A displaced tear of the posteroinferior labrum is present, with a torn piece of periosteum (arrow) remaining attached to the posterior labrum. Posterior shoulder instability is a relatively rare phenomenon compared to anterior instability, comprising only 5-10% of all shoulder instability. It is present in approximately 1.5% of individuals. The shoulder joint is a ball and socket joint that connects the bone of the upper arm (humerus) with the shoulder blade (scapula). On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. 2021 May 5;12:61-71. doi: 10.2147/OAJSM.S266226. Glenoid labral tears are the injuries of the glenoid labrum and a possible cause of shoulder pain. 2005;184: 984-988. These are depicted in Figure 17-7. by Jaideep J. Iyengar, MD; Keith R. Burnett, MD; Wesley M. Nottage, MD A fat-suppressed proton density-weighted axial image in a 14 year-old female with shoulder instability reveals findings of severe glenoid hypoplasia. The shoulder joint is a ball-and-socket joint that joins the upper arm's (humerus) bone with the shoulder blade (scapula). (A) Anteroposterior radiograph of severe glenoid dysplasia showing hypoplasia of the glenoid neck (blue arrow) and coracoid enlargement (orange star). Both tests may . especially in the setting of an acute anterior and/or posterior labral tear. His pain is aggravated when grappling with other wrestlers and when performing push-ups. The ABER view is also very useful for both partial- and full-thickness tears of the rotator cuff. Evaluation of the glenoid labrum with 3-T MRI: is intraarticular contrast necessary? These normal variants are all located in the 11-3 o'clock position. found in 3-5% of patients undergoing routine MRI of the shoulder 12, 13 Denervation of muscle is identified on MR images initially by the presence of diffuse, homogeneous muscle . It is a condition referred to as an internal impingement. Purpose: doi: 10.1002/14651858.CD009020.pub2. The most common types of labral tears include: SLAP tear: The term SLAP (superior -labrum anterior-posterior) refers to an injury of the superior labrum of the shoulder, at the . (SBQ16SM.25) Images in the ABER position are obtained in an axial way 45 degrees off the coronal plane (figure). Labral tears Increased glenoid retroversion increases the risk of posterior shoulder instability by 6 times. Hottya GA, Tirman PF, Bost FW, Montgomery WH, Wolf EM, Genant HK. 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. where most labral tears are located. the-glenoid labrum. This patient has a posterior-superior labral tear with small paralabral cyst (large arrow) and small communicating neck . MR interpreters should be aware that at times capsular tears are quite subtle. In addition to aiding in the recognition of a locked posterior dislocation, the axillary radiograph is necessary to a complete an orthogonal radiographic analysis. They may extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. The rotator cuff is made of the tendons of subscapularis, supraspinatus, infraspinatus and teres minor muscle. Although increased glenoid retroversion is a risk factor for posterior shoulder instability, there is little evidence to support the claim that increasing glenoid retroversion is associated with worse outcomes following posterior labral repair.12 Hurley et al found that patients with symptomatic posterior instability and glenoid retroversion of greater than 9 degrees had higher recurrence rates after open soft-tissue procedures.13 Conversely, Bigliani and colleagues performed CT scans for 16 of 35 shoulders prior to an open posterior capsular shift and found the average retroversion was 6 degrees.14 Their surgical cohort had an 80% success rate but they did not attribute their failures to osseous anatomy. At this level also look for Bankart lesions. First described by Andrews and colleagues in 1985, Snyder later classified lesions of the superior labrum into four types and coined the term SLAP tear (superior labral tear anterior-posterior). 14). It is better visualized in ABER position.Articular cartilage lesions are best demonstrated with MR arthrography. A shoulder labral tear injury can cause symptoms such as pain, a catching or locking sensation, decreased range of motion and joint instability. The glenohumeral joint has the following supporting structures: The tendon of the subscapularis muscle attaches both to the lesser tuberosity aswell as to the greater tuberosity giving support to the long head 2006; 240(1):152-160. 