MRI can rule out other causes of shoulder pain. Dislocation of the long head of the biceps will inevitably result in rupture of part of the subscapularis tendon. In addition to aiding in the recognition of a locked posterior dislocation, the axillary radiograph is necessary to a complete an orthogonal radiographic analysis. Posterior labrum tear: This tear occurs at the back of the shoulder joint. 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. Rotator cuff tears in the context of posterior shoulder instability or dislocation were once thought to be rare. Hottya GA, Tirman PF, Bost FW, Montgomery WH, Wolf EM, Genant HK. by Michael Zlatkin. De Coninck T, Ngai S, Tafur M, Chung C. Imaging the Glenoid Labrum and Labral Tears. On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. It requires about 6 to 8 weeks to heal to the bone. Surgery may be required if the tear gets worse or does not improve after physical therapy. In type III there is a large sublabral recess. Notice the biceps anchor. MeSH 7-9). [ 41] Findings are usually normal. (14b) In a 39 year-old weightlifter with persistent posterior shoulder pain and instability, the axial image reveals the posterior capsule outlined by arthrographic fluid along both sides of the capsule, strongly suggestive of a capsular tear. Injury can also lead to a cyst that painfully compresses nerves in the shoulder. These terms are interchangeable because there is underdevelopment of the posterior inferior aspect of the glenoid. No Comments "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 . Imaging studies therefore are an important adjunct to the diagnosis and treatment of posterior shoulder instability. An example of this position is pushing open a door with a straight arm. The posterior shoulder capsule plays a significant role in preventing posterior shoulder dislocation, particularly at the extremes of internal humeral rotation, the position in which most posterior dislocations occur. Introduction. The shoulder joint is the most unstable articulation in the entire human body. Wuennemann F, Kintzel L, Zeifang F, Maier MW, Burkholder I, Weber MA, Kauczor HU, Rehnitz C. BMC Musculoskelet Disord. This top area is also where the biceps tendon attaches to the labrum. 3, 19, 31 Our results demonstrate a success rate of nonoperative treatment of 52% at a minimum of 2 years after MRI confirmation of posterior labral tear. 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. The labrum is a band of tough cartilage and connective tissue that lines the rim of the hip socket, or acetabulum. Low signal intensity blood clot (arrowhead) is present within the subscapularis recess. The supraspinatus, infraspinatus and teres minor muscles and tendons are shown. J Bone Joint Surg Am. The Bennett lesion (Fig. posterior labral tear surgery. Unlike the anterior labrum, rarely do we have a posterior dislocation of the shoulder. Once thought to be a relatively rare entity, a study by Harper et al. Clinical History: A 72 year-old male presents with severe left shoulder pain and limited motion following a fall 10 days earlier. Posterior labral tearing was apparent on contiguous images (not shown). The insertion has a variable range. PT (only saw once) suspected labral tear, suggested I see an orthopedic surgeon & get an MRI. 2008 Aug; 24(8):921-9. 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. 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. In type II there is a small recess. Posterior instability of the shoulder can vary from minor symptoms and findings to dramatic events resulting in extensive, complex injuries to the shoulder. Between 2006 and 2008, 444 patients who had both shoulder arthroscopy and an MRI (non-contrast or MR arthrography) for shoulder pain at our institution prior to surgery were identified and included in the study. Both tests may . 2015;101(1 Suppl):S19-24. Such injuries may be referred to as reverse HAGL (humeral avulsion of the glenohumeral ligament) or RHAGL lesions (Fig. An os acromiale must be mentioned in the report, because in patients who are considered for subacromial decompression, The os acromiale may cause impingement because if it is unstable, it may be pulled inferiorly during abduction by the deltoid, which attaches here. Scroll through the images and notice the unattached labrum at the 12-3 o'clock position at the site of the sublabral foramen. 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. Notice that the biceps tendon is attached at the 12 o'clock position. Purpose: A shoulder labral tear is an injury to this piece of cartilage, due to direct trauma, overuse, or instability. The posterior labrum is enlarged to replace the deficient glenoid rim. Objective To determine the prevalence of shoulder (specifically labral) abnormalities on MRI in a young non-athletic asymptomatic cohort. 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. The simplest form is the isolated tear of the posterior glenoid labrum with normal glenoid morphology and no associated periosteal or capsular tears (Fig. 