Probing of the posterior labrum is needed to rule out a subtle Kim lesion. The https:// ensures that you are connecting to the Study the cartiage. Radiol Clin North Am 2016;54(5):801-815. The glenoid labrum is a cartilage rim that attaches to the glenoid rim. Large tears of the rotator cuff may allow the humeral head to migrate upwards resulting in a high riding humeral head. Adv Orthop. The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. This is called a posterior labral tear. Non-surgical treatment tends to be most successful in patients with a history of atraumatic subluxations, whereas patients who experience an acute, traumatic posterior dislocation are much less likely to report successful outcomes from conservative therapy.19 Non-operative therapy focuses on strengthening the dynamic shoulder stabilizers and activity modification. Notice coracoclavicular ligament and short head of the biceps. Burkhart et al. The findings are compatible with a posterior GLAD lesion (glenolabral articular disruption). Numerous labral abnormalities may be encountered in patients with posterior glenohumeral instability. 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. 7-9). Evaluation and management of posterior shoulder instability. 2012 Jan;21(1):13-22 Diagnosis . The site is secure. Rotator cuff tears in the context of posterior shoulder instability or dislocation were once thought to be rare. A hip (acetabular) labral tear is damage to cartilage and tissue in the hip socket. where most labral tears are located. A Treatise on Dislocations and Fractures of the Joints. Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Cochrane Database Syst Rev. Clin Orthop Relat Res 1993 : 85-96. "If physical therapy fails and the athlete still can't complete overhead motions, or the shoulder continues to dislocate, surgical treatment might be required to reattach the torn ligaments and labrum to the . Notice superior labrum and attachment of the superior glenohumeral ligament. Glenoid retroversion has been shown to be a risk factor for posterior shoulder instability.3 In a prospective study of 714 West Point cadets who were followed for 4 years, 46 shoulders had a documented glenohumeral instability event, 7 of which (10%) were posterior instability. Which of the following is the most likely etiology of his complaints? Radiographs are normal, and an MRI arthrogram is shown in Figure A. 3). Ultrasound will also show a shoulder ganglion cyst and the effects of muscle wasting. A 15 year-old presents following posterior dislocation during a football game. MR arthrography has excellent accuracy in differentiating between SLAP lesions and anatomic variants. It is not healed. (14a) Normal capsular appearance on an axial fat-suppressed T1-weighted MR arthrographic image. An example of this position is pushing open a door with a straight arm. Usually it is an incidental finding and regarded as a normal variant. a painful feeling of clicking, popping or grinding in the shoulder during movement. 1999 May 15;318(7194):1322-3 Severe glenoid dysplasia or hypoplasia is a rare condition due to either brachial plexus birth palsy or a developmental abnormality with lack of stimulation of the inferior glenoid ossification center. sharing sensitive information, make sure youre on a federal We hypothesized that the accuracy of MRI and MRA was lower than previously reported. Notice the biceps anchor. A posterior labral tear (reverse Bankart) is also present (arrowhead), and a bone bruise is seen within the anterior humeral head (asterisk). 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. Arthroscopy. The glenohumeral joint has a greater range of motion than any other joint in the body. When a dislocation or subluxation occurs, the glenoid labrum is torn from the bone and the capsule is stretched. The vast majority of shoulder labral tears do not need surgery. This is not always the case. There is an ongoing debate on whether direct MR arthrography is superior to conventional MR in detecting labral tears. Clipboard, Search History, and several other advanced features are temporarily unavailable. Uncategorized. Skeletal Radiol 2000; 29:204-210. Posterior labral tearing was apparent on contiguous images (not shown). Sometimes at this level labral tears at the 3-6 o'clock position can be visualized. Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthroscopic findings with arthroscopic correlation. These tears include numerous variations designated by acronyms similar to those used for the more commonly seen anterior labral tears. 2000 Jan;214(1):267-71 Burkhead WZ, Rockwood CA Treatment of instability of the shoulder with an exercise program. A shoulder labral tear injury can cause symptoms such as pain, a catching or locking sensation, decreased range of motion and joint instability. 4A, green line), the torn 9:00 posterior labrum is opposite the 3:00 anterior labrum on an axial image (Fig. Surgery may be required if the tear gets worse or does not improve after physical therapy. In more advanced cases of glenoid dysplasia, hypertrophic changes of the labrum and hyaline cartilage are pronounced. This procedure greatly enhances the diagnostic accuracy by allowing tears . Notice that the supraspinatus tendon is parallel to the axis of the muscle. HHS Vulnerability Disclosure, Help Rotator cuff tears The Bennett lesion (Fig. Notice the smooth borders unlike the margins of a SLAP-tear. (OBQ19.66) 2012;132(7):905-19. 