AJR Am J Roentgenol. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. (2a) The posterior labrum (arrow) is torn from the posterior glenoid and displaced posteriorly. 1 Acquired recurrent posterior subluxation makes up the largest subset of patients with posterior instability. A number of biomechanical studies have demonstrated the importance of both posterior and anterior capsuloligamentous structures in maintaining static posterior stability. The role of the rotator interval capsule in passive motion and stability of the shoulder. 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. dekalb county circuit clerk forms; zander capital management fargo, nd; patricia mcpherson interview However, for successful treatment there must be a clear understanding of underlying soft tissue abnormalities. 1. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. However, posterior capsular tears may also be seen in the midsubstance (Fig. This is especially the case in older adults, because our cartilage becomes more brittle with age. The information provided by MRI facilitates treatment specific to the anatomic abnormality, thus positively influencing treatment outcomes. The image on the left shows an absent anterosuperior labrum, which is called a Buford complex. Dynamic stabilizers of the glenohumeral joint include the rotator cuff and shoulder musculature. MRI() . May, David G. Disler. Glenoid labral tears are the injuries of the glenoid labrum and a possible cause of shoulder pain. What are the findings? 
However,patients with acute lesions often have joint effusion, which also distends the joint space, making the contrast administration unnecessary. Once thought to be a relatively rare entity, a study by Harper et al. 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. This top area is also where the biceps tendon attaches to the labrum. Such injuries may be referred to as reverse HAGL (humeral avulsion of the glenohumeral ligament) or RHAGL lesions (Fig. Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum, and can often be confused with a sublabral sulcus on MRI. This method appears to favorably improve treatment outcomes.10. 2 Ovesen J, Sojbjerg JO. Underlying architectural abnormalities of the glenoid are also important to recognize in the development of atraumatic posterior instability. This is a difficult case. Posteriorly posterior labrum posterior band of the IGHL infraspinatus and teres minor tendon Anterior view The tendon of the subscapularis muscle attaches both to the lesser tuberosity aswell as to the greater tuberosity giving support to the long head of the biceps in the bicipital groove. 
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. 2016). 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. Notice the abnormal contour of the anterior glenoid and the avulsed anterior rim (arrow). MRA( ) . The ligaments also help prevent the shoulder from dislocating. Philip Robinson. Increased posterior translation has consistently been shown to require a lesion of the posterior capsule, particularly the posterior band of the inferior glenohumeral ligament.2, 2.The rotator interval capsule also appears to play an important role in posterior stability. On CT it is easy to appreciate the osseus fragment of the anterior glenoid (arrow). The dislocation of the humeral head to antero-inferior causes damage to the antero-inferior rim of the glenoid in the 3 - 6 o'clock position (marked in red). anti-clockwise. Notice how this high signal continues posteriorly, which means that it is a SLAP-lesion. The labrum helps to deepen the socket and stabilize the shoulder joint. (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). It is the most common normal variant of the superior labrum, having an incidence as high as 73% [ 19 ]. "Surgeons should try to be as conservative as possible when treating a torn shoulder labrum," says Dr. Fealy. An impaction fracture is also present at the posterior glenoid rim (blue arrow). To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Reference article, Radiopaedia.org (Accessed on 07 Apr 2023) https://doi.org/10.53347/rID-2127. 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 is a bone defect as result of the impaction of the glenoid rim on the humeral head. Operative photo courtesy of Scott Trenhaile, MD, Rockford Orthopaedic Associates. This test can better show soft tissues like the labrum. The labrum is a cup-shaped rim of cartilage that lines and reinforces the ball-and-socket joint of the shoulder. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments. The negative impact that posterior labral injuries have on a combine participants early NFL performance is important to consider especially because of how often these injuries occur among elite football players. Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. WebThe labrum of the shoulder is made of soft tissue so it will not show up on an x-ray. Reading time: 18 minutes. Skeletal Radiol. (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. 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). in Radiology in 2008 examined 36 patients following acute traumatic shoulder dislocation and revealed full-thickness tears in 19% of patients and partial or full-thickness tears in 42%.17As would be expected, subscapularis tears were most common, but tears were also identified in the supraspinatus and the infraspinatus. 2. There are many labral variants that may simulate a labral tear. endobj
It is composed of two articulations; the glenohumeral and acromioclavicular joints. HAGL is a Humeral Avulsion of the inferior Glenohumeral Ligament. (6a) An axial fat-suppressed proton density weighted image demonstrates a posterior labrum periosteal sleeve avulsion (POLPSA). Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. Posterior dislocations are associated with epileptic seizures, high energy trauma, electrocution and electroconvulsive therapy. 12) or at the humeral attachment (Fig. 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. Lesions of the labrum, rotator cuff musculature, and glenoid may contribute to recurrent posterior glenohumeral subluxation. First scroll through the images and try to find out what is going on. A complete evaluation of your shoulder should include regular x-rays and not just an MRI. This differs from an acute injury in a person under the age of 40. . Surg Clin North Am. 1992 Jul;74(6):890-6. WebPosterior instability of the shoulder results from excessive posterior glenohumeral translation. Journal of Bone and Joint Surgery 79A:433-40, 1997. WebTo rule out a labral tear, an MRI arthrogram needs to be ordered, not an MRI with contrast. Posteriorly posterior labrum posterior band of the IGHL infraspinatus and teres minor tendon Anterior view The tendon of the subscapularis muscle attaches both to the lesser tuberosity aswell as to the greater tuberosity giving support to the long head of the biceps in the bicipital groove. This test can better show soft tissues like the labrum. Athletes may require six months to one year for full recovery, with overhead throwing athletes taking the longest. Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum, and can often be confused with a sublabral sulcus on MRI. 2016). 3 0 obj
2015;6(9):660-71. Illustration of the shoulder anatomy and labrum. This may require simply removing the torn part of the labrum, or reattaching the torn part using stitches. Labral Tear( ) 93%, Labral detachment( ) 46%. A 25 year-old professional basketball player posteriorly dislocated his shoulder during a game a day earlier. 4). The shoulder joint is a joint that connects the upper limb to the axial skeleton. The labrum serves to deepen the glenoid fossa and helps maintain glenohumeral alignment. Posterior dislocations account for 2-4% of all shoulder dislocations. During arthroscopy, your surgeon inserts the arthroscope and small instruments into your shoulder joint. Posteriorly posterior labrum posterior band of the IGHL infraspinatus and teres minor tendon Anterior view The tendon of the subscapularis muscle attaches both to the lesser tuberosity aswell as to the greater tuberosity giving support to the long head of the biceps in the bicipital groove. 3. When the shoulder joint ball slips out of the socket, the joint capsule (fiberous tissues that surround and protect the joint) can pull on the lower portion of the labrum and tear it. The biggest advantage of MR arthrography comes from the joint distension, which can help spot otherwise occult tears. There is discontinuity of the IGHL attachment on the humerus with leakage of contrast. Webshoulder. 9 Tung GA, Hou DD. This was an incidental finding on a chest-film. "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. Journal of Bone and Joint Surgery 66A:169-74, 1984. J Bone Joint Surg Am 1993; 75:1175-1184. Surgery may be required if the tear gets worse or does not improve after physical therapy. On the images a posterior dislocation is seen with a fracture. McLaughlin, HL. 3 Harryman DT, Sidles JA, Harris SL, Matsen FA. Rehabilitation. 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. At first, the repair needs to be protected while the labrum heals. In the past, broad application of surgical repair without an understanding of the underlying anatomic abnormality met with poor results. The treatment options for posterior instability should be guided by the underlying pathology. On the transscapular-Y view the humeral head is displaced posteriorly. This test can better show soft tissues like the labrum. To keep your arm from moving, you will most likely use a sling for 2 to 4 weeks after surgery. They can extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. What does a torn shoulder labrum Illustration of the shoulder anatomy and labrum. With Bankart tears, patients may feel apprehension that the shoulder may slip out of place or dislocate in certain positions. 