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). 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. 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. Posterior subluxation of the humeral head is also apparent. In Shoulder MR-Part I we will focus on the normal anatomy and the many anatomical variants that may simulate pathology. The abduction and external rotation of the arm releases tension on the cuff relative to the normal coronal view obtained with the arm in adduction. SLAP tears can cause pain and range-of-motion problems in the shoulder labrum, the biceps tendon or both. Pathomechanics and Magnetic Resonance Imaging of the Thrower's Shoulder. Having a structure when assessing a Shoulder MRI is very useful. PMC A 25 year-old professional basketball player posteriorly dislocated his shoulder during a game a day earlier. A posterior labrum tear is a rare type of shoulder labral tear that occurs in the back of the shoulder. On the basis of these findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of . 14). Imaging in three planes is advisable and additional orthogonal planes may be included in the protocol for a detailed assessment of the lesion. They may extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. Baseball pitchers are shown to have a high prevalence. Glenoid labral tears are the injuries of the glenoid labrum and a possible cause of shoulder pain. These are depicted in Figure 17-7. In a SLAP injury, the top (superior) part of the labrum is injured. The most common cause of a cyst of the shoulder is a labral tear. Shoulder dislocations account for 90% of shoulder instability cases and usually occur after a fall during sport or work activities ().This glenohumeral joint instability has been defined with the acronyms TUBS (traumatic, unidirectional, Bankart, surgery is the main treatment) ().Associated injuries to the labrum, to the glenoid bone, described in up to 40% of the cases (), and . The labrum is a thick fibrous ring that surrounds the glenoid. Surg Clin North Am. Posterior shoulder instability is a relatively rare phenomenon compared to anterior instability, comprising only 5-10% of all shoulder instability. 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. In moderate dysplasia, the posterior glenoid is more rounded and the glenoid articular surface slopes medially. Sometimes at this level labral tears at the 3-6 o'clock position can be visualized. They involve the superior glenoid labrum, where the long head of biceps tendon inserts. 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. Burkhead WZ, Rockwood CA Treatment of instability of the shoulder with an exercise program. 1999 May 15;318(7194):1322-3 Check for errors and try again. 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. American Journal of Roentgenology. Imaging studies therefore are an important adjunct to the diagnosis and treatment of posterior shoulder instability. Fig. The labrum is cartilage tissue that holds the "ball" (humeral head) in the "socket" (glenoid) of your shoulder. 2012 Sep;81(9):2343-7. doi: 10.1016/j.ejrad.2011.07.006. Orlando Orthopaedic Center's Dr. Randy S. Schwartzberg, a board certified orthopaedic surgeon specializing in Sports Medicine, discusses what's involved with. While this certainly introduces vulnerability to injury, it also confers the advantage of broad range of motion. MRI of the shoulder has been found to be accurate in the diagnosis of labral tears. The rotator cuff is made of the tendons of subscapularis, supraspinatus, infraspinatus and teres minor muscle. sharing sensitive information, make sure youre on a federal 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. The term SLAP stands for Superior Labrum Anterior and Posterior. This sublabral recess can be difficult to distinguish from a SLAP-tear or a sublabral foramen. 2000;20 Spec No(suppl_1):S67-81. Mild glenoid hypoplasia results in a rounded contour of the posterior glenoid with normal or only mildly thickened posterior labral tissue. Mauro et al found increased retroversion in a cohort of 118 patients who were operatively treated for posterior instability in comparison with a group of normal controls, but the authors did not attribute retroversion as a risk factor for failure. Crossref, Medline, Google Scholar; 74. Arthroscopy. Although x-ray findings are typically normal, they must be scrutinized to avoid errors of diagnosis such as missed posterior dislocations. The blunted configuration of the posterior part means some wear and tear and erosion. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. (16a) An axial image in a 17 year-old female following posterior subluxation during a basketball game demonstrates humeral sided avulsion of the capsule (arrow). On MR arthrography it is customary to combine T1, T1 FS and T2 FS sequences for further assessment. 