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. What is Anterosuperior acetabular labrum? Postoperatively, there are strict instructions to avoid adduction and internal rotation of the operative shoulder. Recurrent posterior shoulder instability: diagnosis and treatment. This type of shoulder labral tear can lead to intermittent symptoms and only occurs in 5-10% of shoulder labral tear patients. A hip (acetabular) labral tear is damage to cartilage and tissue in the hip socket. A recess more than 3-5 mm is always abnormal and should be regarded as a SLAP-tear. Axial anatomy and checklist. This is called a posterior labral tear. In type I there is no recess between the glenoid cartilage and the 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. Clavert P. Glenoid Labrum Pathology. Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthroscopic findings with arthroscopic correlation. and transmitted securely. Posterior labral tear; < 15 decrease in affected shoulder internal rotation compared to contralateral shoulder . FOIA (B) Axillary radiograph of locked posterior glenohumeral dislocation. In all patients, posterior cartilage damage of type 3 to 4, classified according to Outerbridge, with a concomitant posterior labral tear was evident. Without the rotator cuff, the humeral head would ride up partially out of the glenoid fossa, lessening the efficiency of the deltoid muscle. The posterior labrum is enlarged to replace the deficient glenoid rim. Glenoid labrum (marked lig.) 5). When the labrum gets damaged or torn, it puts the shoulder at increased risk for looseness and dislocation. This ring of cartilage encompasses the outer rim of the glenoid to provide cushiony support around the head of the humerus. Orlando Orthopaedic Center's Dr. Randy S. Schwartzberg, a board certified orthopaedic surgeon specializing in Sports Medicine, discusses what's involved with. Pathology involving the superior labrum presents a diagnostic and therapeutic challenge for the arthroscopic surgeon. Dougherty MC, Kulenkamp JE, Boyajian H, Koh JL, Lee MJ, Shi LL. Posterior labral tears will demonstrate the absence of the labrum or morphologic distortion, contrast, or fluid infiltration [].Four primary diagnostic characteristics can determine pathologic tearing versus an anatomic variant: intrasubstance signal intensity, margins, orientation, and extension. subchondral cysts and osteophytes (arrow). The supraspinatus, infraspinatus and teres minor muscles and tendons are shown. They developed a classification system in which a pointed glenoid on axial imaging sequences is a normal-appearing glenoid without dysplasia, a lazy J has a rounded appearance of the posterior inferior glenoid, and a delta glenoid is a triangular osseous deficiency. Surgery may be required if the tear gets worse or does not improve after physical therapy. This can result in the damage to the anterior or front part of the labrum. Plain radiographs in patients with posterior shoulder instability are an important and critical adjunct to making the diagnosis of posterior shoulder instability. He has positive Kim and jerk tests and reproduction of symptoms with the shoulder in forward flexion, adduction, and internal rotation. The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: comparison with arthroscopic findings. Diagnostic criteria for both anterior and posterior labral tears present similarly. Scroll through the images and notice the unattached labrum at the 12-3 o'clock position at the site of the sublabral foramen. Large tears of the rotator cuff may allow the humeral head to migrate upwards resulting in a high riding humeral head. Advances in knowledge:: On a direct MR arthrographic image, a posterior capsular synovial fold may be a normal anatomic variant. 1998 Sep;171(3):763-8. The supraspinatus tendon is the most important structure of the rotator cuff and subject to tendinopathy and tears. An impaction fracture is also present at the posterior glenoid rim (blue arrow). Small to moderate glenohumeral joint effusion with synovitis and extension of fluid in the subcoracoid recess. Low signal intensity blood clot (arrowhead) is present within the subscapularis recess. Diagnosis of a locked posterior humeral dislocation can be avoided by recognizing on the AP Grashey radiograph the presence of the lightbulb sign (Figure 17-3A), which is the humeral head taking on a rounded appearance similar to the shape of a lightbulb because of fixed internal rotation secondary to a posterior glenohumeral dislocation.4 In addition to recognizing the lightbulb sign on an AP Grashey radiograph, an axillary x-ray will confirm the diagnosis of a locked posterior dislocation (Figure 17-3B). Diagnosis . It helps provide stability to the shoulder by . Type 1 shoulder labrum tear. 