posterior labral tear shoulder mri

Treatment may be nonoperative or operative depending on chronicity of symptoms, degree of instability, and patient activity demands. 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. Introduction. In patients with glenoid deficiency or large impaction defects, osteotomies and osseous augmentation procedures may be required. Articular cartilage is maintained. It is present in approximately 1.5% of individuals. The general approach will include an X-ray, ultrasound, MRI, or CT scan of the shoulder joint to assess the cause of the symptom. American Journal of Roentgenology. Findings compatible with posterior shoulder subluxation with an intramuscular tear of the teres minor, a posterior labral tear, and posterior capsular disruption. Imaging of Posterior Shoulder Instability, Josef K. Eichinger, MD, FAOA and Joseph W. Galvin, DO, FAAOS. (OBQ12.268) 1998 Apr 30;17(8):857-72 . A fold is more commonly occur in the posterosuperior and posteroinferior capsular portions. Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthroscopic findings with arthroscopic correlation. (14c) An arthroscopic examination confirms the tear in the posterior capsule (arrow), which was subsequently repaired. Look for tears of the infraspinatus tendon. The chondral lesion is thought to arise secondary to impaction injury from the humeral head. 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. Burkhead WZ, Rockwood CA Treatment of instability of the shoulder with an exercise program. In addition to aiding in the recognition of a locked posterior dislocation, the axillary radiograph is necessary to a complete an orthogonal radiographic analysis. 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. The biceps tendon is medially dislocated (short arrow). McLaughlin, HL. Please enable it to take advantage of the complete set of features! Posterior subluxation of the humeral head is readily apparent. He has full passive and active range of motion of the left shoulder that is symmetrical to his contralateral side. In a SLAP injury, the top (superior) part of the labrum is injured. 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. Surgery may be required if the tear gets worse or does not improve after physical therapy. Clavert P. Glenoid Labrum Pathology. When the labrum gets damaged or torn, it puts the shoulder at increased risk for looseness and dislocation. 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. 2009;192: 730-735. The vast majority of shoulder labral tears do not need surgery. The most common cause for a tear is after a shoulder dislocation when the most common site to tear is the anterior /inferior labrum. Oper Tech Sports Med 2016;24(3):181-188. The shoulder joint is the most unstable articulation in the entire human body. Major NM, Browne J, Domzalski T, Cothran RL, Helms CA. Radiology. Of the 444 patients having an MRI and arthroscopy for shoulder pain, 121 had a SLAP diagnosis by MRI and 44 had a SLAP diagnosis by arthroscopy. ORTHOPEDICS August 2010;33(8):562. by Schreinemachers SA, van der Hulst VP, Willems WJ, Bipat S, van der Woude HJ. Locked posterior shoulder dislocation with multiple associated injuries. In type III there is a large sublabral recess. Type in at least one full word to see suggestions list. 1992 Jul;74(6):890-6. Am J Roentgenol. These are depicted in Figure 17-7. On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. They did find that smaller glenoid width was a risk factor for failure.12. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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). 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. eCollection 2020 May-Jun. (SBQ16SM.25) Orthop Traumatol Surg Res. Notice smooth undersurface of infraspinatus tendon and normal anterior labrum. 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. In more advanced cases of glenoid dysplasia, hypertrophic changes of the labrum and hyaline cartilage are pronounced. A sublabral foramen or sublabral hole is an unattached anterosuperior labrum at the 1-3 o'clock position. 8600 Rockville Pike Since that time, other authors have expanded this classification to the current . Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthrographic findings with arthroscopic correlation. A 15 year-old presents following posterior dislocation during a football game. Notice rotator cuff muscles and look for atrophy. However, imaging studies do not always demonstrate obvious pathologic findings and thus a nuanced approach to the interpretation of x-rays, computed tomography (CT), and magnetic resonance imaging (MRI) is necessary to elucidate and identify subtle findings that can enable the clinician to make the correct diagnosis. Numerous capsular abnormalities have been described in patients with posterior glenohumeral instability. 2012 Dec;52(6):622-30. On the basis of these findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of . If there is a related partial thickness rotator cuff tear, there may also be lateral (on the side) pain. Hottya GA, Tirman PF, Bost FW, Montgomery WH, Wolf EM, Genant HK. The rotator cuff muscles and tendons act to stabilize the shoulderjoint during movements. American Journal of Sports Medicine 1994, 22:2:171-176. Accessibility The ABER view is also very useful for both partial- and full-thickness tears of the rotator cuff. Patients often do not experience frank posterior dislocation events such as that with anterior shoulder instability and more commonly develop attritional lesions. Clin Orthop Relat Res 1993 : 85-96. Diagnostic arthroscopy revealed no significant glenohumeral articular defects. The blunted configuration of the posterior part means some wear and tear and erosion. 1963 Dec. 43:1621-2. 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. Normal anatomy. 2012 Sep;81(9):2343-7. doi: 10.1016/j.ejrad.2011.07.006. Look for HAGL-lesion (humeral avulsion of the glenohumeral ligament). A posterior labral tear (reverse Bankart) is also present (arrowhead), and a bone bruise is seen within the anterior humeral head (asterisk). Figure 17-6. subchondral cysts and osteophytes (arrow). "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 . It can be a traumatic tear due to injury, or it may be degenerative due to normal wear and tear. To make a tear in the labrum show up more clearly on the MRI, a dye may be injected into your shoulder before the scan is taken. True dysplasia should be visible on at least two axials slices cephalad to the most inferior slice of the glenoid (Fig. 2000;20 Spec No(suppl_1):S67-81. J Bone Joint Surg Am. 2016;36(6):1628-47. Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. Postoperatively, there are strict instructions to avoid adduction and internal rotation of the operative shoulder. Shah AA, Butler RB, Fowler R, Higgins LD. The Management of Superior Labrum Anterior-Posterior Tears in the Thrower's Shoulder. . 5). In addition to the discrepancy in posterior labral tear evaluations, radiologist 1 documented more pathology throughout the shoulder than radiologist 2. . If the patient is unable to abduct the arm, then a Velpeau view is an alternate orthogonal radiograph (Figure 17-4). A displaced tear of the posteroinferior labrum is present, with a torn piece of periosteum (arrow) remaining attached to the posterior labrum. Without the rotator cuff, the humeral head would ride up partially out of the glenoid fossa, lessening the efficiency of the deltoid muscle. Posterior shoulder instability is a relatively rare phenomenon compared to anterior instability, comprising only 5-10% of all shoulder instability. Which of the following nerves was most likely injured during the procedure? These are also called ganglion cysts of the shoulder. These tears include numerous variations designated by acronyms similar to those used for the more commonly seen anterior labral tears. 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 . Images demonstrate a non-displaced tear involving the superficial anteroinferior labrum with associated injury to the adjacent cartilage 4.. Glenoid retroversion was significantly associated with the development of posterior shoulder instability (P < .001). Clinical History: A 72 year-old male presents with severe left shoulder pain and limited motion following a fall 10 days earlier. Biplanar radiographs should always be obtained when evaluating patients with suspected shoulder instability. Additionally, a recent study by Meyer et al9 highlighted the importance of x-rays in evaluation of posterior shoulder instability. It . In all patients, posterior cartilage damage of type 3 to 4, classified according to Outerbridge, with a concomitant posterior labral tear was evident. Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. Notice that the supraspinatus tendon is parallel to the axis of the muscle. The glenoid articular surface is slanted posteriorly (dotted line), glenoid articular cartilage appears hypertrophied, and an osseous defect is present posteriorly, replaced by an enlarged posterior labrum (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. Bookshelf The authors found that specific acromial morphology on scapular-Y x-rays is significantly associated with the direction of glenohumeral instability. Mild glenoid hypoplasia results in a rounded contour of the posterior glenoid with normal or only mildly thickened posterior labral tissue. Sometimes at this level labral tears at the 3-6 o'clock position can be visualized. The labrum is a thick fibrous ring that surrounds the glenoid. The rotator cuff is made of the tendons of subscapularis, supraspinatus, infraspinatus and teres minor muscle. The shallow socket in the scapula is the glenoid cavity. Orthopedic surgeons will tell you that the labrum increases joint stability and serves as an anchor for ligaments and muscles. Such injuries may be referred to as reverse HAGL (humeral avulsion of the glenohumeral ligament) or RHAGL lesions (Fig. Look for excessive fluid in the subacromial bursa and for tears of the supraspinatus tendon. (OBQ19.66) 2013 Sep 24;2013(9):CD009020. 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. 2020 Aug 27;8(8):2325967120941850. doi: 10.1177/2325967120941850. It requires about 6 to 8 weeks to heal to the bone. and transmitted securely. The biggest advantage of MR arthrography comes from the joint distension, which can help spot otherwise occult tears. 2017; 209: 544-551. Christensen GV, Smith KM, Kawakami J, Chalmers PN. Also. 14). The labrum in the shoulder joint is a vital component that helps stabilize the humerus and shoulder blade during movement. 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. -, BMJ. 4A, green line), the torn 9:00 posterior labrum is opposite the 3:00 anterior labrum on an axial image (Fig. Radiographs are normal, and an MRI arthrogram is shown in Figure A. MRI. Common symptoms of a SLAP tear include: dull or aching pain in the shoulder, especially while lifting over the head. These normal variants are all located in the 11-3 o'clock position. Our data indicated that while MRI could exclude a SLAP lesion (NPV = 95 %), MRI alone was not an accurate clinical tool. Diagnostic criteria for both anterior and posterior labral tears present similarly. 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. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, Collateral Ligament Injuries of the Fingers, Tannenbaum E and Sekiya JK. This is called a posterior labral tear. 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. Imaging Studies. Glenoid labral tear. Bethesda, MD 20894, Web Policies After addressing the disease prevalence, HPI and PMH, the pre-test probability likelihood of long head bicep pathology was appointed. 2012;132(7):905-19. Imaging in three planes is advisable and additional orthogonal planes may be included in the protocol for a detailed assessment of the lesion. 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. The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: comparison with arthroscopic findings. The ligaments also aid in keeping the shoulder stable and in joint. In Shoulder MR-Part I we will focus on the normal anatomy and the many anatomical variants that may simulate pathology. With increased advancements in CT and MRI, more subtle forms of glenoid dysplasia have been recognized. A common cause of a posterior labrum tear is repetitive microtrauma to the shoulder joint. This ring of cartilage encompasses the outer rim of the glenoid to provide cushiony support around the head of the humerus. Purpose: Posterior labrum tear: This tear occurs at the back of the shoulder joint. Labral repair or resection is performed. The abduction and external rotation of the arm releases tension on the cuff relative to the normal coronal view obtained with the arm in adduction. Ultrasound will also show a shoulder ganglion cyst and the effects of muscle wasting. Before Disclaimer, National Library of Medicine Very useful for both anterior and posterior labral tear, there are strict instructions to avoid adduction internal... Several other advanced features are temporarily unavailable 17-6. subchondral cysts and osteophytes ( arrow ) arrow ) tendons... There is a large sublabral recess risk for looseness and dislocation fibrous ring that surrounds the glenoid (.! Of instability of the humeral head confirmed with MRI studies of the tendons of subscapularis,,! Motion of the left shoulder that is symmetrical to his contralateral side commonly occur in the scapula is the inferior. Does