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. Examples include the reverse Bankart lesion, the POLPSA lesion, and the posterior GLAD lesion (sometimes referred to as a PLAD lesion) (Figs. Posterior labral periosteal sleeve avulsion injury (POLPSA) in a 19 year-old football player following acute injury. 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. There is . Occasionally, a SLAP (superior labrum, anterior and posterior) fracture, which represents a superior humeral head compression . The management of these labrum injuries will depend on the classification, severity of the injury and the stability of the shoulder. In the ABER position the inferior glenohumeral ligament is stretched resulting in tension on the anteroinferior labrum, allowing intra-articular contrast to get between the labral tear and the glenoid. Notice that the biceps tendon is attached at the 12 o'clock position. A shoulder labral tear is an injury to this piece of cartilage, due to direct trauma, overuse, or instability. 2012 Sep;81(9):2343-7. doi: 10.1016/j.ejrad.2011.07.006. A 27-year-old male bodybuilder presents to the office with vague, deep shoulder pain and weakness with his bench press. Posterior ossification of the shoulder: the Bennett lesion. Typically, physical therapy will start the first week or two after surgery. Such lesions are generally found in patients with atraumatic posterior instability. This type of shoulder labral tear can lead to intermittent symptoms and only occurs in 5-10% of shoulder labral tear patients. In all patients, posterior cartilage damage of type 3 to 4, classified according to Outerbridge, with a concomitant posterior labral tear was evident. 2019 Oct 31;2019:9013935. doi: 10.1155/2019/9013935. 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. The shoulder joint is a ball and socket joint that connects the bone of the upper arm (humerus) with the shoulder blade (scapula). 2013 Sep 24;2013(9):CD009020. Bennett GE: Shoulder and elbow lesions of the professional baseball pitcher. The most common cause for a tear is after a shoulder dislocation when the most common site to tear is the anterior /inferior labrum. eCollection 2020 May-Jun. In patients with traumatic posterior subluxation or dislocation, injuries to labrum, capsule, bone and rotator cuff may be found, and accurate diagnosis with MRI allows the most appropriate treatment pathway to be chosen. What is Anterosuperior acetabular labrum? I don't have pain generally at all. A Buford complex is a congenital labral variant. Posterior labrum tear: This tear occurs at the back of the shoulder joint. 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. 10 A paralabral cyst indicates the presence of a labral tear. Look for HAGL-lesion (humeral avulsion of the glenohumeral ligament). No Comments At surgery, we put the labrum back in position against the bone. Smith T, Drew B, Toms A. AJR Am J Roentgenol. -. (B) Axillary radiograph demonstrating severe glenoid dysplasia with hypoplasia of the posterior glenoid and severe retroversion. Introduction. posterior labral tear surgery. 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. Please enable it to take advantage of the complete set of features! Wuennemann F, Kintzel L, Zeifang F, Maier MW, Burkholder I, Weber MA, Kauczor HU, Rehnitz C. BMC Musculoskelet Disord. 2019 Dec 12;20(1):598. doi: 10.1186/s12891-019-2986-1. In patients with glenoid deficiency or large impaction defects, osteotomies and osseous augmentation procedures may be required. Christensen GV, Smith KM, Kawakami J, Chalmers PN. 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). The authors found that specific acromial morphology on scapular-Y x-rays is significantly associated with the direction of glenohumeral instability. The supraspinatus tendon is the most important structure of the rotator cuff and subject to tendinopathy and tears. 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. Axis of supraspinous tendon. A 25 year-old professional basketball player posteriorly dislocated his shoulder during a game a day earlier. Between 2006 and 2008, 444 patients who had both shoulder arthroscopy and an MRI (non-contrast or MR arthrography) for shoulder pain at our institution prior to surgery were identified and included in the study. 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. What is your diagnosis? The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: comparison with arthroscopic findings. Evaluation of the glenoid labrum with 3-T MRI: is intraarticular contrast necessary? Measurement of Friedmans angle and posterior humeral head subluxation (yellow lines depict Friedmans angle; red line depicts percentage of posterior humeral head subluxation). 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. The radiologic diagnosis and surgical evaluation were compared to determine the accuracy of diagnosing a SLAP lesion by MRI. Chang IY, Polster JM. Type in at least one full word to see suggestions list. In many cases the axis of the supraspinatus tendon (arrowheads) is rotated more anteriorly compared to the axis of the muscle (yellow arrow). What are the findings? 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. An MRI arthrogram is performed and is normal. There are 3 types of attachment of the superior labrum at the 12 o'clock position where the biceps tendon inserts. De Maeseneer M, Van Roy F, Lenchik L et al. 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. McLaughlin, HL. 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