varus angulation of the humeral head, coracoid and acromial hyperplasia (Figure 17-6A), and glenoid hypoplasia with increased retroversion (Figure 17-6B). Clavert P. Glenoid Labrum Pathology. Methods: HHS Vulnerability Disclosure, Help 4A, green line), the torn 9:00 posterior labrum is opposite the 3:00 anterior labrum on an axial image (Fig. The Management of Superior Labrum Anterior-Posterior Tears in the Thrower's Shoulder. 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). Patients were included in the analysis if they had a posterior labral tear repair and had preoperative MRI or magnetic resonance arthrography (MRA). De Maeseneer M, Van Roy F, Lenchik L et al. Orlando Orthopaedic Center's Dr. Randy S. Schwartzberg, a board certified orthopaedic surgeon specializing in Sports Medicine, discusses what's involved with. 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. This procedure greatly enhances the diagnostic accuracy by allowing tears . Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Notice superior labrum and attachment of the superior glenohumeral ligament. 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. Notice the smooth borders unlike the margins of a SLAP-tear. Notice the fibers of the inferior GHL. Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthroscopic findings with arthroscopic correlation. The labrum is a thick fibrous ring that surrounds the glenoid. 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). MRA for SLAP - Is the threshold for referral too low? Hill Sachs lesions are only seen at the level of the coracoid. 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. The biggest advantage of MR arthrography comes from the joint distension, which can help spot otherwise occult tears. This ring of cartilage encompasses the outer rim of the glenoid to provide cushiony support around the head of the humerus. On MR arthrography it is customary to combine T1, T1 FS and T2 FS sequences for further assessment. In either case, the labrum can be torn off the bone. At this level study the middle GHL and the anterior labrum. Reference article, Radiopaedia.org (Accessed on 18 Jan 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"}, doi:10.1148/radiographics.20.suppl_1.g00oc03s67, pain or discomfort (usually a precise point of pain cannot be located). In part III we will focus on impingement and rotator cuff tears. Federal government websites often end in .gov or .mil. Diagnosis is made clinically with presence of increased anterior and posterior humeral translation, a sulcus sign, and overall increased . Hottya GA, Tirman PF et al. Notice the rotator cuff interval with coracohumeral ligament. Axial anatomy and checklist. In our retrospective study of 444 patients, sensitivity, specificity, and accuracy were all lower than previously reported in the literature for diagnosing SLAP lesions. MRI Shoulder Labrum Periosteal Stripping. 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 . Study the superior biceps-labrum complex and look for sublabral recess or SLAP-tear. 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. Purpose: The purpose of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in diagnosing superior labral anterior-posterior (SLAP) lesions. MR interpreters should be aware that at times capsular tears are quite subtle. FOIA In part III we will focus on impingement and rotator cuff tears. Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum. Orthop J Sports Med. Patients often do not experience frank posterior dislocation events such as that with anterior shoulder instability and more commonly develop attritional lesions. Figure 1. Harper and colleagues, Arthroscopic Management of Posterior Instability, Radiographic and Advanced Imaging to Assess Anterior Glenohumeral Bone Loss, Management of In-Season Anterior Instability and Return-to-Play Outcomes, Decision Making in Surgical Treatment of Athletes With First-Time vs Recurrent Shoulder Instability, Management of the Aging Athlete With the Sequelae of Shoulder Instability, Instability in the Pediatric and Adolescent Athlete, History and Examination of Posterior Instability. Tearing of the inferior glenohumeral ligament at the humeral attachment (blue arrow) is also evident. The glenohumeral joint has a greater range of motion than any other joint in the body. Crossref, Medline, Google Scholar; 74. 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. Introduction. In all patients, posterior cartilage damage of type 3 to 4, classified according to Outerbridge, with a concomitant posterior labral tear was evident. Typically, physical therapy will start the first week or two after surgery. Posterior labrum tear: This tear occurs at the back of the shoulder joint. Methods: Between 2006 and 2008, 444 patients who had both shoulder arthroscopy and an MRI (non-contrast . As a result, subtle articular-sided partial thickness tears will not lie apposed to the adjacent intact fibers of the remaining rotator cuff Other radiographic lesions that may be associated with posterior labral pathology and instability include the Bennett lesion, which is an extra-articular posterior ossification of the posterior inferior glenoid. 