posterior labral tear shoulder mri

The vast majority of shoulder labral tears do not need surgery. J Am Med Assoc 117: 510-514, 1941. Large tears of the rotator cuff may allow the humeral head to migrate upwards resulting in a high riding humeral head. Am J Roentgenol. Findings compatible with posterior shoulder subluxation with an intramuscular tear of the teres minor, a posterior labral tear, and posterior capsular disruption. In part II we will discuss shoulder instability. 2000;20 Spec No(suppl_1):S67-81. Treatment of the labral tears in these scenarios involves treatment of the shoulder dislocation and stabilising the shoulder. A hip (acetabular) labral tear is damage to cartilage and tissue in the hip socket. 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. Type 1 shoulder labrum tear. The axillary radiograph is also helpful in the traumatic scenario for identifying a posterior glenoid rim fracture or a reverse Hill-Sachs lesion. Imaging in three planes is advisable and additional orthogonal planes may be included in the protocol for a detailed assessment of the lesion. 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. MRA for SLAP - Is the threshold for referral too low? The labrum is a band of tough cartilage and connective tissue that lines the rim of the hip socket, or acetabulum. As joint instability is often present, capsuloplasty may be added to the procedure. While this certainly introduces vulnerability to injury, it also confers the advantage of broad range of motion. The radiologic diagnosis and surgical evaluation were compared to determine the accuracy of diagnosing a SLAP lesion by MRI. ALPSA lesions are . Look for variants like the Buford complex. The choice of treatment options for posterior glenohumeral instability is highly dependent upon the nature and acuity of the instability and the extent of associated injuries. The ligaments also aid in keeping the shoulder stable and in joint. Types of labral tears. We hypothesize that this population will have fewer labral abnormalities than an athletic population. The labrum is a thick fibrous ring that surrounds the glenoid. Recurrent posterior shoulder instability: diagnosis and treatment. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. If the pre-test probability was above 90% or below 10% . (OBQ12.268) Fluid distends the joint and only lies along the inner margin of the joint capsule (arrowheads). 2019 Oct 31;2019:9013935. doi: 10.1155/2019/9013935. Glenoid labral tears are the injuries of the glenoid labrum and a possible cause of shoulder pain. In patients with posterior instability, the presence of glenoid hypoplasia is predictably higher, with one report finding deficiency of the posteroinferior glenoid in 93% of patients with atraumatic posterior instability.10 When diagnosing posterior glenoid hypoplasia on MRI, care should be taken not to overcall the entity, as volume averaging can result in a false appearance of dysplasia on the most inferior axial slice. A sublabral foramen or sublabral hole is an unattached anterosuperior labrum at the 1-3 o'clock position. Posterior labral tearing was apparent on contiguous images (not shown). Surgical treatment: arthroscopic debridement . Notice coracoclavicular ligament and short head of the biceps. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. Oper Tech Sports Med 2016;24(3):181-188. AJR Am J Roentgenol. If this appearance is present, a capsular tear should be strongly suspected (Fig. Hottya GA, Tirman PF, Bost FW, Montgomery WH, Wolf EM, Genant HK. Increased glenoid retroversion increases the risk of posterior shoulder instability by 6 times. FOIA 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 The undersurface of the supraspinatus tendon should be smooth. His pain is aggravated when grappling with other wrestlers and when performing push-ups. The chondral lesion is thought to arise secondary to impaction injury from the humeral head. Figure 17-1. 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. Results: In Shoulder MR-Part I we will focus on the normal anatomy and the many anatomical variants that may simulate pathology. (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). Dislocation of the long head of the biceps will inevitably result in rupture of part of the subscapularis tendon. The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. Probing of the posterior labrum is needed to rule out a subtle Kim lesion. 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. 3). 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). 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). (A) Lightbulb sign demonstrating rounded appearance of the humeral head with a posterior glenohumeral dislocation. The ABER view is also very useful for both partial- and full-thickness tears of the rotator cuff. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. A shoulder labral tear is an injury to this piece of cartilage, due to direct trauma, overuse, or instability. Diagnostic arthroscopy revealed no significant glenohumeral articular defects. McLaughlin, HL. The general approach will include an X-ray, ultrasound, MRI, or CT scan of the shoulder joint to assess the cause of the symptom. Normal glenoid morphology is present. 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. Accessibility An os acromiale must be mentioned in the report, because in patients who are considered for subacromial decompression, 2019 Dec 12;20(1):598. doi: 10.1186/s12891-019-2986-1. (B) Axillary radiograph of locked posterior glenohumeral dislocation. An anteroposterior (AP) Grashey image (also known as a true AP view because the beam is oriented perpendicular to the scapula, which is oriented 30 degrees anterior to the coronal plane) (Figure 17-1) along with an axillary x-ray (Figure 17-2), are the minimum radiographs that should be obtained. 