Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, Collateral Ligament Injuries of the Fingers, Tannenbaum E and Sekiya JK. Tearing of the inferior glenohumeral ligament at the humeral attachment (blue arrow) is also evident. Notice smooth undersurface of infraspinatus tendon and normal anterior labrum. Additionally, a recent study by Meyer et al9 highlighted the importance of x-rays in evaluation of posterior shoulder instability. The labrum is the cartilage dish that sits between the ball and the socket configuration of the shoulder joint. The shoulder, because of its wide range of motion, is anatomically predisposed to instability, but the vast majority of shoulder instability is anterior, with posterior instability estimated to affect 2-10% of unstable shoulders.1Although anterior shoulder dislocations have been recognized since the dawn of medicine, the first medical description of posterior shoulder dislocation did not occur until 1822.2In modern times, posterior shoulder instability is still a commonly missed diagnosis, in part due to a decreased index of suspicion for the entity among many physicians. J Bone Joint Surg Am. 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. 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 . The posterior capsule is torn at the humeral attachment (arrow). HHS Vulnerability Disclosure, Help On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. Posterior labral tear; < 15 decrease in affected shoulder internal rotation compared to contralateral shoulder . A shoulder labral tear injury can cause symptoms such as pain, a catching or locking sensation, decreased range of motion and joint instability. Methods: Between 2006 and 2008, 444 patients who had both shoulder arthroscopy and an MRI (non-contrast . The approach to surgery is dependent upon the type of injuries sustained by the patient, and the developmental or acquired alterations in anatomy that may be present. Accessibility Sports Health 2011 May, 3(3):253-263, Cooper A. Federal government websites often end in .gov or .mil. An MRI arthrogram is performed and is normal. Radiographics. Oper Tech Sports Med 2016;24(3):181-188. SLAP tears can cause pain and range-of-motion problems in the shoulder labrum, the biceps tendon or both. If there is a related partial thickness rotator cuff tear, there may also be lateral (on the side) pain. Posterior subluxation of the humeral head is readily apparent. Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography? The capsule is a broad ligament that surrounds and stabilizes the joint. 8600 Rockville Pike An impaction fracture is also present at the posterior glenoid rim (blue arrow). Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. -, Am J Sports Med. 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. Images demonstrate a non-displaced tear involving the superficial anteroinferior labrum with associated injury to the adjacent cartilage 4.. The IGHL, labrum, and periosteum are stripped and medially displaced along the anterior neck of the scapula. Purpose: In type II there is a small recess. The authors found that specific acromial morphology on scapular-Y x-rays is significantly associated with the direction of glenohumeral instability. Recurrent posterior shoulder instability: diagnosis and treatment. This usually happens from an interior shoulder dislocation (a dislocation when the humeral head comes out of the front of the socket). Diagnosis is made clinically with presence of increased anterior and posterior humeral translation, a sulcus sign, and overall increased . 10 A paralabral cyst indicates the presence of a labral tear. He has full passive and active range of motion of the left shoulder that is symmetrical to his contralateral side. Large tears of the rotator cuff may allow the humeral head to migrate upwards resulting in a high riding humeral head. (14c) An arthroscopic examination confirms the tear in the posterior capsule (arrow), which was subsequently repaired. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. QID: . The shoulder joint is the most unstable articulation in the entire human body. Would you like email updates of new search results? Radiology. On the basis of these findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of . ORTHOPEDICS August 2010;33(8):562. by Schreinemachers SA, van der Hulst VP, Willems WJ, Bipat S, van der Woude HJ. Surgical Management of Superior Labral Tears in Athletes: Focus on Biceps Tenodesis. MRI of the shoulder second edition Follow me on twitter:https://twitter.com/#!/DrEbr. AJR Am J Roentgenol. 1999 May 15;318(7194):1322-3 Study the cartilage. Look for HAGL-lesion (humeral avulsion of the glenohumeral ligament). This patient has a posterior-superior labral tear with small paralabral cyst (large arrow) and small communicating neck . A Treatise on Dislocations and Fractures of the Joints. Labral tears Apart from that, CT is superior to MR in assessing bony structures, so this modality is helpful in detecting co-existing small glenoid rim fractures. This can result in the damage to the anterior or front part of the labrum. We hypothesized that the accuracy of MRI and MRA was lower than previously reported. When a dislocation or subluxation occurs, the glenoid labrum is torn from the bone and the capsule is stretched. Ultrasound will also show a shoulder ganglion cyst and the effects of muscle wasting. 3. Labral tears, such as a SLAP tear that cause a paralabral cyst, can occur due to trauma (dislocation), repetitive movement . On plain radiography of the shoulder, an anteroposterior (AP) view of the shoulder in internal and external rotation, outlet, and axillary views should be obtained. Lee SB, Kim KJ, ODriscoll SW, Morrey BF, An KN Dynamic glenohumeral stability provided by the rotator cuff muscles in the mid-range and end-range of motion. 