Labral tears eCollection 2020 May-Jun. 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. In two patients (Case 1 and 3) along with labral cysts with tear, showed, enlarged capsule and positive drive through sign. Uncategorized. Such injuries may be referred to as reverse HAGL (humeral avulsion of the glenohumeral ligament) or RHAGL lesions (Fig. -. MR arthrography had an accuracy of 69 %, sensitivity of 80 %, and a PPV of 29 %. A small chondral defect is present (arrowhead) adjacent to the free edge of the posterior labrum. The radiologic diagnosis and surgical evaluation were compared to determine the accuracy of diagnosing a SLAP lesion by MRI. There was a posterior labrum tear. Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthrographic findings with arthroscopic correlation. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Imaging of Posterior Shoulder Instability. It can be a traumatic tear due to injury, or it may be degenerative due to normal wear and tear. Posterior labral tearing was apparent on contiguous images (not shown). However labral tears may originate at the 3-6 o'clock position and subsequently extend superiorly. Tendonitis of the long head of the biceps. Acute traumatic posterior shoulder dislocation: MR findings. American Journal of Roentgenology. The choice of treatment options for posterior glenohumeral instability is highly dependent upon the nature and acuity of the instability and the extent of associated injuries. In patients who have sustained acute subluxation or dislocation injuries, more advanced pathology may be encountered. government site. SLAP tears can cause pain and range-of-motion problems in the shoulder labrum, the biceps tendon or both. Future larger studies are needed to confirm these findings. 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). Posterior labrum tear: This tear occurs at the back of the shoulder joint. posteriorly directed force with the arm in a flexed, internally rotated and adducted position, patients with increased glenoid retroversion (~17) were 6x more likely to experience posterior instability compared to those with less glenoid retroversion (~7), helps generate cavity-compression effect of glenohumeral joint, anchors posterior inferior glenohumeral ligament (PIGHL, vague, nonspecific posterior shoulder pain, worsens with provocative activities that apply a posteriorly directed force to the shoulder, ex: pushing heavy doors, bench press, push-ups, arm positioned with shoulder forward flexed 90 and adducted, apply posteriorly directed force to shoulder through humerus, positive if patient experiences sense of instability or pain, grasp the proximal humerus and apply a posteriorly directed force, assess distance of translation and patient response, grade 2 = over edge of glenoid but spontaneously relocates, grade 3 = over edge of glenoid, does not spontaneously relocate, arm positioned with shoulder abducted 90 and fully internally rotated, axially load humerus while adducting the arm across the body, arm positioned with shoulder abducted 90 and forward flexed 45, apply posteriorly and inferiorly directed force to shoulder through humerus, posterior shoulder dislocations may be missed on AP radiographs alone, arthroscopic and open techniques may be used, suture anchor repair and capsulorrhaphy results in fewer recurrences and revisions than non-anchored repairs, return to previous level of function in overhead throwing athletes not as reproducible as other athletes, failure risk increases if adduction and internal rotation are not avoided in the acute postoperative period, posterior branch of the axillary nerve is at risk during arthroscopic stabilization, travels within 1 mm of the inferior shoulder capsule and glenoid rim, at risk during suture passage at the posterior inferior glenoid, can lead to anterior subluxation or coracoid impingement, Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics, Traumatic Anterior Shoulder Instability (TUBS), Humeral Avulsion Glenohumeral Ligament (HAGL), Posterior Shoulder Instability & Dislocation, Multidirectional Shoulder Instability (MDI), Luxatio Erecta (Inferior Glenohumeral Joint Dislocation), Glenohumeral Internal Rotation Deficit (GIRD), Brachial Neuritis (Parsonage-Turner Syndrome), Glenohumeral Arthritis (Shoulder Arthritis), Shoulder Arthroscopy: Indications & Approach, Valgus Extension Overload (Pitcher's Elbow), Lateral Ulnar Collateral Ligament Injury (PLRI), Elbow Arthroscopy: Indications & Approach. (B) Axillary radiograph demonstrating severe glenoid dysplasia with hypoplasia of the posterior glenoid and severe retroversion. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Chmiel-Nowak M, Sheikh Y, Feger J, et al. The rotator cuff is made of the tendons of subscapularis, supraspinatus, infraspinatus and teres minor muscle. The ABER view is also very useful for both partial- and full-thickness tears of the rotator cuff. Overall, MRI had an accuracy of 76 %, a PPV of 24 %, and a NPV of 95 %. American Journal of Roentgenology. Orlando Orthopaedic Center's Dr. Randy S. Schwartzberg, a board certified orthopaedic surgeon specializing in Sports Medicine, discusses what's involved with. Imaging in three planes is advisable and additional orthogonal planes may be included in the protocol for a detailed assessment of the lesion. Adv Orthop. Normal anatomy. 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. 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. Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthroscopic findings with arthroscopic correlation. (10a) Ossification is seen along the posterior glenoid (arrows) in a professional baseball pitcher with a history of posterior instability. Patients were included in the analysis if they had a posterior labral tear repair and had preoperative MRI or magnetic resonance arthrography (MRA). A sublabral foramen or sublabral hole is an unattached anterosuperior labrum at the 1-3 o'clock position. Study the inferior labral-ligamentary complex. 2000 Jan;214(1):267-71 In all patients, posterior cartilage damage of type 3 to 4, classified according to Outerbridge, with a concomitant posterior labral tear was evident. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population. (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). postulated that dislocations result in a 360 degree injury, with trauma to the anterior labrum, resulting in changes posteriorly, and vice versa. Posterior shoulder dislocations can result in posterior labral tears. MRI. In the healthy state, the humerus sits on the glenoid similar to the way a golf ball rests on a tee. Operative findings were used as the gold standard for posterior labral tear extension. In our retrospective study of 444 patients, sensitivity, specificity, and accuracy were all lower than previously reported in the literature for diagnosing SLAP lesions. Look for variants like the Buford complex. Clinical History: A 72 year-old male presents with severe left shoulder pain and limited motion following a fall 10 days earlier. These are depicted in Figure 17-7. Crossref, Google Scholar; 73. 10 A paralabral cyst indicates the presence of a labral tear. Diagnostic criteria for both anterior and posterior labral tears present similarly. 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. The most common symptoms of a shoulder labrum tear can occur intermittently. ORTHOPEDICS August 2010;33(8):562. by Schreinemachers SA, van der Hulst VP, Willems WJ, Bipat S, van der Woude HJ. Which of the following nerves was most likely injured during the procedure? Notice the fibers of the inferior GHL. Surg Clin North Am. A posterior labrum tear is a rare type of shoulder labral tear that occurs in the back of the shoulder. 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. MRI is well recognized as an effective means to diagnose internal impingement of the shoulder. When comparing the 2 groups, they found that 12% of patients in the Bennett group had a posterior labral tear on MRI, whereas only 6.8% of patients in the non-Bennett group had a documented posterior labral tear, although the results were not statistically significant. 1A: The ball (humerus) normally rests within the socket (glenoid) like a golf ball on a tee. (14b) In a 39 year-old weightlifter with persistent posterior shoulder pain and instability, the axial image reveals the posterior capsule outlined by arthrographic fluid along both sides of the capsule, strongly suggestive of a capsular tear. In previous studies, conventional MR sensitivity in detection of labral tears has ranged from 44% to 93% sensitivity compared with arthroscopy [1, 2].Two recent studies have assessed conventional MRI evaluation of the glenoid labrum using a 0.2-T extremity MR system. SLAP tear: A superior labrum anterior to posterior (SLAP) tear occurs at the top of the glenoid (shoulder socket) and extends from the front to the back, where the biceps tendon connects to the shoulder. Reverse-bankart lesion: Also known as a posterior labral tear, this injury affects the rear and lower ends of the labrum. The supraspinatus, infraspinatus and teres minor muscles and tendons are shown. The general approach will include an X-ray, ultrasound, MRI, or CT scan of the shoulder joint to assess the cause of the symptom. In Shoulder MR-Part I we will focus on the normal anatomy and the many anatomical variants that may simulate pathology. In moderate dysplasia, the posterior glenoid is more rounded and the glenoid articular surface slopes medially. Bethesda, MD 20894, Web Policies In part III we will focus on impingement and rotator cuff tears. Wirth MA, Lyons FR, Rockwood CA Jr. Hypoplasia of the glenoid: a review of sixteen patients. 