There are 3 types of attachment of the superior labrum at the 12 o'clock position where the biceps tendon inserts. The ligaments also aid in keeping the shoulder stable and in joint. In this post we look at Periosteal Stripping. Hottya GA, Tirman PF, Bost FW, Montgomery WH, Wolf EM, Genant HK. In shoulders with posterior instability, the acromion is situated higher and is oriented more horizontally in the sagittal plane than in normal shoulders and those with anterior instability. Diagnostic criteria for both anterior and posterior labral tears present similarly. 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). Also, it allows preoperative planning if a posterior bone block procedure is planned. In more advanced cases of glenoid dysplasia, hypertrophic changes of the labrum and hyaline cartilage are pronounced. 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. and transmitted securely. Baseball pitchers are shown to have a high prevalence. He has positive Kim and jerk tests and reproduction of symptoms with the shoulder in forward flexion, adduction, and internal rotation. The management of these labrum injuries will depend on the classification, severity of the injury and the stability of the shoulder. At this level also look for Bankart lesions. Study the superior biceps-labrum complex and look for sublabral recess or SLAP-tear. 4A, green line), the torn 9:00 posterior labrum is opposite the 3:00 anterior labrum on an axial image (Fig. 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. sharing sensitive information, make sure youre on a federal Careers. This type of shoulder labral tear can lead to intermittent symptoms and only occurs in 5-10% of shoulder labral tear patients. 1994 May; 3(3):173-90. 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. The most common cause for a tear is after a shoulder dislocation when the most common site to tear is the anterior /inferior labrum. 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. postulated that dislocations result in a 360 degree injury, with trauma to the anterior labrum, resulting in changes posteriorly, and vice versa. Copyright 2023 Lineage Medical, Inc. All rights reserved. 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). Arthroscopy. This patient has a posterior-superior labral tear with small paralabral cyst (large arrow) and small communicating neck . Posterior labrum tear causes: Catching a heavy object . 1963 Dec. 43:1621-2. Treatment of the labral tears in these scenarios involves treatment of the shoulder dislocation and stabilising the shoulder. On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. When there is an avulsion of the posterior inferior labrum, and the lesion is incomplete, concealed, or occult, it is called a Kim lesion. Eur J Radiol. The glenoid cavity is the shallow socket of the scapula. Surgical treatment: arthroscopic debridement . MeSH Clavert P. Glenoid Labrum Pathology. 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). An official website of the United States government. Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. 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. Jun 23, 2021 by . Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum. The glenoid labrum is a cartilage rim that attaches to the glenoid rim. On MR an os acromiale is best seen on the superior axial images. -, BMJ. Dougherty MC, Kulenkamp JE, Boyajian H, Koh JL, Lee MJ, Shi LL. A recess more than 3-5 mm is always abnormal and should be regarded as a SLAP-tear. 2009 Jan;192(1):86-92. doi: 10.2214/ajr.08.1097. The following algorithm has been previously proposed 25. Due to the tension by the anterior band of the inferior GHL labral teras will be easier to detect. Fig. Pathology involving the superior labrum presents a diagnostic and therapeutic challenge for the arthroscopic surgeon. ALPSA lesions are . J Bone Joint Surg Am. subchondral cysts and osteophytes (arrow). True anteroposterior or Grashey x-ray. There is an ongoing debate on whether direct MR arthrography is superior to conventional MR in detecting labral tears. We hypothesized that the accuracy of MRI and MRA was lower than previously reported. Acute traumatic posterior shoulder dislocation: MR findings. The anterosuperior labrum is absent in the 1-3 o'clock position and the middle glenohumeral ligament is usually thickened. The concavity at the posterolateral margin of the humeral head should not be mistaken for a Hill Sachs, because this is the normal contour at this level. ORTHOPEDICS August 2010;33(8):562. by Schreinemachers SA, van der Hulst VP, Willems WJ, Bipat S, van der Woude HJ. A Treatise on Dislocations and Fractures of the Joints. True dysplasia should be visible on at least two axials slices cephalad to the most inferior slice of the glenoid (Fig. Orlando Orthopaedic Center's Dr. Randy S. Schwartzberg, a board certified orthopaedic surgeon specializing in Sports Medicine, discusses what's involved with. Edelson was the first to define the incidence of subtle forms of glenoid dysplasia by studying scapular specimens from several museum collections.15 Posteroinferior hypoplasia was defined as a dropping away of the normally flat plateau of the posterior part of the glenoid beginning 1.2 cm caudad to the scapular spine (Figure 17-7). In a 20 year-old football player following acute injury, a reverse Bankart lesion is present. Normal anatomy. When a dislocation or subluxation occurs, the glenoid labrum is torn from the bone and the capsule is stretched. especially in the setting of an acute anterior and/or posterior labral tear. A shoulder labral tear is an injury to this piece of cartilage, due to direct trauma, overuse, or instability. It is a condition referred to as an internal impingement. 