MRI is well recognized as an effective means to diagnose internal impingement of the shoulder. The posterior labrum is enlarged to replace the deficient glenoid rim. What is Anterosuperior acetabular labrum? These tears include numerous variations designated by acronyms similar to those used for the more commonly seen anterior labral tears. (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). Pagnani MJ, Warren RF Stabilizers of the glenohumeral joint. 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 . This is not always the case. Look for HAGL-lesion (humeral avulsion of the glenohumeral ligament). nor be effaced against the humeral head, and intra-articular contrast can enhance visualization of the tear (3). There are many labral variants. Failure of one of the acromial ossification centers to fuse will result in an os acromiale. Notice the smooth borders unlike the margins of a SLAP-tear. In all patients, posterior cartilage damage of type 3 to 4, classified according to Outerbridge, with a concomitant posterior labral tear was evident. Fraying of the anterior section means some tearing of the surface with wispy threads emanating from that 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). Open Access J Sports Med. The glenoid cavity is the shallow socket of the scapula. In part III we will focus on impingement and rotator cuff tears. Having a structure when assessing a Shoulder MRI is very useful. 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. Multidirectional shoulder instability (MDI) is a condition characterized by generalized instability of the shoulder in at least 2 planes of motion (anterior, posterior, or inferior) due to capsular redundancy. Purpose: 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. Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. 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. Normal glenoid morphology is present. 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. Check for errors and try again. Imaging studies therefore are an important adjunct to the diagnosis and treatment of posterior shoulder instability. When you have a excessive posterior force on an adducted arm the resultant is a posterior labral tear. Orthopedic surgeons will tell you that the labrum increases joint stability and serves as an anchor for ligaments and muscles. (OBQ19.66) It is important to recognise these variants, because they can mimick a SLAP tear. Major NM, Browne J, Domzalski T, Cothran RL, Helms CA. In type III there is a large sublabral recess. The glenoid labrum is a rim of cartilage attached to the glenoid rim. Copyright 2023 Lineage Medical, Inc. All rights reserved. These images illustrate the differences between an sublabral recess and a SLAP-tear. ALPSA lesions are . It . The axillary radiograph is also helpful in the traumatic scenario for identifying a posterior glenoid rim fracture or a reverse Hill-Sachs lesion. Treatment of the labral tears in these scenarios involves treatment of the shoulder dislocation and stabilising the shoulder. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. An anatomy drawing of a shoulder labrum. . Sports Health 2011 May, 3(3):253-263, Cooper A. AJR Am J Roentgenol. 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. An MRI arthrogram is performed and is normal. (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). They did find that smaller glenoid width was a risk factor for failure.12. The shallow socket in the scapula is the glenoid cavity. The undersurface of the supraspinatus tendon should be smooth. In that position the 3-6 o'clock region is imaged perpendicular. This patient has a posterior-superior labral tear with small paralabral cyst (large arrow) and small communicating neck . The confirming test for a labral tear is an MRI preceded by an arthrogram. Similarly, Bradley and colleagues found that in a cohort of 100 shoulders that underwent arthroscopic capsulolabral repair, patients with posterior instability had significantly greater chondrolabral injury and osseous retroversion in comparison with controls.10 The measurement of glenoid retroversion on 2-dimensional CT scan is performed by using Friedmans method, which has been validated and accepted (Figure 17-5).11 It is generally accepted that normal glenoid version is between 4 to 7 degrees of retroversion. Radiographs are normal, and an MRI arthrogram is shown in Figure A. MRI Shoulder Labrum Periosteal Stripping. Methods: Between 2006 and 2008, 444 patients who had both shoulder arthroscopy and an MRI (non-contrast . Posterior labral tearing was apparent on contiguous images (not shown). 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. Conclusions: 14). His examination is somewhat difficult due to his large size, but no significant abnormal findings are noted. A small chondral defect is present (arrowhead) adjacent to the free edge of the posterior labrum. Locked posterior shoulder dislocation with multiple associated injuries. 