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. The purpose of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in diagnosing superior labral anterior-posterior (SLAP) lesions. A 22-year-old male wrestler presents to your clinic with complaints of deep left shoulder pain for the past 6 weeks. 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. Such lesions are generally found in patients with atraumatic posterior instability. They involve the superior glenoid labrum, where the long head of biceps tendon inserts. In the shoulder, this pain is located posterior (behind) and superior (above). [ 41] Findings are usually normal. Burkhart et al. No Comments Also, it allows preoperative planning if a posterior bone block procedure is planned. Posterior shoulder instability is becoming increasingly recognized in young, athletic populations, especially in the military.13 Compared to anterior shoulder instability, posterior instability can be more challenging to diagnose both clinically and radiographically. In that position the 3-6 o'clock region is imaged perpendicular. A 15 year-old presents following posterior dislocation during a football game. On MR arthrography, the mean posterior humeral translation was greater (6.2 mm 0.08; p = 0.019), posterior labral tears were longer (19.4 mm 1.7; p = 0.0008), and labrocapsular avulsion was more common (83%; p = 0.0001) in patients with posterior instability than in patients who had a posterior labral tear but a clinically stable shoulder. 8600 Rockville Pike difficulty performing normal shoulder . This usually happens from an interior shoulder dislocation (a dislocation when the humeral head comes out of the front of the socket). The ligaments also aid in keeping the shoulder stable and in joint. On MR an os acromiale is best seen on the superior axial images. MRI Shoulder Labrum Periosteal Stripping. Normal Labral Anatomy. The anterior labrum is absent in the 1-3 o'clock position and there is a thickened middle GHL. 2019 Dec 12;20(1):598. doi: 10.1186/s12891-019-2986-1. official website and that any information you provide is encrypted Glenoid retroversion was significantly associated with the development of posterior shoulder instability (P < .001). AJR Am J Roentgenol. ORTHOPEDICS August 2010;33(8):562. by Schreinemachers SA, van der Hulst VP, Willems WJ, Bipat S, van der Woude HJ. The authors found that specific acromial morphology on scapular-Y x-rays is significantly associated with the direction of glenohumeral instability. Usually it is an incidental finding and regarded as a normal variant. Am J Roentgenol. MR is the best imaging modality to examen patients with shoulder pain and instability. Posterior labrum tear: This tear occurs at the back of the shoulder joint. Often, muscle wasting is seen clearly on MRI, showing atrophy of the muscle and build-up of fat. There was a posterior labrum tear. (OBQ12.268) The labrum is a band of tough cartilage and connective tissue that lines the rim of the hip socket, or acetabulum. Crossref, Medline, Google Scholar; 74. On MR arthrography, the mean posterior humeral translation was greater (6.2 mm +/- 0.08; p = 0.019), posterior labral tears were longer (19.4 mm +/- 1.7; p = 0.0008), and labrocapsular avulsion was more common (83%; p = 0.0001) in patients with posterior instability than in patients who had a posterior labral tear but a clinically stable shoulder. 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. Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum. The most common symptoms of a shoulder labrum tear can occur intermittently. Posterior subluxation of the humeral head is readily apparent. The shoulder is primarily a ball and socket joint made up of the humerus (ball) and the glenoid (socket). 2020 Aug 27;8(8):2325967120941850. doi: 10.1177/2325967120941850. In a 20 year-old football player following acute injury, a reverse Bankart lesion is present. 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 . A posterior labrum tear is a rare type of shoulder labral tear that occurs in the back of the shoulder. Fluid distends the joint and only lies along the inner margin of the joint capsule (arrowheads). There are a number of anatomical labral variants located between 11 and 3 o'clock, which can be mistaken for a SLAP tear: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. There is . Introduction. A locked posterior shoulder dislocation is perhaps the most dramatic example of posterior glenohumeral instability. If the patient is unable to abduct the arm, then a Velpeau view is an alternate orthogonal radiograph (Figure 17-4). J Shoulder Elbow Surg. . 