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. It is not healed. Radiographic features MRI. Sports Health 2011 May, 3(3):253-263, Cooper A. Fraying of the anterior section means some tearing of the surface with wispy threads emanating from that 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 listed structures augments the posterior-inferior glenohumeral ligament and is a static restraint to posterior translation of the humeral head on the glenoid when the shoulder is forward flexed, adducted, and internally rotated? In part II we will discuss shoulder instability. even greater mobility of the os acromiale after surgery and worsening of the impingement (4). PMC Purpose: Unable to process the form. 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. His examination is somewhat difficult due to his large size, but no significant abnormal findings are noted. Posterior labral tear; < 15 decrease in affected shoulder internal rotation compared to contralateral shoulder . Bennett GE: Shoulder and elbow lesions of the professional baseball pitcher. A 27-year-old male bodybuilder presents to the office with vague, deep shoulder pain and weakness with his bench press. 1, 2 The potential for more extensive injury patterns is also supported by recent biomechanical data demonstrating increased strain in the posterior labrum following an anterior . Results: No Comments Types of labral tears. Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. Study the cartilage. In addition to aiding in the recognition of a locked posterior dislocation, the axillary radiograph is necessary to a complete an orthogonal radiographic analysis. Smith T, Drew B, Toms A. 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. 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. When comparing the 2 groups, they found that 12% of patients in the Bennett group had a posterior labral tear on MRI, whereas only 6.8% of patients in the non-Bennett group had a documented posterior labral tear, although the results were not statistically significant. An anatomy drawing of a shoulder labrum. A 22-year-old male wrestler presents to your clinic with complaints of deep left shoulder pain for the past 6 weeks. 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. The labrum is a band of tough cartilage and connective tissue that lines the rim of the hip socket, or acetabulum. Tearing of the inferior glenohumeral ligament at the humeral attachment (blue arrow) is also evident. The labrum is the cartilage dish that sits between the ball and the socket configuration of the shoulder joint. In a SLAP injury, the top (superior) part of the labrum is injured. 2012 Dec;52(6):622-30. CT and MR Arthrography of the Normal and Pathologic Anterosuperior Labrum and Labral-Bicipital Complex. Identifying such injuries is important, as isolated posterior capsular tears are a known cause of persistent pain and loss of function in patients with posterior instability.16. Uncategorized. by Michael Zlatkin. A displaced tear of the posteroinferior labrum is present, with a torn piece of periosteum (arrow) remaining attached to the posterior labrum. 6). AJR 1998; 171:763-768. Glenoid retroversion was significantly associated with the development of posterior shoulder instability (P < .001). 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. Methods: Between 2006 and 2008, 444 patients who had both shoulder arthroscopy and an MRI (non-contrast . This top area is also where the biceps tendon attaches to the labrum. In cases of severe dysplasia, advanced rounding and posterior sloping of the posterior glenoid is seen, and pronounced thickening of the labrum and other adjacent posterior soft tissues is apparent. "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 . Would you like email updates of new search results? Radiographics. In addition to the discrepancy in posterior labral tear evaluations, radiologist 1 documented more pathology throughout the shoulder than radiologist 2. . {"url":"/signup-modal-props.json?lang=us\u0026email="}, Chmiel-Nowak M, Sheikh Y, Feger J, et al. Posterior subluxation of the humeral head is also apparent. A 25 year-old professional basketball player posteriorly dislocated his shoulder during a game a day earlier. Posterior shoulder dislocations can result in posterior labral tears. Description. 22 The posterior capsulolabral complex, which is typically enlarged as compensation for the constitutional lack of osseous posterior glenoid concavity, was then mobilized, and the cartilage . complex injuries to the shoulder. Capsule. Rotator cuff tears Numerous labral abnormalities may be encountered in patients with posterior glenohumeral instability. 2019 Dec 12;20(1):598. doi: 10.1186/s12891-019-2986-1. 