Musculoskeletal MRI. 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. (2010) ISBN: 9781441959720 -, 5. B. J. Manaster, David A. Posterior instability of the shoulder results from excessive posterior glenohumeral translation.

Complications.

posterior shoulder dislocation Radiographic features MRI On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. 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. 6,11,16,17 In the current study, 244 of the shoulders that underwent shoulder MRI demonstrated a posterior glenoid labral tear WebThe labrum can tear a few different ways: 1) completely off the bone, 2) within or along the edge of the labrum, or 3) where the bicep tendon attaches. Those undergoing open surgery should expect more pain, longer recovery, and in some cases incomplete shoulder rotation. posterior shoulder dislocation Radiographic features MRI On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. Athletes may require six months to one year for full recovery, with overhead throwing athletes taking the longest. AJR 1998; 171:763-768. Glenoid labral tear. Bankart lesions are labral tears without an osseus fragment. MR interpreters should be aware that at When the shoulder joint ball slips out of the socket, the joint capsule (fiberous tissues that surround and protect the joint) can pull on the lower portion of the labrum and tear it. Palmer W, Bancroft L, Bonar F et al. This is a post-reduction view. The two most common types of labral injuries are the SLAP teartearand Bankart tear. Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum, and can often be confused with a sublabral sulcus on MRI. Below: an MRI arthrogram showing injection of contrast into the shoulder joint. Posterior dislocations account for 2-4% of all shoulder dislocations. The labrum acts both as a bumper and as an attachment point for the ligaments of the shoulder. In more advanced cases of glenoid dysplasia, hypertrophic changes of the labrum and hyaline cartilage are pronounced. Other described types include 6: The investigation of choice is an MR arthrogram, which is variably reported as having accuracies of 75-90%, although distinguishing between subtypes can be difficult 2. (6a) An axial fat-suppressed proton density weighted image demonstrates a posterior labrum periosteal sleeve avulsion (POLPSA). An acute SLAP injury may result from: People who participate in repetitive overhead sports, such as throwing athletes or weightlifters, can experience labrum tears as a result of repeated shoulder motion. (2001) ISBN: 0721690270 -. These labral tears make the shoulder unstable and susceptible to repeated dislocations. Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. The ligaments also help prevent the shoulder from dislocating. 2000;20 Spec No(suppl_1):S67-81. Posterior dislocation-fracture. 2000 Jun; 82(6):849-57. Saupe N, White LM, Bleakney R, et al. This test can better show soft tissues like the labrum. Posterior dislocations are associated with epileptic seizures, high energy trauma, electrocution and electroconvulsive therapy. % This test can better show soft tissues like the labrum. This was an incidental finding on a chest-film. The biggest advantage of MR arthrography comes from the joint distension, which can help spot otherwise occult tears. Normal shoulder MRI. The image on the right shows a cartilage defect in the 4 o'clock position. Examples include the reverse Bankart lesion, the POLPSA lesion, and the posterior GLAD lesion (sometimes referred to as a PLAD lesion) (Figs. How long you require a sling depends upon the severity of your injury. Musculoskeletal Imaging,The Requisites (Expert Consult- Online and Print),4. The glenoid labrum, an important static stabilizer of the shoulder joint, has several normal labral variants that can be difficult to discriminate from labral tears and is subject to specific pathologic lesions (anteroinferior, posteroinferior, and superior labral anteroposterior lesions) with characteristic imaging features. A posterior labral tear (reverse Bankart) is also present (arrowhead), and a bone bruise is seen within the anterior humeral head (asterisk). Instability in this group typically results from a single traumatic event or repetitive microtrauma. Sometimes an axillary view can be of help, but when in doubt go to CT. Tearing of the inferior glenohumeral ligament at the humeral attachment (blue arrow) is also evident. Figure 2. Bankart tears may extend to superior, but this is uncommon. Become a Gold Supporter and see no third-party ads. (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). If this appearance is present, a capsular tear should be strongly suspected (Fig. Although it can be a slow process, following your surgeons guidelines and rehabilitation plan is vital to a successful outcome. This may require simply removing the torn part of the labrum, or reattaching the torn part using stitches. 37-year-old man with shoulder injury and posterior labral tear. Fluid undermines a tear of the posterior glenoid labrum (arrow) in a 42 year-old male with persistent posterior shoulder pain. The anterior labrum is absent at the 1-3 o 'clock position 1 Acquired recurrent posterior subluxation makes up the largest subset of patients with posterior instability. (1a) A fat suppressed proton density-weighted axial image. The surgical technique most commonly used for repairing a SLAP injury is arthroscopy. Arthroscopic procedures, in which the doctor operates through a small incision, are usually preferred because they are less invasive than open surgery. Clavert P. Glenoid Labrum Pathology. SLAP tears typically extend from the 10 to the 2 o'clock position, but can extend more posteriorly or anteriorly and even extend into the biceps tendon. 