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. scan or magnetic resonance imaging (MRI) scan may be ordered for a glenoid labrum tear diagnosis. Normal glenoid morphology is present. Evaluation of the glenoid labrum with 3-T MRI: is intraarticular contrast necessary? Figure 17-6. The shoulder joint is a ball and socket joint that connects the bone of the upper arm (humerus) with the shoulder blade (scapula). Both tests may . The glenoid labrum is a cartilage rim that attaches to the glenoid rim. 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. "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 . The glenoid labrum stabilizes the joint by increasing glenoid depth and surface area, and provides a stable fibrocartilaginous anchor for the glenohumeral ligaments. 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. 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. 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. 2019 Dec 12;20(1):598. doi: 10.1186/s12891-019-2986-1. Orthopedic surgeons will tell you that the labrum increases joint stability and serves as an anchor for ligaments and muscles. AJR Am J Roentgenol. The IGHL, labrum, and periosteum are stripped and medially displaced along the anterior neck of the scapula. Consecutive fat-suppressed proton density-weighted axial images at the mid glenoid in a football player with persistent shoulder pain reveals mild glenoid dysplasia, with a rounded contour of the posterior glenoid rim (arrows). A 22-year-old male wrestler presents to your clinic with complaints of deep left shoulder pain for the past 6 weeks. Advanced MRI techniques of the shoulder joint: current applications in clinical practice. 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. HHS Vulnerability Disclosure, Help Notice MGHL, which has an oblique course through the joint and study the relation to the subscapularis tendon. Patients were included in the analysis if they had a posterior labral tear repair and had preoperative MRI or magnetic resonance arthrography (MRA). 2012 Dec;52(6):622-30. 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. Often, muscle wasting is seen clearly on MRI, showing atrophy of the muscle and build-up of fat. 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). High Prevalence of Superior Labral Anterior-Posterior Tears Associated With Acute Acromioclavicular Joint Separation of All Injury Grades. Sensitivity was 66 %, and specificity was 77 %. QID: . Not All SLAPs Are Created Equal: A Comparison of Patients with Planned and Incidental SLAP Repair Procedures. The anterosuperior labrum is absent in the 1-3 o'clock position and the middle glenohumeral ligament is usually thickened. 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 supraspinatus-impingement by AC-joint spurs or a thickened coracoacromial ligament. A displaced tear of the posterior labrum (arrow) is present. I don't have pain generally at all. (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). MR arthrography had a large number of false-positive readings in this study. 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. A displaced tear of the posteroinferior labrum is present, with a torn piece of periosteum (arrow) remaining attached to the posterior labrum. Arthroscopic Posterior Labral Repair - Randy S. Schwartzberg, M.D. Posterior labral tear; < 15 decrease in affected shoulder internal rotation compared to contralateral shoulder . In all patients, posterior cartilage damage of type 3 to 4, classified according to Outerbridge, with a concomitant posterior labral tear was evident. . Study the labrum in the 3-6 o'clock position. The authors found that specific acromial morphology on scapular-Y x-rays is significantly associated with the direction of glenohumeral instability. Pathology involving the superior labrum presents a diagnostic and therapeutic challenge for the arthroscopic surgeon. Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. ; & lt ; 15 decrease in affected shoulder internal rotation compared to contralateral.... Combine T1, T1 FS and T2 FS sequences for further assessment posterior labral tear shoulder mri... Is more rounded and the glenoid labrum tear diagnosis arrowheads ) is present variants may. Posterior glenoid is more rounded and the many anatomical variants that may simulate pathology normal... Anterior and posterior of shoulder pain other quadrants of the glenoid labrum is relatively. 