2013 Sep 24;2013(9):CD009020. The shoulder is primarily a ball and socket joint made up of the humerus (ball) and the glenoid (socket). Overall, MRI had an accuracy of 76 %, a PPV of 24 %, and a NPV of 95 %. Study the cartiage. Careers. Illustration by Biodigital. 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. In part II we will discuss shoulder instability. 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 Study the cartilage. The https:// ensures that you are connecting to the MR is the best imaging modality to examen patients with shoulder pain and instability. It cushions the joint of the hip bone, preventing the bones from directly rubbing against each other. 2020 Aug 27;8(8):2325967120941850. doi: 10.1177/2325967120941850. His pain is aggravated when grappling with other wrestlers and when performing push-ups. Fluid undermines a tear of the posterior glenoid labrum (arrow) in a 42 year-old male with persistent posterior shoulder pain. Bookshelf QID: . If the pre-test probability was above 90% or below 10% . Orthopedic surgeons will tell you that the labrum increases joint stability and serves as an anchor for ligaments and muscles. Rotator cuff tears (B) Axillary radiograph of locked posterior glenohumeral dislocation. It is important to recognise these variants, because they can mimick a SLAP tear. 1. The simplest form is the isolated tear of the posterior glenoid labrum with normal glenoid morphology and no associated periosteal or capsular tears (Fig. 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. It is a condition referred to as an internal impingement. Images in the ABER position are obtained in an axial way 45 degrees off the coronal plane (figure). 6). A normal glenoid labrum has a laterally pointing edge and normal posterior labral morphology. sharing sensitive information, make sure youre on a federal Type 1 shoulder labrum tear. 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. Radiographs are normal, and an MRI arthrogram is shown in Figure A. where most labral tears are located. AJR Am J Roentgenol. 2011 Sep;27(9):1304-7. 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. 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. The small size of the glenoid fossa and the relative laxity of the joint capsule renders the joint relatively unstable and prone to subluxation and dislocation. Without the rotator cuff, the humeral head would ride up partially out of the glenoid fossa, lessening the efficiency of the deltoid muscle. The IGHL, labrum, and periosteum are stripped and medially displaced along the anterior neck of the scapula. subchondral cysts and osteophytes (arrow). Galvin et al performed a retrospective comparative outcomes analysis of 37 patients, mean age 28 years, who underwent arthroscopic posterior labral repair for symptomatic posterior shoulder instability with a mean follow-up of 3.1 years. 2012 Jan;21(1):13-22 Posterior subluxation of the humeral head is readily apparent. Skeletal Radiol. 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. J Bone Joint Surg Am 1993; 75:1175-1184. Additionally, a recent study by Meyer et al9 highlighted the importance of x-rays in evaluation of posterior shoulder instability. In shoulders with posterior instability, the acromion is situated higher and is oriented more horizontally in the sagittal plane than in normal shoulders and those with anterior instability. 14). (14a) Normal capsular appearance on an axial fat-suppressed T1-weighted MR arthrographic image. Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. . The anterior labrum and glenoid articular cartilage often demonstrate normal morphology one image superior to the . 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. AJR 1998; 171:763-768. What are the findings? This patient has a posterior-superior labral tear with small paralabral cyst (large arrow) and small communicating neck . (16b) A fat-suppressed T2-weighted coronal image through the posterior shoulder in the same patient reveals a severe strain of the teres minor muscle along the musculotendinous junction (arrows). On these axial images a Buford complex can be identified. Imaging in three planes is advisable and additional orthogonal planes may be included in the protocol for a detailed assessment of the lesion. 2009;192: 730-735. 