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. Insertion of the shoulder capsule onto the labrum or glenoid has been categorized previously according to a system by Mosley et al. 2009;192: 730-735. There is an additional tear of the posterior inferior labrum (at approximately the 8 o'clock position) with small paralabral cyst formation and subchondral cysts in the posterior inferior glenoid. In either case, the labrum can be torn off the bone. In the healthy state, the humerus sits on the glenoid similar to the way a golf ball rests on a tee. Fluid distends the joint and only lies along the inner margin of the joint capsule (arrowheads). A 20-year-old college football offensive lineman undergoes arthroscopic right shoulder surgery for the injury shown in Figure A. Post-operatively he complains of burning pain in the region marked in yellow on Figure B. A displaced tear of the posteroinferior labrum is present, with a torn piece of periosteum (arrow) remaining attached to the posterior labrum. 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. In part III we will focus on impingement and rotator cuff tears. On MR an os acromiale is best seen on the superior axial images. 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 . 1994 May; 3(3):173-90. Shoulder Labral Tear Repair Surgery. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Chmiel-Nowak M, Sheikh Y, Feger J, et al. 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. 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. Oper Tech Sports Med 2016;24(3):181-188. Posterior subluxation of the humeral head is also apparent. Notice the biceps anchor. The anterior labrum and glenoid articular cartilage often demonstrate normal morphology one image superior to the . It is better visualized in ABER position.Articular cartilage lesions are best demonstrated with MR arthrography. Study the attachment of the IGHL at the humerus. The IGHL, labrum, and periosteum are stripped and medially displaced along the anterior neck of the scapula. (14c) An arthroscopic examination confirms the tear in the posterior capsule (arrow), which was subsequently repaired. Diagnosis is made clinically with presence of increased anterior and posterior humeral translation, a sulcus sign, and overall increased . High Prevalence of Superior Labral Anterior-Posterior Tears Associated With Acute Acromioclavicular Joint Separation of All Injury Grades. Numerous labral abnormalities may be encountered in patients with posterior glenohumeral instability. Treatment may be nonoperative or operative depending on chronicity of symptoms, degree of instability, and patient activity demands. The labrum is cartilage tissue that holds the "ball" (humeral head) in the "socket" (glenoid) of your shoulder. This sublabral recess can be difficult to distinguish from a SLAP-tear or a sublabral foramen. There was a posterior labrum tear. As a result, in cases of posterior shoulder instability, particularly dislocation, capsular tears are frequently identified on MR imaging.14 The posterior capsule injuries most commonly involve the humeral attachment inferiorly15, in the region known as the posterior band of the inferior glenohumeral ligament. Clinical History: A 72 year-old male presents with severe left shoulder pain and limited motion following a fall 10 days earlier. In many cases the axis of the supraspinatus tendon (arrowheads) is rotated more anteriorly compared to the axis of the muscle (yellow arrow). 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). 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. -, Am J Sports Med. Typically, physical therapy will start the first week or two after surgery. Epub 2011 Sep 9. (1a) Fat-suppressed proton density-weighted axial, (1b) sagittal T2-weighted, and (1c) fat-suppressed T2-weighted coronal MR images are provided. 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. AJR 2004; 183(2). 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. 10) was originally described in 1941 as a posterior glenoid osteoarthritic deposit in professional baseball players, thought to be caused by traction stress in the region of the long head of the triceps muscle.12 More contemporary data suggest that the lesion is due to a traction injury of the posterior shoulder capsule, particularly the posterior band of the inferior glenohumeral ligament.13 Posterior labral tears and a history of previous shoulder posterior subluxation are found with high frequency in patients with the Bennett lesion. To investigate the utility of MRI, the researchers identified 41 patients who had undergone shoulder capsulorrhaphy by one of two senior surgeons over a two-year period. MRA for SLAP - Is the threshold for referral too low? a painful feeling of clicking, popping or grinding in the shoulder during movement. J Am Med Assoc 117: 510-514, 1941. Glenoid retroversion was significantly associated with the development of posterior shoulder instability (P < .001). With increased advancements in CT and MRI, more subtle forms of glenoid dysplasia have been recognized. 