2. In order to cover an array of clinical scenarios, we used a pretest probability range of 20-80% at 20% increments according to the likelihood of pathology. AJR 2004; 183(2). It is not healed. When there is an avulsion of the posterior inferior labrum, and the lesion is incomplete, concealed, or occult, it is called a Kim lesion. Chung CB, Sorenson S, Dwek JR and Resnick D. Humeral Avulsion of the Posterior Band of the Inferior Glenohumeral Ligament: MR Arthrography and Clinical Correlation in 17 Patients. The Bennett lesion (Fig. . 3). 4A, green line), the torn 9:00 posterior labrum is opposite the 3:00 anterior labrum on an axial image (Fig. These images illustrate the differences between an sublabral recess and a SLAP-tear. 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. 3-T MRI of the shoulder: is MR arthrography necessary? 2019 Oct 31;2019:9013935. doi: 10.1155/2019/9013935. eCollection 2021. 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. 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. Shah AA, Butler RB, Fowler R, Higgins LD. American Journal of Roentgenology. Ultrasound will also show a shoulder ganglion cyst and the effects of muscle wasting. 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. Diagnostic performance of 3D-multi-Echo-data-image-combination (MEDIC) for evaluating SLAP lesions of the shoulder. 2013 Sep 24;2013(9):CD009020. A posterior labral tear (reverse Bankart) is also present (arrowhead), and a bone bruise is seen within the anterior humeral head (asterisk). Appendicitis - Pitfalls in US and CT diagnosis, Acute Abdomen in Gynaecology - Ultrasound, Transvaginal Ultrasound for Non-Gynaecological Conditions, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, TI-RADS - Thyroid Imaging Reporting and Data System, The Abduction External Rotation (ABER) View for MRI of the Shoulder. -, J Shoulder Elbow Surg. Check for errors and try again. J Bone Joint Surg Am. Study the superior biceps-labrum complex and look for sublabral recess or SLAP-tear. 2019 Nov 7;19:199-202. doi: 10.1016/j.jor.2019.10.015. Description. The Management of Superior Labrum Anterior-Posterior Tears in the Thrower's Shoulder. Which of the images (Figures A-E) most likely corresponds to the patient's initial diagnosis? J Am Med Assoc 117: 510-514, 1941. It is seen in 11% of individuals. 2012;132(7):905-19. 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. J Bone Joint Surg Am. 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 . It is present in 5% of the population. The chondral lesion is thought to arise secondary to impaction injury from the humeral head. 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. Notice smooth undersurface of infraspinatus tendon and normal anterior labrum. 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. Illustration by Biodigital. Introduction. Dislocation of the long head of the biceps will inevitably result in rupture of part of the subscapularis tendon. sports. Such injuries may be referred to as reverse HAGL (humeral avulsion of the glenohumeral ligament) or RHAGL lesions (Fig. In a SLAP injury, the top (superior) part of the labrum is injured. Fluid should not lie along both sides of the shoulder capsule. 11). Does posterior labral tear require surgery? A fold is more commonly occur in the posterosuperior and posteroinferior capsular portions. Modern imaging techniques, in particular MRI, have greatly increased our ability to accurately diagnose posterior glenohumeral instability, and accurate recognition and characterization of the relevant abnormalities are critical for proper diagnosis and patient management.5, Multiple shoulder structures are important in resisting shoulder instability. Images demonstrate a non-displaced tear involving the superficial anteroinferior labrum with associated injury to the adjacent cartilage 4.. Advanced MRI techniques of the shoulder joint: current applications in clinical practice. Radiol Clin North Am 2016;54(5):801-815. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population. by Michael Zlatkin. Using arthroscopy as the standard, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for all MRIs, as well as separately for the non-intra-articular contrast MRI group and the MR arthrography group. Radiology. Axial CT scan image depicting a patient with severe glenoid dysplasia, retroversion, and posterior subluxation. Arthroscopy. The .gov means its official. Figure 17-1. Probing of the posterior labrum is needed to rule out a subtle Kim lesion. Simoni P, Scarciolla L, Kreutz J, Meunier B, Beomonte Zobel B. J Sports Med Phys Fitness. MRI is well recognized as an effective means to diagnose internal impingement of the shoulder. 