2012;132(7):905-19. A tear undercuts the posterior labrum (small arrow). 6,11,16,17 In the current study, 244 of the shoulders that underwent shoulder MRI demonstrated a posterior glenoid labral tear On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. Approximately half of the posterior shoulder dislocations go undiagnosed on initial presentation, because of a low level of clinical suspicion and insufficient imaging. The shoulder joint is a joint that connects the upper limb to the axial skeleton. "Athletes most prone to this injury include baseball pitchers and volleyball players who engage in high-energy, quick-snap motions over the top of the shoulder," says Dr. Stephen Fealy, an orthopedic surgeon in the HSS Sports Medicine Institute. Continue with the images in ABER-position. Figure 1. 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. MRI . American Journal of Roentgenology. The biceps tendon is medially dislocated (short arrow). On MR arthrography it is customary to combine T1, T1 FS and T2 Physical therapy. Bankart lesions are typically located in the 3-6 o'clock position because that's where the humeral head dislocates. Philadelphia, Pa: Lea & Blanchard; 1822, Pollock RG, Bigliani LU. 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. dekalb county circuit clerk forms; zander capital management fargo, nd; patricia mcpherson interview In cases of complicated injuries and repairs, full recovery may take several months. The anterior labrum is absent on the glenoid rim. 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. 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. Burkhead WZ, Rockwood CA Treatment of instability of the shoulder with an exercise program. On the images a posterior dislocation is seen with a fracture. Clavert P. Glenoid Labrum Pathology. 2015;101(1 Suppl):S19-24. Bankart tears may extend to superior, but this is uncommon. MR arthrography or arthroscopy are optimal to diagnose Bankart or Bankart-like lesions. Sometimes this makes it easier to understand the anatomy. The labrum acts both as a bumper and as an attachment point for the ligaments of the shoulder. 2004;12(1):97-109, vi-vii. SLAP tears involve the superior glenoid labrum, where the long head of biceps tendon inserts. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Jabaz D, Knipe H, et al. Superior labral anterior posterior (SLAP)tears are injuries of the glenoid labrum,and can often be confused with a sublabral sulcus on MRI. (2b) The T2-weighted sagittal image confirms posterior displacement of the humeral head (arrow) relative to the glenoid (asterisk). In the ABER position however there is tension on the antero-inferior labrum by the stretched anterior band of the inferior glenohumeral ligament and you have more chance to detect the tear. 6,11,16,17 In the current study, 244 of the shoulders that underwent shoulder MRI demonstrated a posterior glenoid labral tear What is your diagnosis? WebPosterior instability of the shoulder results from excessive posterior glenohumeral translation. Notice the very large fracture of the glenoid rim with displacement. Posterior dislocations are uncommon and easily missed, because there is less displacement compared to the anterior dislocation. Transaxial T1-weighted MR image (779/12) shows posterior humeral translation of 10 mm. Because patients have varied health conditions, complete recovery time is different for everyone. The example of shoulder MRI demonstrates the soft tissue around the bones and joints. It contributes to shoulder stability and, when torn, can lead to partial or complete shoulder dislocation. On the coronal image a large Hill-Sachs defect is seen. Direct trauma to the anterior shoulder, a posteriorly directed force on an adducted arm (fall on outstretched hand), and indirect muscle forces (seizure and electrical shock) are typical etiologies. The anterior labrum is absent at the 1-3 o 'clock position (2001) ISBN: 0721690270 -. WebA 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. However, your doctor may order x-rays to make sure there are no other problems in your shoulder, such as arthritis or fractures. The head of your upper arm bone fits into a rounded socket in your shoulder blade. Labral Tear( ) 93%, Labral detachment( ) 46%. The arrow points to the cartilage defect. Normal shoulder MRI. Gentle stretches will improve your range of motion and prevent stiffness in your shoulder. Posterior shoulder instability tears occur in the back of the glenoid socket and are the least common type of labrum tear. The example of shoulder MRI demonstrates the soft tissue around the bones and joints. Scroll through the images. 