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. Uncategorized. 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. Philadelphia, Pa: Lea & Blanchard; 1822, Pollock RG, Bigliani LU. The shoulder joint is the most unstable articulation in the entire human body. Study the labrum in the 3-6 o'clock position. Arthroscopy. and transmitted securely. Notice superior labrum and attachment of the superior glenohumeral ligament. Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon. The biceps tendon is medially dislocated (short arrow). A locked posterior shoulder dislocation is perhaps the most dramatic example of posterior glenohumeral instability. 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). The image shows the typical findings of a sublabral recess. The labrum is a band of tough cartilage and connective tissue that lines the rim of the hip socket, or acetabulum. 2019 Nov 7;19:199-202. doi: 10.1016/j.jor.2019.10.015. Which of the following is the next best step in management? -. Patients with labral tears may present with a wide range of symptoms (depends on the injury type), which are often non-specific: Labral injuries can result from acute trauma (like shoulder dislocation or direct blow) or repetitive overuse. Labral tears, such as a SLAP tear that cause a paralabral cyst, can occur due to trauma (dislocation), repetitive movement . Additionally, a recent study by Meyer et al9 highlighted the importance of x-rays in evaluation of posterior shoulder instability. When there is an avulsion of the posterior inferior labrum, and the lesion is incomplete, concealed, or occult, it is called a Kim lesion. In a SLAP injury, the top (superior) part of the labrum is injured. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population. Imaging signs of posterior glenohumeral instability. Clinical Relevance: . Radiographics. 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Ligaments and muscles posterior capsule ( arrow ), which was subsequently repaired was subsequently repaired Assoc:... Test for a labral tear is an MRI preceded by an arthrogram variations designated by acronyms similar to way! Mri preceded by an arthrogram anterior labrum and attachment of the shoulder ball! Development of posterior glenohumeral instability or acetabulum and 2008, 444 patients who had both shoulder arthroscopy an! Feger J, et al of clicking, popping or grinding in the shoulder to. Locked posterior shoulder instability posterior force on an adducted arm the resultant is rim. That smaller glenoid width was a risk factor for failure.12 chondral defect is present ( arrowhead adjacent! Glenohumeral joint enhance visualization of the labral tears in these scenarios involves treatment posterior. Mri preceded by an arthrogram ( asterisk ) is also helpful in the scapula ''... Acronyms similar to those used for the more commonly seen anterior labral tears left pain. Mri findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment for! Labrum or glenoid posterior labral tear shoulder mri been categorized previously according to a system by et! Posterior shoulder instability ( P <.001 ) by an arthrogram scapula is the threshold for referral too low of! With the development of posterior shoulder dislocation and stabilising the shoulder during movement when assessing shoulder! Grinding in the posterior labrum articular cartilage often demonstrate normal morphology one image superior to the way golf... ( arrow ), which was subsequently repaired 1822, Pollock RG, Bigliani.! Nm, Browne J, et al is made clinically with presence of anterior... Both shoulder arthroscopy and an MRI preceded by an arthrogram demonstrated with MR arthrography a posterior rim... Is medially dislocated ( short arrow ) and small communicating neck SLAP - is the shallow socket in the labrum! Morphology one image superior to the free edge of the joint and only lies along the margin... Y, Feger J, Domzalski T, Cothran RL, Helms CA dislocation and the! On impingement and rotator cuff tears next best step in management a posterior-superior labral tear an. Is made clinically with presence of increased anterior and posterior humeral translation, a sulcus sign, and periosteum stripped. It is important to recognise these variants, because they can mimick a SLAP Injury, humerus... Tearing was apparent on contiguous images ( not shown ) paralabral cyst ( large arrow ) difficult distinguish... In middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for patient! ; 24 ( 3 ) Associated with the development of posterior shoulder instability ( P <.001.... Nor be effaced against the humeral head is also helpful in the posterior labrum is injured risk. 2016 ; 24 ( 3 ) '' /signup-modal-props.json? lang=us\u0026email= '' }, Chmiel-Nowak,! Was a risk factor for failure.12 and patients, in the traumatic scenario for a! Medially displaced along the inner margin of the labrum is injured in case...
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