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. The glenoid labrum, an important static stabilizer of the shoulder joint, has several normal labral variants that can be difficult to discriminate from labral tears and is subject to specific pathologic lesions (anteroinferior, posteroinferior, and superior labral anteroposterior lesions) with characteristic imaging features. On coronal images you want to make sure whether this is a variant like a labral recess or labral foramen or whether this is a SLAP. There are several different types of SLAP tears. Rotator cuff tears in the context of posterior shoulder instability or dislocation were once thought to be rare. Injuries isolated to labrum and capsule can often be successfully repaired with arthroscopic techniques including capsulolabral repair, capsular shift, and capsular shrinkage. This test can better show soft tissues like the labrum. 2011 Sep;27(9):1304-7. Due to these recurrent dislocations significant bone loss and erosion of the anterior glenoid rim may occur, which maintains the unstable situation. The example of shoulder MRI demonstrates the soft tissue around the bones and joints. Posterior instability of the shoulder can vary from minor symptoms and findings to dramatic events resulting in extensive, complex injuries to the shoulder. There are many labral variants that may simulate a labral tear. Fluid distends the joint and only lies along the inner margin of the joint capsule (arrowheads). (3a) An axial fat-suppressed proton density weighted image demonstrates a rounded posterior margin (arrows) and a prominently hypertrophied posterior labrum (arrowhead) compatible with posterior glenoid hypoplasia. (7a) A coronal T2-weighted fat-suppressed image through the posterior glenohumeral joint in a patient following posterior glenohumeral dislocation demonstrates hemorrhage and edema at the interrupted humeral insertion of the inferior glenohumeral ligament compatible with a posterior band inferior glenohumeral ligament avulsion (PHAGL). The labrum of the shoulder is made of soft tissue so it will not show up on an x-ray. (1a) Fat-suppressed proton density-weighted axial, (1b) sagittal T2-weighted, and (1c) fat-suppressed T2-weighted coronal MR images are provided. It is the most common normal variant of the superior labrum, having an incidence as high as 73% [ 19 ]. At first, the repair needs to be protected while the labrum heals.
Both types of tears are usually accompanied by aching pain and difficulty performing normal shoulder movements. WebThe labrum of the shoulder is made of soft tissue so it will not show up on an x-ray. What are the findings? American Journal of Roentgenology. Operative photo courtesy of Scott Trenhaile, MD, Rockford Orthopaedic Associates. WebThe labrum can tear a few different ways: 1) completely off the bone, 2) within or along the edge of the labrum, or 3) where the bicep tendon attaches. 1998 Sep;171(3):763-8. They are not in the 3-6 o'clock position, which makes it easy to differentiate them from a Bankart tear. On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. Some SLAP injuries require cutting the biceps tendon attachment. an ALPSA-lesion (black arrow). 3. WebA 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. Although athletes are most prone to labral tears, people who experience a traumatic event such as falling down a flight of stairs are also at risk. The only exception to this rule is the reverse Bankart, which is the result of a posterior dislocation and injury to the inferoposterior labrum. 12) or at the humeral attachment (Fig. Posterior dislocations account for 2-4% of all shoulder dislocations. Plain film and CT may be utilized to evaluate bony contour abnormalities such as the reverse Bankart lesion or retroversion of the glenoid. The diagnosis of posterior instability depends on a clinical history of instability, reproduction of symptoms by physical examination, and an appropriate diagnostic evaluation. Posterior labral tearing was apparent on contiguous images (not shown). An axial image in a 53 year-old male following an acute traumatic posterior dislocation reveals tears of the posterior labrum (arrow) and posterior capsule (arrowhead). In cases of complicated injuries and repairs, full recovery may take several months. A tear undercuts the posterior labrum (small arrow). Motion in a posterior direction is limited by the posterior rim of the glenoid which is in an anteverted position. However, posterior capsular tears may also be seen in the midsubstance (Fig. Etiology, diagnosis, and treatment. WebTo rule out a labral tear, an MRI arthrogram needs to be ordered, not an MRI with contrast. 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.

On the transscapular-Y view the humeral head is displaced posteriorly. Check for errors and try again. J Bone Joint Surg Am 1993; 75:1175-1184. 2016). 174 no. Now you know that you have to look for a Bankart or variant. 3 Harryman DT, Sidles JA, Harris SL, Matsen FA. While also providing evaluation of osseous anatomy, MRI provides superior depiction of the labral and capsuloligamentous pathology that may be contributory to or indicative of posterior instability. This is a Buford complex, which is a normal variant. 2016;36(6):1628-47. However, your doctor may order x-rays to make sure there are no other problems in your shoulder, such as arthritis or fractures. Magnetic resonance imaging (MRI) scan. 10B MRI of posterior labrum tear. The labrum is the attachment site for the shoulder ligaments and supports the ball-and-socket joint as well as the rotator cuff tendons and muscles. The results of these tests will help your doctor decide if additional testing or imaging of your shoulder is necessary. 1990;6(4):274-9. In general, throwing athletes can return to early interval throwing 3 to 4 months after surgery. What does a torn shoulder labrum A Perthes lesion is a labroligamentous avulsion like a Bankart, but with a medially stripped intact periosteum.

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