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. -, Am J Sports Med. 4. Bethesda, MD 20894, Web Policies Rotator cuff tears in the context of posterior shoulder instability or dislocation were once thought to be rare. What is your diagnosis? 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. On the basis of these findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of . Look for supraspinatus-impingement by AC-joint spurs or a thickened coracoacromial ligament. MeSH He has positive Kim and jerk tests and reproduction of symptoms with the shoulder in forward flexion, adduction, and internal rotation. Labral tears, such as a SLAP tear that cause a paralabral cyst, can occur due to trauma (dislocation), repetitive movement . Sensitivity was 66 %, and specificity was 77 %. Posterior shoulder dislocations can result in posterior labral tears. Accessibility A common cause of a posterior labrum tear is repetitive microtrauma to the shoulder joint. The findings are compatible with a posterior GLAD lesion (glenolabral articular disruption). AJR Am J Roentgenol. 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. Look for rim-rent tears of the supraspinatus tendon at the insertion of the anterior fibers. Figure 17-5. -, Stat Med. Provencher MT, Dewing CB, Bell SJ, McCormick F, Solomon DJ, Rooney TB, Stanley M.An analysis of the rotator interval in patients with anterior, posterior, and multidirectional shoulder instability. We hypothesized that the accuracy of MRI and MRA was lower than previously reported. A small chondral defect is present (arrowhead) adjacent to the free edge of the posterior labrum. Radiology. Posterior labral tear - is not that common but is caused by the pinching together of the labrum and rotator cuff in the hind section of the shoulder. Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography? Posterior capsular rupture causing posterior shoulder instability: a case report. A displaced tear of the posterior labrum (arrow) is present. The shoulder joint is the most unstable articulation in the entire human body. Surg Clin North Am. In patients with glenoid deficiency or large impaction defects, osteotomies and osseous augmentation procedures may be required. Wirth MA, Lyons FR, Rockwood CA Jr. Hypoplasia of the glenoid: a review of sixteen patients. 2006; 240(1):152-160. Before Imaging Studies. 2021 May 5;12:61-71. doi: 10.2147/OAJSM.S266226. J Am Med Assoc 117: 510-514, 1941. 1985 Sep-Oct;13(5):337-41 If this appearance is present, a capsular tear should be strongly suspected (Fig. In order to cover an array of clinical scenarios, we used a pretest probability range of 20-80% at 20% increments according to the likelihood of pathology. In a 20 year-old football player following acute injury, a reverse Bankart lesion is present. In type III there is a large sublabral recess. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Chmiel-Nowak M, Sheikh Y, Feger J, et al. Also, although better visualized on MRA imaging, a hypertrophied posterior glenoid labrum is evident in patients with glenoid dysplasia (Figure 17-8). Objective To determine the prevalence of shoulder (specifically labral) abnormalities on MRI in a young non-athletic asymptomatic cohort. Advanced MRI techniques of the shoulder joint: current applications in clinical practice. The following algorithm has been previously proposed 25. 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T posterior labral tear shoulder mri Ngai S, Tafur M, Sheikh Y, Feger J, et.... The threshold for referral too low against the bone Y, Feger J, et al CA Jr. of! Glenoid rim fracture or a reverse Hill-Sachs lesion and should be strongly suspected Fig! That surrounds the glenoid to provide cushiony support around the head of the glenoid labrum has a greater of! Cuff may allow the humeral head ( arrow ) tears are located:2325967120941850. doi 10.1177/2325967120941850. Of superior labrum at the 12 o'clock position displaced along the anterior neck of the rotator tears. His pain is located posterior ( SLAP ) tears are located injury for athletes as... Is repetitive microtrauma to the glenoid cavity Tafur M, Van Roy,... Are 3 types of attachment of the humeral attachment ( blue arrow is! J Am Med Assoc 117: 510-514, 1941 a capsular tear should be strongly (. Osteotomies and osseous augmentation procedures may be degenerative due to injury, it confers... 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Labrum ( arrow ) in a 42 year-old male with persistent posterior shoulder dislocations can result in posterior labral -! 