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 IGHL, labrum, and periosteum are stripped and medially displaced along the anterior neck of the scapula. In type II there is a small recess. Glenoid dysplasia/hypoplasia occurred in 19% to 35% of specimens.15,16 Additionally, several studies have identified that subtle posteroinferior glenoid deficiency and hypoplasia are significantly associated with posterior labral tears and symptomatic posterior shoulder instability.1719 Weishaupt et al18 used CT arthrograms to determine the incidence and severity of glenoid dysplasia in a population of patients with atraumatic posterior shoulder instability. We hypothesized that the accuracy of MRI and MRA was lower than previously reported. At this level study the middle GHL and the anterior labrum. Imaging in three planes is advisable and additional orthogonal planes may be included in the protocol for a detailed assessment of the lesion. Study the cartiage. Measurement of Friedmans angle and posterior humeral head subluxation (yellow lines depict Friedmans angle; red line depicts percentage of posterior humeral head subluxation). Typically, physical therapy will start the first week or two after surgery. A tear of the labrum can also occur in the back part of the socket. Common symptoms of a SLAP tear include: dull or aching pain in the shoulder, especially while lifting over the head. Once thought to be a relatively rare entity, a study by Harper et al. It requires about 6 to 8 weeks to heal to the bone. Posterior Labral Tear, Shoulder Soterios Gyftopoulos, MD, MSc ; Michael J. Tuite, MD To access 4,300 diagnoses written by the world's leading experts in radiology. 3-T MRI of the shoulder: is MR arthrography necessary? A wide ligament that surrounds and stabilises the joint is known as the capsule. Federal government websites often end in .gov or .mil. This can result in the damage to the anterior or front part of the labrum. Simoni P, Scarciolla L, Kreutz J, Meunier B, Beomonte Zobel B. J Sports Med Phys Fitness. Glenoid labral tears are the injuries of the glenoid labrum and a possible cause of shoulder pain. A useful indirect sign to be aware of, whether using MR arthrography or routine MR, is to recognize that normally the shoulder capsule should only be outlined by fluid along its inner margin. [ 41] Findings are usually normal. Advanced MRI techniques of the shoulder joint: current applications in clinical practice. In Shoulder MR-Part I we will focus on the normal anatomy and the many anatomical variants that may simulate pathology. 2019 Dec 12;20(1):598. doi: 10.1186/s12891-019-2986-1. 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 . Look for rim-rent tears of the supraspinatus tendon at the insertion of the anterior fibers. (2b) The T2-weighted sagittal image confirms posterior displacement of the humeral head (arrow) relative to the glenoid (asterisk). eCollection 2021. Our data indicated that while MRI could exclude a SLAP lesion (NPV = 95 %), MRI alone was not an accurate clinical tool. When the Evaluation of the glenoid labrum with 3-T MRI: is intraarticular contrast necessary? If there is a related partial thickness rotator cuff tear, there may also be lateral (on the side) pain. The shoulder joint is a ball-and-socket joint that joins the upper arm's (humerus) bone with the shoulder blade (scapula). MR is the best imaging modality to examen patients with shoulder pain and instability. Low signal intensity blood clot (arrowhead) is present within the subscapularis recess. Imaging of superior labral anterior to posterior (SLAP) tears of the shoulder. even greater mobility of the os acromiale after surgery and worsening of the impingement (4). Hottya GA, Tirman PF et al. Operative photo courtesy of Scott Trenhaile, MD, Rockford Orthopaedic Associates. High Prevalence of Superior Labral Anterior-Posterior Tears Associated With Acute Acromioclavicular Joint Separation of All Injury Grades. Which of the images (Figures A-E) most likely corresponds to the patient's initial diagnosis? The shoulder is primarily a ball and socket joint made up of the humerus (ball) and the glenoid (socket). 1999 May 15;318(7194):1322-3 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. 5,6,7 The classic MRI findings of internal impingement, as seen in this month's case, include partial articular surface tears at the posterior supraspinatus/anterior infraspinatus insertion, greater tuberosity bony changes, and tearing of the . Shah AA, Butler RB, Fowler R, Higgins LD. 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