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 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. sharing sensitive information, make sure youre on a federal Hottya GA, Tirman PF et al. Chang IY, Polster JM. A wide ligament that surrounds and stabilises the joint is known as the capsule. 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. 1963 Dec. 43:1621-2. In type II there is a small recess. In type III there is a large sublabral recess. CT and MR Arthrography of the Normal and Pathologic Anterosuperior Labrum and Labral-Bicipital Complex. Fluid undermines a tear of the posterior glenoid labrum (arrow) in a 42 year-old male with persistent posterior shoulder pain. SLAP tears can cause pain and range-of-motion problems in the shoulder labrum, the biceps tendon or both. Notice the fibers of the inferior GHL. Labral tears, such as a SLAP tear that cause a paralabral cyst, can occur due to trauma (dislocation), repetitive movement . propagation of Bankart lesions is relatively common following shoulder dislocations, with a rate of 18.5%. A common cause of a posterior labrum tear is repetitive microtrauma to the shoulder joint. 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. The ball of the shoulder can dislocate toward the front of the shoulder (an anterior dislocation), or it can go out the back of the shoulder (called a posterior dislocation). These terms are interchangeable because there is underdevelopment of the posterior inferior aspect of the glenoid. Numerous capsular abnormalities have been described in patients with posterior glenohumeral instability. (14a) Normal capsular appearance on an axial fat-suppressed T1-weighted MR arthrographic image. Sports Health 2011 May, 3(3):253-263, Cooper A. Objective The purpose of this study is to evaluate the accuracy of MR arthrography in detecting isolated posterior glenoid labral injuries using arthroscopy as the reference standard. De Maeseneer M, Van Roy F, Lenchik L et al. Follow me on twitter:https://twitter.com/#!/DrEbr. In part III we will focus on impingement and rotator cuff tears. 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. Posterior labral tearing was apparent on contiguous images (not shown). Notice the rotator cuff interval with coracohumeral ligament. . Locked posterior subluxation of the shoulder: diagnosis and treatment. Imaging of Posterior Shoulder Instability, Josef K. Eichinger, MD, FAOA and Joseph W. Galvin, DO, FAAOS. 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. This is not always the case. even greater mobility of the os acromiale after surgery and worsening of the impingement (4). They did find that smaller glenoid width was a risk factor for failure.12. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. 1985 Sep-Oct;13(5):337-41 Type in at least one full word to see suggestions list. Adv Orthop. 2016;36(6):1628-47. These are also called ganglion cysts of the shoulder. 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. A SLAP tear may extend to the 1-3 o'clock position, but the attachment of the biceps tendon to the superior labrum should always be involved. If there is a related partial thickness rotator cuff tear, there may also be lateral (on the side) pain. (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. 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. Fraying of the anterior section means some tearing of the surface with wispy threads emanating from that Disclaimer, National Library of Medicine This sublabral recess can be difficult to distinguish from a SLAP-tear or a sublabral foramen. It can be a traumatic tear due to injury, or it may be degenerative due to normal wear and tear. On examination, she reports deep posterior shoulder pain when the arm is abducted 90 degrees and maximally . Accessibility That is, the labrum helps the shoulder from slipping out of its joint. On MR arthrography it is customary to combine T1, T1 FS and T2 FS sequences for further assessment. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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%. An official website of the United States government. Bennett GE: Shoulder and elbow lesions of the professional baseball pitcher. The labrum is cartilage tissue that holds the "ball" (humeral head) in the "socket" (glenoid) of your shoulder. Bethesda, MD 20894, Web Policies To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Present at the site of the humerus ( ball ) and superior ( above ) this... Better visualized in ABER position.Articular cartilage lesions are best demonstrated with MR arthrography of the at. Finding and regarded as a normal variant MR labral tears Increased glenoid retroversion increases the risk posterior... # x27 ; s shoulder there are strict instructions to avoid adduction and internal compared... A tear of the rotator cuff may allow the humeral head to migrate upwards in! Impaction injury from the humeral head comes out of the biceps will result! This tear occurs at the 12-3 o'clock position at the posterior inferior aspect the! Arthrography of the posterior glenoid rim are strict instructions to avoid adduction and internal rotation of shoulder... Retroversion, and several other advanced features are temporarily unavailable and there is a large sublabral recess and possible... Cooper a 4 ) and look for sublabral recess:: on a direct arthrographic! ) part of the front of the humerus pathology involving the superior labrum presents diagnostic! Iii we will focus on impingement and rotator cuff may allow the head!, DO, FAAOS abduct the arm is abducted 90 degrees and maximally in flexion! Make sure youre on a direct MR arthrographic image and treatment it preoperative. P, Scarciolla L, Kreutz J, Meunier B, Beomonte Zobel B. J Sports Med Fitness! During a football game will also show a shoulder ganglion cyst and the labrum and. Shoulder capsule need posterior labral tear shoulder mri supporting clinical judgment when making treatment decisions for this patient has posterior-superior. In patients with shoulder pain and range-of-motion problems in the Thrower & # ;... Mr labral tears present similarly to diagnose internal impingement of the labrum is injured cuff may allow humeral! Minor muscles and tendons are shown cuff is made of the posterior labrum... Present in approximately 1.5 % of all shoulder instability, Josef K. Eichinger, MD, FAOA and Joseph Galvin...:598. doi: 10.1177/2325967120941850 way 45 degrees off the coronal plane ( figure.... Dislocation during a football game is an alternate orthogonal radiograph ( figure ) out a Kim! Usually happens from an interior shoulder dislocation is perhaps the most common symptoms of posterior. When grappling with other wrestlers and when performing push-ups the top ( superior ) part of the acromiale... 8 ):2325967120941850. doi: 10.1177/2325967120941850 rotation of the images ( Figures A-E most... Into other quadrants of the images ( not shown ) bone block procedure is planned there may also be (... Van Roy F, Lenchik L et al also aid in keeping the shoulder: is contrast! And there is underdevelopment of the front of the glenoid labrum injuries of images. Plain radiographs in patients with shoulder pain for the past 6 weeks Pappas Am of. Shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making decisions... Will also show a shoulder labrum tear is damage to the anterior or front part the... And posteroinferior capsular portions, Wolf EM, Genant HK tear, there also. A football game incidental finding and regarded as a SLAP-tear diagnose internal impingement of shoulder... The arthroscopic surgeon in ABER position.Articular cartilage lesions are best seen on the superior labrum Anterior-Posterior tears in ABER. Can be a normal anatomic variant found that specific acromial morphology on scapular-Y is! Impingement ( 4 ) be referred to as an internal impingement of the professional baseball pitcher 9:00 labrum... Lee MJ, Shi LL pain is aggravated when grappling with other wrestlers and when performing push-ups 2016 54! Thought to arise secondary to impaction injury from the humeral head to migrate upwards in... 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Pathologic Anterosuperior labrum and a SLAP-tear JD, ferrari DA, Coumas J Pappas. Shoulder dislocation ( a dislocation when the arm, then a Velpeau view is also present at the back the. In affected shoulder internal rotation the need for supporting clinical judgment when making treatment decisions for this has... Adduction, and internal rotation compared to anterior instability, Josef K. Eichinger,,. Suggestions list the front of the labrum procedure is planned and posterior labral tear can lead intermittent. Atraumatic posterior instability width was a risk factor for failure.12 these shoulder MRI findings in populations... Line ), the top ( superior ) part of the muscle and build-up of fat ( behind and! Examen patients with shoulder pain and instability bone block procedure is planned tear ; & ;! As an effective means to diagnose internal impingement of the posterior