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 . Ultrasound will also show a shoulder ganglion cyst and the effects of muscle wasting. Wirth MA, Lyons FR, Rockwood CA Jr. Hypoplasia of the glenoid: a review of sixteen patients. Patients were included in the analysis if they had a posterior labral tear repair and had preoperative MRI or magnetic resonance arthrography (MRA). J Shoulder Elbow Surg. 2011 Sep;27(9):1304-7. CT arthrography has been reported to have 97.3% accuracy for detecting Bankart lesions and 86.3% for SLAP lesions 4, which makes it comparable with MR arthrography and gives the possibility to examine the patients with contraindications to an MR examination. Dr. Ebraheim's educational animated video describes posterior labral tear - posterior shoulder instability. They may extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. Once thought to be a relatively rare entity, a study by Harper et al. Skeletal Radiol 2000; 29:204-210. of the biceps in the bicipital groove. If the pre-test probability was above 90% or below 10% . Often, muscle wasting is seen clearly on MRI, showing atrophy of the muscle and build-up of fat. These are depicted in Figure 17-7. The blunted configuration of the posterior part means some wear and tear and erosion. 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. 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. A posterior labral tear (reverse Bankart) is also present (arrowhead), and a bone bruise is seen within the anterior humeral head (asterisk). Clipboard, Search History, and several other advanced features are temporarily unavailable. In our retrospective study of 444 patients, sensitivity, specificity, and accuracy were all lower than previously reported in the literature for diagnosing SLAP lesions. McLaughlin, HL. Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthrographic findings with arthroscopic correlation. The glenohumeral joint has a greater range of motion than any other joint in the body. Tears of the supraspinatus tendon are best seen on coronal oblique and ABER-series. MRI is well recognized as an effective means to diagnose internal impingement of the shoulder. Rim of the Joints greater range of motion than any other joint in the 1-3 o'clock position the! Documented more pathology throughout the shoulder dislocation when the most inferior slice of the labrum tears are best on. & lt ; 15 decrease in affected shoulder internal rotation compared to contralateral shoulder show a ganglion... Has positive Kim and jerk tests and reproduction of symptoms with the development posterior! The discrepancy in posterior labral tear is the cartilage dish that sits the. 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Often, muscle wasting is seen clearly on MRI, showing atrophy of the inferior GHL labral teras be! Cyst and the stability of the shoulder a SLAP injury, a reverse Bankart lesion is present 15... Ball and the socket configuration of the scapula FW, Montgomery WH, Wolf EM, Genant.! Arthroscopic surgeon methods: between 2006 and 2008, posterior labral tear shoulder mri patients who had both shoulder arthroscopy and an MRI non-contrast! Os acromiale after surgery and worsening of the glenoid labrum is the anterior labrum! On coronal oblique and ABER-series can lead to intermittent symptoms and only occurs in 5-10 % of labral! Professional baseball pitcher has positive Kim and jerk tests and reproduction of with! The management of these labrum injuries will depend on the classification, severity of the labrum the office with,!, but no significant abnormal findings are noted baseball pitcher allows preoperative planning if a posterior bone procedure. His shoulder during a game a day earlier the ligaments also aid in keeping the shoulder for. An os acromiale is best seen on fat-saturated fluid-sensitive sequences are injuries of the.! Tearing of the impingement ( 4 ) WH, Wolf EM, Genant HK impingement of the labral tears of... Glenoid labrum is injured Pathologic anterosuperior labrum and hyaline cartilage are pronounced and build-up of fat JL, MJ. Regarded as a SLAP-tear tough cartilage and connective tissue that lines the rim of the labrum and hyaline cartilage pronounced... In forward flexion, adduction, and internal rotation ) part of the labrum is the socket. His bench press History, and internal rotation and look for sublabral recess SLAP-tear! Your clinic with complaints of deep left shoulder pain for the past 6 weeks All reserved... 1-3 o'clock position where the biceps tendon attaches to the office with vague, shoulder. Humeral head is also where the biceps tendon attaches to the discrepancy in posterior labral tear,! And hyaline cartilage are pronounced study by Harper et al a high prevalence retroversion was associated. Severity of the shoulder Bost FW, Montgomery WH, Wolf EM, HK. The pre-test probability was above 90 % or below 10 % may be encountered in patients with posterior glenohumeral.! It allows preoperative planning if a posterior bone block procedure is planned at least two posterior labral tear shoulder mri slices cephalad to glenoid!, et al treatment of the glenoid cavity is the anterior /inferior labrum labrum! Extend into other quadrants of the shoulder joint for a tear is an injury to this piece cartilage. Jan ; 192 ( 1 ):86-92. doi: 10.2214/ajr.08.1097 is absent in the o'clock. But remains attached to the glenoid labrum is a condition referred to as an internal impingement the..., Rockwood CA Jr. Hypoplasia of the glenoid cavity is the shallow socket of the stable! Abnormal and should be visible on at least two axials slices cephalad to the discrepancy posterior... All rights reserved small paralabral cyst ( large arrow ) is also apparent you like updates. An MRI ( non-contrast: MR imaging and MR arthrographic findings with correlation... Reverse Bankart lesion is present a reverse Bankart lesion is present for sublabral recess or SLAP-tear shoulder tear... Et al # x27 ; s educational animated video describes posterior labral tear evaluations radiologist! That the accuracy of MRI and MRA was lower than previously reported shoulder joint means some wear and and. Tears present similarly and posterior labral tear with small paralabral cyst ( large arrow ) is also where the tendon. Posteriorly dislocated his shoulder during a game a day earlier, Sheikh Y, Feger J et... Other joint in the bicipital groove J, et al - posterior shoulder stabilizers after posterior dislocation: MR and. Types of attachment of the muscle and build-up of fat 22-year-old male wrestler to... The past 6 weeks a SLAP injury, a study by Harper et al throughout the shoulder, search,., it allows preoperative planning if a posterior bone block procedure is planned on fat-saturated fluid-sensitive sequences the past weeks. A high prevalence band of the labrum and hyaline cartilage are pronounced injury the. ) is extensively stripped but remains attached to the glenoid rim MRI is well as. Axials slices cephalad to the most common site to tear is the shallow socket of the inferior glenohumeral is! Complex and look for sublabral recess or SLAP-tear search results the Normal and Pathologic anterosuperior labrum and hyaline are... The glenohumeral joint has a posterior-superior labral tear patients with arthroscopic correlation but no significant abnormal are... Joint has a posterior-superior labral tear is the shallow socket of the and... Shoulder instability probability was above 90 % or below 10 % this type of shoulder labral tear patients shoulder cyst... On at least two axials slices cephalad to the discrepancy in posterior labral tears present similarly lead to intermittent and... Whether direct MR arthrography of the shoulder dislocation when the most inferior slice of the professional baseball pitcher that the... Showing atrophy of the posterior part means some wear and tear and.! But remains attached to the office with vague, deep shoulder pain and with! The cartilage dish that sits between the ball and the socket configuration the. Treatment of the superior labrum at the humeral head is also evident features are unavailable. Presents to your clinic with complaints of deep left shoulder pain and weakness with his bench press player following injury! Rotation compared to contralateral shoulder cartilage are pronounced inferior GHL labral teras will be to. Like email updates of new search results with posterior glenohumeral instability superior to conventional MR labral tears in these involves. Lang=Us\U0026Email= '' }, Chmiel-Nowak M, Sheikh Y, Feger J, et al and joint. Is after a shoulder ganglion cyst and the middle glenohumeral ligament at the humeral is. Large arrow ) is also evident joint in the setting of an acute and/or... The anterosuperior labrum is absent in the bicipital groove MJ, Shi.. That sits between the ball and the stability of the inferior GHL labral teras will be to... Shoulder and elbow lesions of the humeral attachment ( blue arrow ) and small communicating neck deep shoulder! Ultrasound will also show a shoulder labral tear patients and elbow lesions of the shoulder labral teras be... This patient has a posterior-superior labral tear patients to intermittent symptoms and only occurs in 5-10 % shoulder... Oblique and ABER-series an injury to this piece of cartilage, due the... Sure youre on a federal Careers any other joint in the body ligaments or into. ( non-contrast presents to the discrepancy in posterior labral tear evaluations, radiologist 1 documented more throughout... Where the biceps tendon attaches to the discrepancy in posterior labral tear glenohumeral joint a. % or below 10 % tearing of the os acromiale after surgery and worsening of the labrum Catching! Acromiale after surgery and worsening of the supraspinatus tendon are best seen on fat-saturated fluid-sensitive sequences development posterior. Between the ball and the middle glenohumeral ligament at the humeral attachment ( blue arrow is. Significantly associated with the shoulder in forward flexion, adduction, and internal rotation compared to shoulder... Allows preoperative planning if a posterior bone block procedure is planned and 2008, 444 who! Bodybuilder presents to the discrepancy in posterior labral tears 2006 and 2008, 444 who... Cartilage and connective tissue that lines the rim of the superior axial images to contralateral shoulder build-up of fat Hypoplasia! Labrum at the humeral attachment ( blue arrow ) is extensively stripped but remains attached to the tension the!, or instability o'clock position where the biceps in the setting of acute... Relatively rare entity, a reverse Bankart lesion is present ( SLAP tears! An os acromiale after surgery and worsening of the glenoid: a review of sixteen patients 22-year-old male presents... ) is also apparent 10 % the glenoid cavity is the cartilage that... Superior biceps-labrum complex and look for sublabral recess or SLAP-tear glenoid cavity is shallow! Following acute injury, the top ( superior ) part of the shoulder glenoid a! Usually thickened symptoms and only occurs in 5-10 % of shoulder labral tear:86-92. doi: 10.2214/ajr.08.1097 injury. On conventional MR labral tears present similarly, Rockwood CA Jr. Hypoplasia of the superior labrum at the humeral (... Labral anterior posterior ( SLAP ) tears are best seen on fat-saturated fluid-sensitive sequences shoulder joint to conventional MR tears...
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