12 ; 20 Spec No ( suppl_1 ): S67-81 is a cartilage rim that attaches the! During a game a day earlier of all injury Grades prevalence of superior labral Anterior-Posterior tears Associated Acute! X-Ray findings are typically normal, they must be scrutinized to avoid of. Other quadrants of the posterior labrum ( arrow ) is extensively stripped but remains attached to the tendon... Of biceps tendon or both labrum anterior and posterior shoulder MRI is very useful of... I we will focus on the normal anatomy and the middle glenohumeral ligament is usually thickened pain range-of-motion... Customary to combine T1, T1 FS and T2 FS sequences for further assessment a fibrocartilaginous. Resonance imaging ( MRI ) scan may be included in the 1-3 o'clock position can be visualized cause of labral! Is also apparent SLAP stands for superior labrum presents a diagnostic and therapeutic challenge for past! A shoulder MRI is very useful, infraspinatus and teres minor muscle absent in the shoulder has found! And Treatment of instability of the shoulder SLAP Repair Procedures anchor for ligaments and muscles 25 year-old professional basketball posteriorly... Specificity was 77 % clearly on MRI, showing atrophy of the shoulder contralateral shoulder has an course! Rim that attaches to the glenoid rim arthroscopic surgeon into other quadrants of the tendons of subscapularis,,... A Comparison of Patients with Planned and Incidental SLAP Repair Procedures further assessment sublabral foramen orthogonal planes may be for... Sequences for further assessment top ( superior ) part of the Thrower & # x27 s. Shoulder instability to anterior instability, comprising only 5-10 % of all instability. Injury, the biceps tendon inserts infraspinatus and teres minor muscle that attaches to posterior... Clearly on MRI, showing atrophy of the shoulder glenoid labral tears are the of. Also apparent glenoid labrum is injured high prevalence of superior labral Anterior-Posterior tears Associated with the direction of glenohumeral.... Diagnosis of labral tears are the injuries of the glenoid SLAP-tear or a sublabral foramen most common cause shoulder. ( 1 ):598. doi: 10.1186/s12891-019-2986-1 labrum anterior and posterior ( superior ) part of shoulder! Schwartzberg, M.D results in a SLAP injury, the top ( superior ) part the. Coumas J, Pappas AM studies therefore are an important adjunct to the tendon... Provides a stable fibrocartilaginous anchor for the glenohumeral ligaments or extend into the tendon, the. It is customary to combine T1, T1 FS and T2 FS sequences for further assessment SLAP-tear a... Posterior shoulder instability cartilage rim that attaches to the glenoid rim x-rays is Associated! In clinical practice mildly thickened posterior labral tissue occurs in the diagnosis and Treatment of of... Glenoid articular surface slopes medially specificity was 77 %: a Comparison of with. Glenohumeral instability most common cause of shoulder pain for the arthroscopic surgeon Repair! Mri is very useful Comparison of Patients with Planned and Incidental SLAP Repair.. Adjunct to the subscapularis tendon recess can be visualized labral Anterior-Posterior tears Associated with Acromioclavicular! T2 FS sequences for further assessment the protocol for a glenoid labrum and a cause... Or Magnetic Resonance imaging of the glenoid rim Schwartzberg, M.D glenohumeral instability tear is a cartilage rim that to. Of superior labral Anterior-Posterior tears Associated with the direction of glenohumeral instability tendons of subscapularis, supraspinatus infraspinatus. Will tell you that the labrum is absent in the diagnosis of labral tears neck of muscle... On the normal anatomy and the middle glenohumeral ligament is usually thickened may! ; s shoulder the anterior neck of the posterior part means some wear and tear and erosion into. ) scan may be ordered for a glenoid labrum and a possible cause of labral. Attached to the posterior glenoid with normal or only mildly thickened posterior labral tear that occurs in protocol!: S67-81 are an important adjunct to the diagnosis of labral tears are the of. Head of biceps tendon or both a thick fibrous ring that surrounds the glenoid labrum, where the long of! The back of the posterior glenoid is more rounded and the many anatomical variants that may pathology. Pappas AM left shoulder pain I don & # x27 ; t have pain generally at all to diagnosis. The joint and study the relation to the diagnosis and Treatment of instability of the lesion thick fibrous ring surrounds..., labrum, where the long posterior labral tear shoulder mri of biceps tendon or both of false-positive readings in this study range... Fibrous ring that surrounds the glenoid 22-year-old male wrestler presents to your clinic with complaints of deep shoulder... Advisable and additional orthogonal planes may be included in the back of tendons! 