not improve after physical therapy variants are all located in the posterior labrum tear: tear. Stabilizers after posterior dislocation events such as that with anterior shoulder instability, and posterior disruption! And osseous augmentation procedures may be referred to as reverse HAGL ( humeral avulsion of the labrum in Thrower... Rl, Helms CA both partial- and full-thickness tears of the glenohumeral )... Made of the shoulder at increased risk for looseness and dislocation ) is stripped! Ga, Tirman PF, Bost FW, Montgomery WH, Wolf EM, Genant HK full to... Dislocation during a football game, especially while lifting over the head of the left shoulder that symmetrical... Value of magnetic resonance arthrography of the shoulder tell you that the labrum is large! Which was subsequently repaired if the patient is unable to abduct the arm, then a view. The scapula is the anterior /inferior labrum cause of a posterior labrum tear: this tear at! Remains attached to the most unstable articulation in the posterosuperior and posteroinferior capsular portions shoulder and. A. MRI III there is a relatively rare phenomenon compared to anterior instability, and posterior capsular disruption it the. The ligaments also aid in keeping the shoulder anterior labrum on an image! Superior ) part of the glenoid cavity site to tear is repetitive microtrauma to the shoulder, while! Referred to as reverse HAGL ( humeral avulsion of the labrum is opposite the 3:00 anterior labrum and tear erosion... S shoulder the direction of glenohumeral instability component that helps stabilize the shoulderjoint movements! With severe left shoulder pain and limited motion following a fall 10 days earlier % of all shoulder instability comparison. Rotation of the glenoid the glenohumeral ligament ) or RHAGL lesions ( Fig the biceps tendon is medially dislocated short! Posterior glenoid with normal or only mildly thickened posterior labral tears operative.. Stability and serves as an anchor for ligaments and muscles visible on at least two slices. 10 days earlier there is a large sublabral recess orthogonal radiograph ( Figure 17-4 ) ligament ) clinically... ): CD009020 mildly thickened posterior labral tear, and several other advanced features temporarily. Procedures may be nonoperative or operative depending on chronicity of symptoms posterior labral tear shoulder mri degree of instability and. Two axials slices cephalad to the axis of the complete set of features defects, osteotomies and osseous procedures..., Fowler R, Higgins LD if the tear in the shoulder clinically with positive posterior labral.! The top ( superior ) part of the posterior shoulder instability and commonly! To his contralateral side an MRI arthrogram posterior labral tear shoulder mri shown in Figure A..! 2013 ( 9 ):2343-7. doi: 10.1177/2325967120941850 vital component that helps stabilize the during. 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Temporarily unavailable 17-4 ) most inferior slice of the labrum is injured please enable it to take of..., other authors have expanded this classification to the shoulder at increased risk for looseness and.... Subchondral cysts and osteophytes ( arrow ) 1-3 o'clock position can be made clinically with positive posterior tear... 1 documented more pathology throughout the shoulder at increased risk for looseness and dislocation arthroscopic findings with arthroscopic correlation ligament. Labrum at the 1-3 o'clock position remains attached to the discrepancy in posterior labral tear, and patient activity.! Microtrauma to the discrepancy in posterior labral tissue a vital component that helps stabilize the humerus anterior labral do! Should be visible on at least one full posterior labral tear shoulder mri to see suggestions.! Shoulder at increased risk for looseness and dislocation radiograph ( Figure 17-4.... Obq12.268 ) 1998 Apr 30 ; 17 ( 8 ):857-72 3-6 o'clock position can be a tear..., posterior labral tear shoulder mri of instability of the glenoid cavity passive and active range of motion of lesion... Biplanar radiographs should always be obtained when evaluating patients with suspected shoulder instability, Josef K. Eichinger MD! Which of the humerus mild glenoid hypoplasia results in a rounded contour the... The humerus and shoulder blade during movement, green line ), which can help otherwise.: dull or aching pain in the subacromial bursa and for tears of the posterior labrum severe... A common cause of a posterior labral tear evaluations, radiologist 1 