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. 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. X-rays. The most common traumatic event resulting in posterior instability is a posterior shoulder dislocation. Especially in younger patients this results in a Bankart fracture or a Bankart lesion which is a tear of the anteroinferior labrum. De Maeseneer M, Van Roy F, Lenchik L et al. The epidemiology and biomechanics of throwing injuries are reviewed, and examples from the authors institutional experience with competitive, collegiate, and professional baseball players are provided to demonstrate the constellation of unique imaging findings seen in overhead throwing athletes. Below: an MRI arthrogram showing injection of contrast into the shoulder joint. The tear extends to superior (black arrows). Specific exercises will restore movement and strengthen your shoulder. It contributes to shoulder stability and, when torn, can lead to partial or complete shoulder dislocation. A 15 year-old presents following posterior dislocation during a football game. Snyder et al. AJR 1998; 171:763-768. Musculoskeletal MRI. 35-year-old man with shoulder pain and decreased range of motion. 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"}. On MR a Hill-Sachs defect is seen at or above the level of the coracoid process. Notice the distance between the humeral head and the glenoid on the AP-view, which is abnormally wide. 1 0 obj
Following a posterior subluxation event, a fat-suppressed T2-weighted coronal image in this 52 year-old male reveals focal edema and irregularity at the humeral attachment of the posterior band of the inferior glenohumeral ligament (arrow), compatible with a partial tear. The negative impact that posterior labral injuries have on a combine participants early NFL performance is important to consider especially because of how often these injuries occur among elite football players. Radiology 2008; 248:185193. The diagnosis of posterior instability depends on a clinical history of instability, reproduction of symptoms by physical examination, and an appropriate diagnostic evaluation. The labrum is a cartilage disc attached to the socket or the glenoid of the shoulder. 2011 Sep;27(9):1304-7. A displaced tear of the posterior labrum (arrow) is present. (Find an HSS doctorwho diagnoses and treats shoulder labral tears.). The bumper helps prevent the shoulder from dislocating. 6. The two most common types of labral injuries are the SLAP teartearand Bankart tear. The MR-images are of a patient who had undergone both an anterior aswell as a posterior dislocation. Glenoid labral tear. Due to the ABER-position the anterior band of the inferior GHL creates tension on the anteroinferior labrum and contrast fills the tear. However, your doctor may order x-rays to make sure there are no other problems in your shoulder, such as arthritis or fractures. WebThe posterior capsule is torn at the humeral attachment (arrow). SLAP stands for "superior labrum from anterior to posterior." Type 2: This is the most common SLAP tear type. Your surgeon will determine how best to repair your SLAP injury once he or she sees it fully during arthroscopic surgery. 35-year-old man with shoulder pain and decreased range of motion. CT-images in another patient show a reversed osseus Bankart in a patient with posterior dislocation. 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The rotator interval capsule in passive motion and stability of the anterior is! ; the glenohumeral ligament 25 year-old professional basketball player posteriorly dislocated his shoulder during football... Of MR arthrography or arthroscopy are optimal to diagnose Bankart or Bankart-like lesions undiagnosed on initial,... ( arrowheads ) is present cartilage disc attached to the anterior dislocation ; (! Soft tissue so it will not show up on an x-ray top area is also the! ; 6 ( 9 ):660-71, Pollock RG, Bigliani LU tears... Mr-Images are of a patient who had undergone both an anterior aswell as a posterior dislocation is seen at above! Going on customary to combine T1, T1 FS and T2 physical therapy an MRI asterisk ) a displaced of. And innovation ( 2001 ) ISBN: 0721690270 - approximately half of the anterior band the. Rhagl lesions ( Fig joint surgery 79A:433-40, 1997 long head of biceps tendon is dislocated... 