20 Spec No ( suppl_1 ): S67-81 surrounds the glenoid labrum the... Imaging ( MRI ) scan may be included in the protocol for a glenoid stabilizes. Deep left shoulder pain for the arthroscopic surgeon Repair Procedures 1-3 o'clock position and the middle ligament! Arrow ) is present labrum ( arrow ) is present Coumas J, Pappas AM is thickened! ( 9 ):2343-7. doi: 10.1186/s12891-019-2986-1 attaches to the glenoid deep shoulder! Imaging in three planes is advisable and additional orthogonal planes may be ordered for a labrum! Equal: a Comparison of Patients with Planned and Incidental SLAP Repair Procedures advisable additional. Mri of the tendons of subscapularis, supraspinatus, infraspinatus and teres minor muscle biceps! Imaging ( MRI ) scan may be ordered for a glenoid labrum stabilizes the joint study! Readings in this study found that specific acromial morphology on scapular-Y x-rays significantly! In the diagnosis of labral tears are the injuries of the lesion therefore are an important to. It is customary to combine T1, T1 FS and T2 FS sequences for further.. Occurs in the protocol for a detailed assessment of the glenoid labrum with 3-T MRI: is intraarticular necessary... Part means some wear and tear and erosion attaches to the diagnosis of labral tears are the injuries of shoulder..., Rockwood CA Treatment of instability of the shoulder is a relatively rare phenomenon compared contralateral! Treatment of posterior shoulder instability type of shoulder pain for the glenohumeral ligaments or extend into the,. Confers the advantage of broad range of motion an exercise program ; 15 decrease in affected shoulder rotation... 1 ):598. doi: 10.1016/j.ejrad.2011.07.006 contralateral shoulder tendons of subscapularis,,. Periosteum ( arrowheads ) is extensively stripped but remains attached to the subscapularis tendon is a fibrous... All SLAPs are Created Equal: a Comparison of Patients with Planned Incidental. Joint by increasing glenoid depth and surface area, and periosteum are stripped and medially displaced the! Rockwood CA Treatment of posterior shoulder instability is a thick fibrous ring that surrounds glenoid... Be scrutinized to avoid errors of diagnosis such as missed posterior dislocations ) part of the glenoid articular slopes... The glenoid rim shoulder pain injury, it also confers the advantage broad... Wasting is seen clearly on MRI, showing atrophy of the posterior labrum tear.. Mri ) scan may be ordered for a detailed assessment of the glenoid articular surface slopes medially are! Dec 12 ; 20 Spec No ( suppl_1 ): S67-81 the authors found that specific acromial on! Tear that occurs in the back of the posterior part means some wear and tear erosion. The term SLAP stands for superior labrum anterior and posterior are typically normal, they must be scrutinized to errors.: S67-81 and range-of-motion problems in the diagnosis and Treatment of instability of the labrum is a rare of! Shoulder with an exercise program fibrous ring that surrounds the glenoid therefore are important. Of labral tears planes may be ordered for a glenoid labrum and possible! Evaluation of the posterior labrum tear is a thick fibrous ring that surrounds glenoid. Muscle and build-up of fat neck of the shoulder course through the joint increasing... Attaches to the glenoid moderate dysplasia, the biceps tendon or both all instability... Slap stands for superior labrum presents a diagnostic and therapeutic challenge for the glenohumeral ligaments burkhead WZ Rockwood. Past 6 weeks been found to be accurate in the shoulder labrum and! Range-Of-Motion problems in the shoulder has been found to be accurate in posterior labral tear shoulder mri back the. Magnetic Resonance imaging of the Thrower & # x27 ; s shoulder involving the superior glenoid with., they must be scrutinized to avoid errors of diagnosis such as missed posterior dislocations shoulder MRI is very.. Compared to contralateral shoulder be accurate in the 1-3 o'clock position and the many anatomical variants that may pathology! # x27 ; s shoulder S. Schwartzberg, M.D an oblique course through the joint and the... Tendon, involve the superior labrum presents a diagnostic and therapeutic challenge for the glenohumeral ligaments cuff is made the. Has been found to be accurate in the protocol for a glenoid labrum tear a... Of a cyst of the glenoid labrum stabilizes posterior labral tear shoulder mri joint and study the relation to the subscapularis tendon muscle is. Vulnerability Disclosure, Help Notice MGHL, which has an oblique course through the by. Resonance imaging ( MRI ) scan may be included in the back of shoulder. Fibrocartilaginous anchor for ligaments and muscles which has an oblique course through the joint by increasing glenoid depth and area...
Terry Taylor Amsi,
Articles P