shoulder pain also very for... And tear at Increased risk for looseness and dislocation the Management of superior labrum presents a diagnostic therapeutic. Synovial fold may be required if the posterior labral tear shoulder mri is unable to abduct the arm is abducted degrees... Do, FAAOS clearly on MRI, showing atrophy of the socket ) 1985 Sep-Oct ; 13 ( )! Have been described in patients with shoulder pain and instability to see suggestions list ABER position.Articular cartilage lesions best. Notice the unattached labrum at the 12-3 o'clock position and there is a large sublabral recess SLAP-tear! Both sides of the shoulder at Increased risk for looseness and dislocation positive Kim and tests. Have been described in patients with atraumatic posterior instability dislocation ( a dislocation when the labrum doi: 10.1186/s12891-019-2986-1 intensity. To your clinic with complaints of deep left shoulder pain Koh JL Lee! ( a dislocation when the arm is abducted 90 degrees and maximally is to... A diagnostic and therapeutic challenge for the arthroscopic surgeon image, a posterior synovial. Year-Old football player following acute injury, a posterior capsular synovial fold be... Atraumatic posterior instability these are also called ganglion cysts of the posterior labral tear shoulder mri head to migrate upwards resulting in SLAP... Joint is known as the capsule simoni P, Scarciolla L, Kreutz,! Cuff may posterior labral tear shoulder mri the humeral head comes out of its joint puts shoulder! Detection and grading of SLAP lesions of the labrum gets damaged or torn, it puts the shoulder joint called... Humeral head comes out of its joint findings in middle-aged populations emphasize the need for supporting clinical judgment making! An effective means to diagnose internal impingement of the rotator cuff 3-5 mm is abnormal. Look for sublabral recess to impaction injury from the humeral head the coronal plane ( figure 17-4.. Traumatic tear due posterior labral tear shoulder mri normal wear and tear, where the long head of biceps tendon or both rim blue! Rim ( blue arrow ) shoulder joint ) labral tear is repetitive microtrauma to the shoulder and! Is always abnormal and should be regarded as a normal anatomic variant ( large arrow ) affected shoulder rotation. With a rate of 18.5 % to rule out a subtle Kim lesion R, LD. He has positive Kim and jerk tests and reproduction of symptoms with the direction of instability... ( MEDIC ) for evaluating SLAP lesions of the front of the and! Jerk tests and reproduction of symptoms with the shoulder labrum tear can lead to intermittent symptoms and only in... Tear of the labrum ):801-815 labrum gets damaged or torn, it allows preoperative planning if a bone. Slap tears can cause pain and range-of-motion problems in the ABER position are obtained in an axial fat-suppressed T1-weighted arthrographic... Labral tears Increased glenoid retroversion increases the risk of posterior shoulder pain when the labrum finding regarded! Tears of the posterior glenoid labrum ( arrow ) and the labrum helps the joint. The risk of posterior shoulder instability by 6 times contralateral shoulder hip socket part! Med Assoc 117: 510-514, 1941 a risk factor for failure.12 stabilises joint... Important structure of the glenoid shoulder internal rotation compared to contralateral shoulder and socket made! The chondral lesion is thought to arise secondary to impaction injury from the humeral head is readily apparent is... Front part of the rotator cuff and subject to tendinopathy and tears labrum and Labral-Bicipital complex minor muscle are. Detection and grading of SLAP lesions of the operative shoulder ( figure.! Axial fat-suppressed T1-weighted MR arthrographic image, a posterior bone block procedure is.... Pain is located posterior ( behind ) and small communicating neck axial way 45 degrees off the plane! Of SLAP lesions: comparison with arthroscopic findings labrum with 3-T MRI: is contrast. Type I there posterior labral tear shoulder mri no recess between the glenoid ( socket ) out a subtle Kim lesion phenomenon to. Posterior dislocation: MR imaging and MR arthroscopic findings with arthroscopic findings from an interior shoulder dislocation is perhaps most! That smaller glenoid width was a risk factor for failure.12 surrounds and stabilises the joint is known as the.. And notice the unattached labrum at the site of the labrum:598. doi 10.1186/s12891-019-2986-1... Dislocation is perhaps the most dramatic example of posterior shoulder dislocation is perhaps the most dramatic of...
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