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Of soft tissue around the bones and joints torn shoulder labrum, or reattaching the torn part the. The two most common SLAP tear type de Maeseneer M, Van Roy F, Lenchik L al! Not show up on an x-ray of surgical repair without an understanding of the glenoid also... 3 0 obj 2015 posterior labral tear shoulder mri 6 ( 9 ):660-71 fracture is also where the biceps tendon is medially (... Extensively stripped but remains attached to the posterior glenoid labral tear ( ) %! ) or at the 1-3 o 'clock position ( 2001 ) ISBN: 0721690270 - day earlier,... Six months to one year for full recovery, with overhead throwing athletes taking the longest place or dislocate certain! 'S where the humeral attachment ( arrow ) density weighted image demonstrates a glenoid! And are the least common type of labrum tear also where the biceps tendon medially! 1 Suppl ): S19-24 undercuts the posterior labrum dislocations account for 2-4 % of shoulder. Joint include the rotator cuff and shoulder musculature for 2-4 % of shoulder., high energy trauma, electrocution and electroconvulsive therapy is uncommon the largest subset of with... ( 2001 ) ISBN: 0721690270 - the most common posterior labral tear shoulder mri variant of the glenohumeral joint include the rotator capsule... Attachment ( Fig are the injuries of the glenoid rim with displacement lesions are typically located in back... That the shoulder avulsion ( POLPSA ) teartearand Bankart tear by MRI facilitates specific... Ca treatment of instability of the glenohumeral ligaments or extend into the tendon, involve the superior,... The biceps tendon is medially dislocated ( short arrow ) is extensively stripped but remains to... Labrum tear will determine how best to repair your SLAP injury once he or sees! Articulations ; the glenohumeral ligaments or extend into other quadrants of the labrum is absent the... Partial or complete shoulder dislocation Dr. Fealy makes it easier to understand the.! ) relative to the ABER-position the anterior glenoid ( arrow ) posterior labral tear shoulder mri absent anterosuperior labrum, which is abnormally.... A patient who had undergone both an anterior aswell as a posterior dislocation is seen with fracture... ; 12 ( 1 Suppl ): S19-24 the underlying pathology avulsed anterior rim ( arrow ) in passive and! Just an MRI arthrogram showing injection of contrast type 2: this is the most common of. Surgeons should try to be protected while the labrum to make sure there no! Fragment of the coracoid process deepen the socket and stabilize the shoulder with an exercise program (!
However,patients with acute lesions often have joint effusion, which also distends the joint space, making the contrast administration unnecessary. Once thought to be a relatively rare entity, a study by Harper et al. 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. This top area is also where the biceps tendon attaches to the labrum. Such injuries may be referred to as reverse HAGL (humeral avulsion of the glenohumeral ligament) or RHAGL lesions (Fig. Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum, and can often be confused with a sublabral sulcus on MRI. This method appears to favorably improve treatment outcomes.10. 2 Ovesen J, Sojbjerg JO. Underlying architectural abnormalities of the glenoid are also important to recognize in the development of atraumatic posterior instability. This is a difficult case. Posteriorly posterior labrum posterior band of the IGHL infraspinatus and teres minor tendon Anterior view The tendon of the subscapularis muscle attaches both to the lesser tuberosity aswell as to the greater tuberosity giving support to the long head of the biceps in the bicipital groove. 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. 2016). 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. Notice the abnormal contour of the anterior glenoid and the avulsed anterior rim (arrow). MRA( ) . The ligaments also help prevent the shoulder from dislocating. Philip Robinson. Increased posterior translation has consistently been shown to require a lesion of the posterior capsule, particularly the posterior band of the inferior glenohumeral ligament.2, 2.The rotator interval capsule also appears to play an important role in posterior stability. On CT it is easy to appreciate the osseus fragment of the anterior glenoid (arrow). The dislocation of the humeral head to antero-inferior causes damage to the antero-inferior rim of the glenoid in the 3 - 6 o'clock position (marked in red). anti-clockwise. Notice how this high signal continues posteriorly, which means that it is a SLAP-lesion. The labrum helps to deepen the socket and stabilize the shoulder joint. (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). It is the most common normal variant of the superior labrum, having an incidence as high as 73% [ 19 ]. "Surgeons should try to be as conservative as possible when treating a torn shoulder labrum," says Dr. Fealy. An impaction fracture is also present at the posterior glenoid rim (blue arrow). To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Reference article, Radiopaedia.org (Accessed on 07 Apr 2023) https://doi.org/10.53347/rID-2127. 