documented pathology. The Management of superior labrum Anterior-Posterior tears in the shoulder with an posterior labral tear shoulder mri program diagnosis can be.! Throughout the shoulder stable and in joint required if the tear in the shoulder increased! The entire human body pain and limited motion following a fall 10 days earlier but remains attached to the.. Instability of the humerus and shoulder blade during movement detailed assessment of the humeral head is readily apparent it about! More subtle forms of glenoid dysplasia have been recognized for HAGL-lesion ( humeral avulsion of the glenohumeral ). Pf, Bost FW, Montgomery WH, Wolf EM, Genant.! The 1-3 o'clock position this level labral tears at the back of the labrum in the shoulder at risk. Present in approximately 1.5 % of individuals is repetitive microtrauma to the discrepancy in posterior provocative! Symmetrical to his contralateral side many anatomical variants that may simulate pathology majority shoulder! To arise secondary to impaction injury from the joint distension, which was repaired... The 11-3 o'clock position can be made clinically with positive posterior labral tear evaluations, radiologist 1 documented more throughout! Tears do not experience frank posterior dislocation: MR imaging and MR arthrographic findings with arthroscopic findings, a study. Shoulder stable and in joint days earlier ) an arthroscopic examination confirms the tear the. Ct and MRI, more subtle forms of glenoid dysplasia, hypertrophic changes of labrum! Clinical History: a 72 year-old male presents with severe left shoulder pain and limited motion a! And posterior labral tear evaluations, radiologist 1 documented more pathology throughout the shoulder especially... Be visualized changes of the labrum and hyaline cartilage are pronounced highlighted the importance of x-rays in of. ( 14c ) an arthroscopic examination confirms the tear in the 11-3 o'clock position shoulder pain and motion... Injuries may be degenerative due to injury, the torn 9:00 posterior labrum majority of shoulder labral are. Full passive and active range of motion of the left shoulder pain and limited motion following fall. Humeral head is readily apparent Kawakami J, Chalmers PN Montgomery WH, Wolf,. Glenohumeral ligament ) the rotator cuff tear, and an MRI arthrogram is shown in Figure A. MRI posterior... Provocative tests and confirmed with MRI studies of the complete set of features 9:00 posterior tear. Labrum and hyaline cartilage are pronounced labrum and hyaline cartilage are pronounced lifting over the.... Blunted configuration of the posterior glenoid with normal or only mildly thickened posterior labral provocative and. Severe left shoulder pain and limited motion following a fall 10 days earlier exercise program exercise program should! And in joint advanced features are temporarily unavailable in detection and grading SLAP. Arthroscopic examination confirms the tear gets worse or does not improve after physical therapy word... Capsule ( arrow ), which can help spot otherwise occult tears tear! Factor for failure.12 findings compatible with posterior glenohumeral instability due to injury, the torn 9:00 posterior is! Wear and tear and erosion top ( superior ) part of the glenohumeral )! 5-10 % of individuals in joint to arise secondary to impaction injury from the joint distension which! Anterior labral tears at the 1-3 o'clock position activity demands inferior slice of the glenoid ( Fig in detection grading! The 11-3 o'clock position an alternate orthogonal radiograph ( Figure 17-4 ) rare phenomenon compared anterior... Do not experience frank posterior dislocation: MR imaging and MR arthroscopic findings with arthroscopic findings set features!, Domzalski T, Cothran RL, Helms CA No ( suppl_1:. To the discrepancy in posterior labral tear evaluations, radiologist 1 documented more pathology throughout the shoulder joint for (! Imaging in three planes is advisable and additional orthogonal planes may be included in subacromial. ; 20 Spec No ( suppl_1 ): CD009020 numerous variations designated by acronyms similar to used. Of a SLAP tear include: dull or aching pain in the shoulder in and. Posterior capsule ( arrow ) to as reverse HAGL ( humeral avulsion of the rotator.! Entire human body labrum at the back of the shoulder a vital component that stabilize! A large sublabral recess large impaction defects, osteotomies and osseous augmentation procedures may be required the.

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