1. scan or magnetic resonance imaging (MRI) scan may be ordered for a glenoid labrum tear diagnosis. J Bone Joint Surg Am 1993; 75:1175-1184. Shah AA, Butler RB, Fowler R, Higgins LD. Tears of the supraspinatus tendon are best seen on coronal oblique and ABER-series. 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. Overall, MRI had an accuracy of 76 %, a PPV of 24 %, and a NPV of 95 %. 15 Imaging of the patient in the ABER position can greatly increase the conspicuity of an ALPSA lesion, which can easily be overlooked on a routine MRI of the shoulder or on the standard axial sequence of an MRA. 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. MRI of the shoulder second edition postulated that dislocations result in a 360 degree injury, with trauma to the anterior labrum, resulting in changes posteriorly, and vice versa. 3-T MRI of the shoulder: is MR arthrography necessary? An impaction fracture is also present at the posterior glenoid rim (blue arrow). 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. 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. Clin Orthop Relat Res 1993 : 85-96. A recess more than 3-5 mm is always abnormal and should be regarded as a SLAP-tear. Look for tears of the infraspinatus tendon. The site is secure. Imaging of Posterior Shoulder Instability, Josef K. Eichinger, MD, FAOA and Joseph W. Galvin, DO, FAAOS. A CT scan is typically performed to evaluate posterior bone loss due to either a reverse bony Bankart lesion or attritional bone loss, and to assess degree of retroversion and glenoid dysplasia, and is performed in revision scenarios. 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. 8600 Rockville Pike Study the inferior labral-ligamentary complex. Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. Study the superior biceps-labrum complex and look for sublabral recess or SLAP-tear. 1998 Apr 30;17(8):857-72 2011 Sep;27(9):1304-7. The glenoid labrum is a cartilage rim that attaches to the glenoid rim. If there is a related partial thickness rotator cuff tear, there may also be lateral (on the side) pain. In part II we will discuss shoulder instability. Notice that the biceps tendon is attached at the 12 o'clock position. A Treatise on Dislocations and Fractures of the Joints. The glenoid labrum is a rim of cartilage attached to the glenoid rim. Smith T, Drew B, Toms A. 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. An anatomy drawing of a shoulder labrum. The rotator cuff is made of the tendons of subscapularis, supraspinatus, infraspinatus and teres minor muscle. It cushions the joint of the hip bone, preventing the bones from directly rubbing against each other. 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.8 Therefore, although Bennett lesions are typically not associated with posterior shoulder instability, it is important to recognize these lesions because they can be associated with posterior labral tears. Rotator cuff tears In the event of a shoulder dislocation, the . Background:The literature demonstrates a high prevalence of asymptomatic knee and hip findings on magnetic resonance imaging (MRI) in athletes. A tear of the labrum can also occur in the back part of the socket. 1994 May; 3(3):173-90. AJR 2004; 183(2). subchondral cysts and osteophytes (arrow). He has full passive and active range of motion of the left shoulder that is symmetrical to his contralateral side. Having a structure when assessing a Shoulder MRI is very useful. When you plan the coronal oblique series, it is best to focus on the axis of the supraspinatus tendon. Diagnosis . Bennett GE: Shoulder and elbow lesions of the professional baseball pitcher. Measurement of Friedmans angle and posterior humeral head subluxation (yellow lines depict Friedmans angle; red line depicts percentage of posterior humeral head subluxation). Labral repair or resection is performed. Figure 17-6. 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. Without the rotator cuff, the humeral head would ride up partially out of the glenoid fossa, lessening the efficiency of the deltoid muscle. In part III we will focus on impingement and rotator cuff tears. Rotator cuff tears in the context of posterior shoulder instability or dislocation were once thought to be rare. Shah N and Tung GA. . Utilizing the gle-noid clockface orientation on a sagittal image (Fig. When a dislocation or subluxation occurs, the glenoid labrum is torn from the bone and the capsule is stretched. Imaging studies therefore are an important adjunct to the diagnosis and treatment of posterior shoulder instability. The anterosuperior labrum is absent in the 1-3 o'clock position and the middle glenohumeral ligament is usually thickened. 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). The first part of rehabilitation labral repair involves letting the labrum heal to the bone. PT (only saw once) suspected labral tear, suggested I see an orthopedic surgeon & get an MRI. 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. 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. Christensen GV, Smith KM, Kawakami J, Chalmers PN. Before (10a) Ossification is seen along the posterior glenoid (arrows) in a professional baseball pitcher with a history of posterior instability. J Shoulder Elbow Surg. 5 A type 1 capsule inserts on the labrum, a type 2 capsule inserts on the junction of the labrum and glenoid, and a type 3 capsule inserts more medially on the glenoid ().The typical posterior capsule inserts on the labrum, either at the labral tip or the . 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View is also visible compatible with posterior shoulder instability, Josef K. Eichinger, MD FAOA! Advisable and additional orthogonal planes may be included in the event of a shoulder labral tear is to! Also visible compatible with a full thickness tear of motion of the stable! Occurs, the glenoid labrum is needed to rule out a subtle Kim lesion Assoc...