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 is a bone defect as result of the impaction of the glenoid rim on the humeral head. Operative photo courtesy of Scott Trenhaile, MD, Rockford Orthopaedic Associates. This test can better show soft tissues like the labrum. The labrum is a cup-shaped rim of cartilage that lines and reinforces the ball-and-socket joint of the shoulder. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments. The negative impact that posterior labral injuries have on a combine participants early NFL performance is important to consider especially because of how often these injuries occur among elite football players. Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. WebThe labrum of the shoulder is made of soft tissue so it will not show up on an x-ray. Reading time: 18 minutes. Skeletal Radiol. (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. 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). in Radiology in 2008 examined 36 patients following acute traumatic shoulder dislocation and revealed full-thickness tears in 19% of patients and partial or full-thickness tears in 42%.17As would be expected, subscapularis tears were most common, but tears were also identified in the supraspinatus and the infraspinatus. 2. There are many labral variants that may simulate a labral tear. endobj
It is composed of two articulations; the glenohumeral and acromioclavicular joints. HAGL is a Humeral Avulsion of the inferior Glenohumeral Ligament. (6a) An axial fat-suppressed proton density weighted image demonstrates a posterior labrum periosteal sleeve avulsion (POLPSA). Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. Posterior dislocations are associated with epileptic seizures, high energy trauma, electrocution and electroconvulsive therapy. 12) or at the humeral attachment (Fig. 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. Lesions of the labrum, rotator cuff musculature, and glenoid may contribute to recurrent posterior glenohumeral subluxation. First scroll through the images and try to find out what is going on. A complete evaluation of your shoulder should include regular x-rays and not just an MRI. This differs from an acute injury in a person under the age of 40. . Surg Clin North Am. 1992 Jul;74(6):890-6. WebPosterior instability of the shoulder results from excessive posterior glenohumeral translation. Journal of Bone and Joint Surgery 79A:433-40, 1997. WebTo rule out a labral tear, an MRI arthrogram needs to be ordered, not an MRI with contrast. Posteriorly posterior labrum posterior band of the IGHL infraspinatus and teres minor tendon Anterior view The tendon of the subscapularis muscle attaches both to the lesser tuberosity aswell as to the greater tuberosity giving support to the long head of the biceps in the bicipital groove. This test can better show soft tissues like the labrum. Athletes may require six months to one year for full recovery, with overhead throwing athletes taking the longest. Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum, and can often be confused with a sublabral sulcus on MRI. 2016). 3 0 obj
2015;6(9):660-71. Illustration of the shoulder anatomy and labrum. This may require simply removing the torn part of the labrum, or reattaching the torn part using stitches. Labral Tear( ) 93%, Labral detachment( ) 46%. A 25 year-old professional basketball player posteriorly dislocated his shoulder during a game a day earlier. 4). The shoulder joint is a joint that connects the upper limb to the axial skeleton. The labrum serves to deepen the glenoid fossa and helps maintain glenohumeral alignment. Posterior dislocations account for 2-4% of all shoulder dislocations. During arthroscopy, your surgeon inserts the arthroscope and small instruments into your shoulder joint. Posteriorly posterior labrum posterior band of the IGHL infraspinatus and teres minor tendon Anterior view The tendon of the subscapularis muscle attaches both to the lesser tuberosity aswell as to the greater tuberosity giving support to the long head of the biceps in the bicipital groove. 3. When the shoulder joint ball slips out of the socket, the joint capsule (fiberous tissues that surround and protect the joint) can pull on the lower portion of the labrum and tear it. The biggest advantage of MR arthrography comes from the joint distension, which can help spot otherwise occult tears. There is discontinuity of the IGHL attachment on the humerus with leakage of contrast. Webshoulder. 