1985 Sep-Oct;13(5):337-41 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.8 Therefore, although Bennett lesions are typically not associated with posterior shoulder instability, it is important to recognize these lesions because they can be associated with posterior labral tears. There is . Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. What is Anterosuperior acetabular labrum? 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. 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. This site needs JavaScript to work properly. 1998 Apr 30;17(8):857-72 Right shoulder has presented with instability, popping, loose feeling, smaller size, & less strength compared to my left arm (I'm right handed), been going on for about 2 years. Skeletal Radiol. The term SLAP stands for Superior Labrum Anterior and Posterior. Posterior subluxation of the humeral head is also apparent. 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. Posterior labral tearing was apparent on contiguous images (not shown). Unlike the anterior labrum, rarely do we have a posterior dislocation of the shoulder. 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). These terms are interchangeable because there is underdevelopment of the posterior inferior aspect of the glenoid. A recess more than 3-5 mm is always abnormal and should be regarded as a SLAP-tear. These normal variants are all located in the 11-3 o'clock position. Adv Orthop. Tendonitis of the long head of the biceps. The shallow socket in the scapula is the glenoid cavity. The labrum is a band of tough cartilage and connective tissue that lines the rim of the hip socket, or acetabulum. This procedure greatly enhances the diagnostic accuracy by allowing tears . The appearance is thought to be due to failure of ossification of the more inferior of the two ossification centers of the glenoid, resulting in a cartilage cap replacing the bone defect.11 The presence of the hypertrophied tissue and associated labral tears is well demonstrated on MRI (Fig. In moderate dysplasia, the posterior glenoid is more rounded and the glenoid articular surface slopes medially. The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. A fold is more commonly occur in the posterosuperior and posteroinferior capsular portions. American Journal of Roentgenology. If the patient is unable to abduct the arm, then a Velpeau view is an alternate orthogonal radiograph (Figure 17-4). Rotator cuff tears Findings compatible with posterior shoulder subluxation with an intramuscular tear of the teres minor, a posterior labral tear, and posterior capsular disruption. There was no subscapularis or rotator cuff tear and no superior labrum tear. 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. In fact, the research shows that labral tears are common in people without shoulder pain and that the surgery to fix them doesn't work any better than a placebo or sham procedure. 5). Methods MR arthrograms of 97 patients with isolated posterior glenoid labral tears by arthroscopy and those of 96 age and gender-matched controls with intact posterior labra were reviewed by two blinded . Simoni P, Scarciolla L, Kreutz J, Meunier B, Beomonte Zobel B. J Sports Med Phys Fitness. Epub 2011 Sep 9. If the pre-test probability was above 90% or below 10% . 1992 Jul;74(6):890-6. -, J Shoulder Elbow Surg. A 27-year-old male bodybuilder presents to the office with vague, deep shoulder pain and weakness with his bench press. A mid-substance tear of the posterior capsule is present with the medial component appearing lax and retracted (arrow). In all patients, posterior cartilage damage of type 3 to 4, classified according to Outerbridge, with a concomitant posterior labral tear was evident. The axial MR-images show an os acromiale with degenerative changes, i.e. If this appearance is present, a capsular tear should be strongly suspected (Fig. Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthrographic findings with arthroscopic correlation. 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. Patients were included in the analysis if they had a posterior labral tear repair and had preoperative MRI or magnetic resonance arthrography (MRA). They did find that smaller glenoid width was a risk factor for failure.12. propagation of Bankart lesions is relatively common following shoulder dislocations, with a rate of 18.5%. 13) of the posterior capsule. However labral tears may originate at the 3-6 o'clock position and subsequently extend superiorly. Notice the biceps anchor. The labrum is a thick fibrous ring that surrounds the glenoid. and transmitted securely. Injury can also lead to a cyst that painfully compresses nerves in the shoulder. The anterior labrum and glenoid articular cartilage often demonstrate normal morphology one image superior to the . Conclusions: A study in cadavers. Figure 17-3. 15 Imaging of the patient in the ABER position can greatly increase the conspicuity of an ALPSA lesion, which can easily be overlooked on a routine MRI of the shoulder or on the standard axial sequence of an MRA. 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 . They may extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. Although x-ray findings are typically normal, they must be scrutinized to avoid errors of diagnosis such as missed posterior dislocations. (OBQ12.268) An area of capsular irregularity (arrow) is apparent as well. A tear extends across the base of the posterior labrum (arrowheads), and mild posterior subluxation of the humeral head relative to the glenoid is present. Which of the following nerves was most likely injured during the procedure? Radiographics. 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). Humeral translation, a recent study by Meyer et al9 highlighted the importance of x-rays in evaluation of posterior stabilizers! 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