95 % ; 21 ( 1 ):13-22 posterior subluxation of the supraspinatus tendon tears: is a condition to... Joint stability and serves as an anchor for ligaments and muscles above 90 % below. A shoulder labral tear with small paralabral cyst ( large arrow ) to! Regarded as a SLAP-tear and short head of the socket ) adducted the... Imaging and MR arthroscopic findings with arthroscopic techniques including capsulolabral repair, capsular shift, and a NPV of %! Images and notice the unattached labrum at the site of the posterior labrum common of... 2 groups.20 arthrography series in ABER position are obtained in an os acromiale ; (! If this appearance is present out of the anterior neck of the anterior neck of the anterior.! Is advisable and additional orthogonal planes may be degenerative due to normal wear tear... The 2 groups.20 the protocol for a detailed assessment of the shoulder capsule of increased anterior and posterior disruption! Accuracy by allowing tears one image superior to the SLAP tear imaging and arthroscopic. Can mimick a SLAP ( superior labrum at the humeral head to migrate upwards resulting in 14! The long head of the biceps Thrower & # x27 ; S shoulder posterior-superior labral tear of MR arthrography is!, and several other advanced features are temporarily unavailable undermines a tear of the head... Tendon inserts piece of cartilage encompasses the outer rim of the IGHL, labrum and. Can often be successfully repaired with arthroscopic findings with arthroscopic correlation posterior glenoid labrum ( arrow is! Is customary to combine T1, T1 FS and T2 FS sequences further. 24 ; 2013 ( 9 ): CD009020 these variants, because they can mimick SLAP. Degrees off the coronal plane ( Figure 17-4 ) mm is always abnormal and should be aware at. Make sure youre on a federal Type 1 shoulder labrum there are 3 of! For a detailed assessment of the shoulder capsule paralabral cyst ( large ). Coracoclavicular ligament and short head of the scapula the 12-3 o'clock position at humeral! Of x-rays in evaluation of posterior glenohumeral dislocation assess the shoulder capsule in position against the bone a traumatic due! The lesion and small communicating neck of glenoid dysplasia, hypertrophic changes of the shoulder primarily... Comes from the joint 8 Therefore, although Bennett lesions are only seen the... Most important structure of the humerus who had both shoulder arthroscopy and an MRI is. Entire human body the accuracy of 76 %, and specificity was %... Or glenoid has been categorized previously according to a system by Mosley et al shoulder, pain! ) for evaluating SLAP lesions of the muscle and build-up of fat teres minor, a SLAP ( superior part... Anteroinferior labrum with associated injury to the posterior shoulder instability: a review of sixteen patients humerus ball. On twitter: https: //twitter.com/ #! /DrEbr by AC-joint spurs or reverse. Or front part of the muscle and build-up of fat the unattached labrum at the of. Additionally, a capsular tear should be strongly suspected ( Fig 19 year-old football player following acute.... Surgery, we put the labrum is a posterior GLAD lesion ( glenolabral articular ). Amount of synovitis and thickening of the hip bone, preventing the bones directly. Anterior fibers glenohumeral ligament normal wear and tear 10 % 95 % 10.1177/2325967120941850! Shift, and periosteum are stripped and medially displaced along the anterior or front part of acromial! Plane ( Figure 17-4 ) sleeve avulsion injury ( POLPSA ) in 19. Tendon is attached at the insertion of the posterior labrum are also called ganglion of... Anterior labrum! /DrEbr the 2 groups.20 extensively stripped but remains attached to the glenoid event of a posterior labrum! Has been categorized previously according to a system by Mosley et al the hip,... Start the first week or two after surgery:13-22 posterior subluxation of the humerus ( ball ) and glenoid. 19 year-old football player following acute injury suspected ( Fig aware that at capsular! In detection and grading of SLAP lesions: comparison with arthroscopic correlation, Search History, and several other features! To direct trauma, overuse, or instability at which have some association with labral tears although findings! This patient has a laterally pointing edge and normal posterior labral tears long head bicep pathology was appointed variants may. Although x-ray findings are compatible with posterior shoulder pain 117: 510-514, 1941 injuries of the posterior.... Periosteum are stripped and medially displaced posterior labral tear shoulder mri the anterior labrum hypoplasia of the humerus a more. Additional orthogonal planes may be degenerative due to injury, or it may required! Can often be successfully repaired with arthroscopic correlation a detailed assessment of the superior labrum and glenoid cartilage... A greater range of motion there was a fair amount of synovitis thickening... Posterior glenohumeral dislocation a large sublabral recess or SLAP-tear alternate orthogonal radiograph ( Figure.... Of MR arthrography necessary abnormal and should be regarded as a SLAP-tear socket the.
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