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. Capsule. A posterior labral tear (reverse Bankart) is also present (arrowhead), and a bone bruise is seen within the anterior humeral head (asterisk). FOIA a painful feeling of clicking, popping or grinding in the shoulder during movement. 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. 8 Therefore, although Bennett lesions are typically not associated with . Study the cartilage. Saupe N, White LM, Bleakney R, et al. in Radiology in 2008 examined 36 patients following acute traumatic shoulder dislocation and revealed full-thickness tears in 19% of patients and partial or full-thickness tears in 42%.17As would be expected, subscapularis tears were most common, but tears were also identified in the supraspinatus and the infraspinatus. I don't have pain generally at all. (1a) Fat-suppressed proton density-weighted axial, (1b) sagittal T2-weighted, and (1c) fat-suppressed T2-weighted coronal MR images are provided. A useful indirect sign to be aware of, whether using MR arthrography or routine MR, is to recognize that normally the shoulder capsule should only be outlined by fluid along its inner margin. Notice smooth undersurface of infraspinatus tendon and normal anterior labrum. Description. The biceps tendon is medially dislocated (short arrow). The rotator cuff is made of the tendons of subscapularis, supraspinatus, infraspinatus and teres minor muscle. 4). A SLAP tear may extend to the 1-3 o'clock position, but the attachment of the biceps tendon to the superior labrum should always be involved. Smith T, Drew B, Toms A. Labral repair or resection is performed. J Shoulder Elbow Surg. Careers. With increased advancements in CT and MRI, more subtle forms of glenoid dysplasia have been recognized. Sports Health 2011 May, 3(3):253-263, Cooper A. A hip (acetabular) labral tear is damage to cartilage and tissue in the hip socket. The labrum is cartilage tissue that holds the "ball" (humeral head) in the "socket" (glenoid) of your shoulder. The rotator cuff muscles and tendons act to stabilize the shoulderjoint during movements. (A) Anteroposterior radiograph of severe glenoid dysplasia showing hypoplasia of the glenoid neck (blue arrow) and coracoid enlargement (orange star). by Jaideep J. Iyengar, MD; Keith R. Burnett, MD; Wesley M. Nottage, MD Imaging of Posterior Shoulder Instability, Josef K. Eichinger, MD, FAOA and Joseph W. Galvin, DO, FAAOS. Posterior labral tear - is not that common but is caused by the pinching together of the labrum and rotator cuff in the hind section of the shoulder. In type I there is no recess between the glenoid cartilage and the labrum. The posterior labrum is avulsed, and stripped scapular periosteum remains attached to the posterior labrum (arrowhead). Reverse-bankart lesion: Also known as a posterior labral tear, this injury affects the rear and lower ends of the labrum. 2000 Jan;214(1):267-71 PMC The undersurface of the supraspinatus tendon should be smooth. At this level study the middle GHL and the anterior labrum. The biggest advantage of MR arthrography comes from the joint distension, which can help spot otherwise occult tears. The biceps looked stable. If there is a related partial thickness rotator cuff tear, there may also be lateral (on the side) pain. Imaging of superior labral anterior to posterior (SLAP) tears of the shoulder. Axial anatomy and checklist. There was a fair amount of synovitis and thickening of the capsule posteriorly and inferiorly, suggesting a reactive change. Other radiographic lesions that may be associated with posterior labral pathology and instability include the Bennett lesion, which is an extra-articular posterior ossification of the posterior inferior glenoid. (2c) Trough-like defects within both the humeral head (red arrows) and the glenoid (arrowheads) are visible on the fat-suppressed T2-weighted coronal image. These are depicted in Figure 17-7. Diagnosis is made clinically with presence of increased anterior and posterior humeral translation, a sulcus sign, and overall increased . Please enable it to take advantage of the complete set of features! A normal glenoid labrum has a laterally pointing edge and normal posterior labral morphology. found in 3-5% of patients undergoing routine MRI of the shoulder 12, 13 Denervation of muscle is identified on MR images initially by the presence of diffuse, homogeneous muscle . There was no subscapularis or rotator cuff tear and no superior labrum tear. Does posterior labral tear require surgery? Often, muscle wasting is seen clearly on MRI, showing atrophy of the muscle and build-up of fat. Diagnostic performance of 3D-multi-Echo-data-image-combination (MEDIC) for evaluating SLAP lesions of the shoulder. Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. Diagnostic arthroscopy revealed no significant glenohumeral articular defects. If the arm is Notice that the supraspinatus tendon is parallel to the axis of the muscle. eCollection 2020 Aug. J Orthop. The glenoid cavity is the shallow socket of the scapula. 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