In addition to aiding in the recognition of a locked posterior dislocation, the axillary radiograph is necessary to a complete an orthogonal radiographic analysis. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. The lesion is usually seen on the MRI. Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. Clipboard, Search History, and several other advanced features are temporarily unavailable. Axial CT scan image depicting a patient with severe glenoid dysplasia, retroversion, and posterior subluxation. AJR Am J Roentgenol. It is seen in 11% of individuals. Surg Clin North Am. 2013 Sep 24;2013(9):CD009020. Once thought to be a relatively rare entity, a study by Harper et al. Please enable it to take advantage of the complete set of features! When you have a excessive posterior force on an adducted arm the resultant is a posterior labral tear. Etiology, diagnosis, and treatment. Normal Labral Anatomy. It is present in approximately 1.5% of individuals. Jun 23, 2021 by . Hottya GA, Tirman PF, Bost FW, Montgomery WH, Wolf EM, Genant HK. Axis of supraspinous tendon. where most labral tears are located. I don't have pain generally at all. Notice smooth undersurface of infraspinatus tendon and normal anterior labrum. In the shoulder, this pain is located posterior (behind) and superior (above). 12) or at the humeral attachment (Fig. 2012 Dec;52(6):622-30. -, Am J Sports Med. Successful nonoperative treatment of posterior shoulder instability has had varying rates of success, between 16 and 70% of patients. ADVERTISEMENT: Supporters see fewer/no ads. Methods: A tear of the labrum can also occur in the back part of the socket. When a dislocation or subluxation occurs, the glenoid labrum is torn from the bone and the capsule is stretched. Radiology 2008; 248:185193. Posterior shoulder dislocations can result in posterior labral tears. 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. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. Clavert P. Glenoid Labrum Pathology. 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 . In two patients (Case 1 and 3) along with labral cysts with tear, showed, enlarged capsule and positive drive through sign. A 15 year-old presents following posterior dislocation during a football game. Clinical Relevance: . Philadelphia, Pa: Lea & Blanchard; 1822, Pollock RG, Bigliani LU. 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. An impaction fracture is also present at the posterior glenoid rim (blue arrow). Wirth MA, Lyons FR, Rockwood CA Jr. Hypoplasia of the glenoid: a review of sixteen patients. The ABER view is also very useful for both partial- and full-thickness tears of the rotator cuff. His pain is aggravated when grappling with other wrestlers and when performing push-ups. A shoulder labral tear is an injury to this piece of cartilage, due to direct trauma, overuse, or instability. We hypothesize that this population will have fewer labral abnormalities than an athletic population. Although x-ray findings are typically normal, they must be scrutinized to avoid errors of diagnosis such as missed posterior dislocations. coracoacromial arch and coracoacromial ligament, glenohumeral ligaments - SGHL, MGHL, IGHL (anterior band). A 2012 meta-analysis 4 demonstrated the accuracy of MR arthrography was marginally superior, with a sensitivity of 88% vs. 76% for conventional MR, and a specificity of 93% vs.87%. Dr. Ebraheim's educational animated video describes posterior labral tear - posterior shoulder instability. 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. 7-9). 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. (A) Lightbulb sign demonstrating rounded appearance of the humeral head with a posterior glenohumeral dislocation. The most common cause of a cyst of the shoulder is a labral tear. 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. 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. Due to the tension by the anterior band of the inferior GHL labral teras will be easier to detect. In Shoulder MR-Part I we will focus on the normal anatomy and the many anatomical variants that may simulate pathology. These images illustrate the differences between an sublabral recess and a SLAP-tear. Which of the following nerves was most likely injured during the procedure? 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. Articular cartilage is maintained. Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon. Introduction. Types of labral tears. AJR Am J Roentgenol. 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). Sports Health 2011 May, 3(3):253-263, Cooper A. A 22-year-old male wrestler presents to your clinic with complaints of deep left shoulder pain for the past 6 weeks. 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. 1963 Dec. 43:1621-2. Notice red arrow indicating a small Perthes-lesion, which was not seen on the standard axial views. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. An arthroscopic examination confirmed the MRI findings and showed multiloculated cysts in the inferior labrum, mostly between 5 o'clock to 7 o'clock positions with labral tear. The axillary radiograph is also helpful in the traumatic scenario for identifying a posterior glenoid rim fracture or a reverse Hill-Sachs lesion. 2019 Nov 7;19:199-202. doi: 10.1016/j.jor.2019.10.015. This sublabral recess can be difficult to distinguish from a SLAP-tear or a sublabral foramen. 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. 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? Federal government websites often end in .gov or .mil. The shoulder is primarily a ball and socket joint made up of the humerus (ball) and the glenoid (socket). 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. It requires about 6 to 8 weeks to heal to the bone. The site is secure. Radiol Clin North Am 2016;54(5):801-815. SLAP tear: A superior labrum anterior to posterior (SLAP) tear occurs at the top of the glenoid (shoulder socket) and extends from the front to the back, where the biceps tendon connects to the shoulder. Reverse-bankart lesion: Also known as a posterior labral tear, this injury affects the rear and lower ends of the labrum. HHS Vulnerability Disclosure, Help Bethesda, MD 20894, Web Policies and transmitted securely. These terms are interchangeable because there is underdevelopment of the posterior inferior aspect of the glenoid. The labrum is the cartilage of the shoulder joint that encircles the socket to stabilize the shoulder. In addition to the discrepancy in posterior labral tear evaluations, radiologist 1 documented more pathology throughout the shoulder than radiologist 2. . It is important to recognise these variants, because they can mimick a SLAP tear. What is your diagnosis? Figure 1. J Bone Joint Surg Am. Materials and methods In this cross-sectional study, non-athletic young adults age 18-29 with no history of shoulder pain received bilateral shoulder MRIs . 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