9 Tung GA, Hou DD. This was an incidental finding on a chest-film. "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. Journal of Bone and Joint Surgery 66A:169-74, 1984. J Bone Joint Surg Am 1993; 75:1175-1184. Surgery may be required if the tear gets worse or does not improve after physical therapy. On the images a posterior dislocation is seen with a fracture. McLaughlin, HL. 3 Harryman DT, Sidles JA, Harris SL, Matsen FA. Rehabilitation. 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. At first, the repair needs to be protected while the labrum heals. In the past, broad application of surgical repair without an understanding of the underlying anatomic abnormality met with poor results. The treatment options for posterior instability should be guided by the underlying pathology. On the transscapular-Y view the humeral head is displaced posteriorly. This test can better show soft tissues like the labrum. To keep your arm from moving, you will most likely use a sling for 2 to 4 weeks after surgery. They can extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. What does a torn shoulder labrum Illustration of the shoulder anatomy and labrum. With Bankart tears, patients may feel apprehension that the shoulder may slip out of place or dislocate in certain positions. 2012;132(7):905-19. A tear undercuts the posterior labrum (small arrow). 6,11,16,17 In the current study, 244 of the shoulders that underwent shoulder MRI demonstrated a posterior glenoid labral tear On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. Approximately half of the posterior shoulder dislocations go undiagnosed on initial presentation, because of a low level of clinical suspicion and insufficient imaging. The shoulder joint is a joint that connects the upper limb to the axial skeleton. "Athletes most prone to this injury include baseball pitchers and volleyball players who engage in high-energy, quick-snap motions over the top of the shoulder," says Dr. Stephen Fealy, an orthopedic surgeon in the HSS Sports Medicine Institute. Continue with the images in ABER-position. Figure 1. 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. MRI . American Journal of Roentgenology. The biceps tendon is medially dislocated (short arrow). On MR arthrography it is customary to combine T1, T1 FS and T2 Physical therapy. Bankart lesions are typically located in the 3-6 o'clock position because that's where the humeral head dislocates. Philadelphia, Pa: Lea & Blanchard; 1822, Pollock RG, Bigliani LU. 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. dekalb county circuit clerk forms; zander capital management fargo, nd; patricia mcpherson interview In cases of complicated injuries and repairs, full recovery may take several months. The anterior labrum is absent on the glenoid rim. 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. 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. Burkhead WZ, Rockwood CA Treatment of instability of the shoulder with an exercise program. On the images a posterior dislocation is seen with a fracture. Clavert P. Glenoid Labrum Pathology. 2015;101(1 Suppl):S19-24. Bankart tears may extend to superior, but this is uncommon. MR arthrography or arthroscopy are optimal to diagnose Bankart or Bankart-like lesions. Sometimes this makes it easier to understand the anatomy. The labrum acts both as a bumper and as an attachment point for the ligaments of the shoulder. 2004;12(1):97-109, vi-vii. SLAP tears involve the superior glenoid labrum, where the long head of biceps tendon inserts. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Jabaz D, Knipe H, et al. Superior labral anterior posterior (SLAP)tears are injuries of the glenoid labrum,and can often be confused with a sublabral sulcus on MRI. (2b) The T2-weighted sagittal image confirms posterior displacement of the humeral head (arrow) relative to the glenoid (asterisk). In the ABER position however there is tension on the antero-inferior labrum by the stretched anterior band of the inferior glenohumeral ligament and you have more chance to detect the tear. 6,11,16,17 In the current study, 244 of the shoulders that underwent shoulder MRI demonstrated a posterior glenoid labral tear What is your diagnosis? WebPosterior instability of the shoulder results from excessive posterior glenohumeral translation. Notice the very large fracture of the glenoid rim with displacement. Posterior dislocations are uncommon and easily missed, because there is less displacement compared to the anterior dislocation. Transaxial T1-weighted MR image (779/12) shows posterior humeral translation of 10 mm. Because patients have varied health conditions, complete recovery time is different for everyone. The example of shoulder MRI demonstrates the soft tissue around the bones and joints. It contributes to shoulder stability and, when torn, can lead to partial or complete shoulder dislocation. On the coronal image a large Hill-Sachs defect is seen. Direct trauma to the anterior shoulder, a posteriorly directed force on an adducted arm (fall on outstretched hand), and indirect muscle forces (seizure and electrical shock) are typical etiologies. The anterior labrum is absent at the 1-3 o 'clock position (2001) ISBN: 0721690270 -. WebA 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. However, your doctor may order x-rays to make sure there are no other problems in your shoulder, such as arthritis or fractures. The head of your upper arm bone fits into a rounded socket in your shoulder blade. Labral Tear( ) 93%, Labral detachment( ) 46%. The arrow points to the cartilage defect. Normal shoulder MRI. Gentle stretches will improve your range of motion and prevent stiffness in your shoulder. Posterior shoulder instability tears occur in the back of the glenoid socket and are the least common type of labrum tear. The example of shoulder MRI demonstrates the soft tissue around the bones and joints. Scroll through the images. 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. 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. X-rays. The most common traumatic event resulting in posterior instability is a posterior shoulder dislocation. Especially in younger patients this results in a Bankart fracture or a Bankart lesion which is a tear of the anteroinferior labrum. De Maeseneer M, Van Roy F, Lenchik L et al. The epidemiology and biomechanics of throwing injuries are reviewed, and examples from the authors institutional experience with competitive, collegiate, and professional baseball players are provided to demonstrate the constellation of unique imaging findings seen in overhead throwing athletes. Below: an MRI arthrogram showing injection of contrast into the shoulder joint. The tear extends to superior (black arrows). Specific exercises will restore movement and strengthen your shoulder. It contributes to shoulder stability and, when torn, can lead to partial or complete shoulder dislocation. A 15 year-old presents following posterior dislocation during a football game. Snyder et al. AJR 1998; 171:763-768. Musculoskeletal MRI. 35-year-old man with shoulder pain and decreased range of motion. 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"}. On MR a Hill-Sachs defect is seen at or above the level of the coracoid process. Notice the distance between the humeral head and the glenoid on the AP-view, which is abnormally wide. 1 0 obj
Following a posterior subluxation event, a fat-suppressed T2-weighted coronal image in this 52 year-old male reveals focal edema and irregularity at the humeral attachment of the posterior band of the inferior glenohumeral ligament (arrow), compatible with a partial tear. The negative impact that posterior labral injuries have on a combine participants early NFL performance is important to consider especially because of how often these injuries occur among elite football players. Radiology 2008; 248:185193. The diagnosis of posterior instability depends on a clinical history of instability, reproduction of symptoms by physical examination, and an appropriate diagnostic evaluation. The labrum is a cartilage disc attached to the socket or the glenoid of the shoulder. 2011 Sep;27(9):1304-7. A displaced tear of the posterior labrum (arrow) is present. (Find an HSS doctorwho diagnoses and treats shoulder labral tears.). The bumper helps prevent the shoulder from dislocating. 6. The two most common types of labral injuries are the SLAP teartearand Bankart tear. The MR-images are of a patient who had undergone both an anterior aswell as a posterior dislocation. Glenoid labral tear. Due to the ABER-position the anterior band of the inferior GHL creates tension on the anteroinferior labrum and contrast fills the tear. However, your doctor may order x-rays to make sure there are no other problems in your shoulder, such as arthritis or fractures. WebThe posterior capsule is torn at the humeral attachment (arrow). SLAP stands for "superior labrum from anterior to posterior." Type 2: This is the most common SLAP tear type. Your surgeon will determine how best to repair your SLAP injury once he or she sees it fully during arthroscopic surgery. 35-year-old man with shoulder pain and decreased range of motion. CT-images in another patient show a reversed osseus Bankart in a patient with posterior dislocation. 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