1994 May; 3(3):173-90. Imaging signs of posterior glenohumeral instability. We hypothesized that the accuracy of MRI and MRA was lower than previously reported. 10 A paralabral cyst indicates the presence of a labral tear. complex injuries to the shoulder. What are the findings? 3. A posterior labrum tear is a rare type of shoulder labral tear that occurs in the back of the shoulder. 2012;132(7):905-19. When a dislocation or subluxation occurs, the glenoid labrum is torn from the bone and the capsule is stretched. Orlando Orthopaedic Center's Dr. Randy S. Schwartzberg, a board certified orthopaedic surgeon specializing in Sports Medicine, discusses what's involved with. They did find that smaller glenoid width was a risk factor for failure.12. (SBQ16SM.25) Copyright 2023 Lineage Medical, Inc. All rights reserved. Clavert P. Glenoid Labrum Pathology. (2a) The fat-suppressed proton density-weighted axial image reveals alignment of the humeral head posteriorly relative to the glenoid, with an impaction fracture of the humeral head articular surface (red arrow). Diagnostic performance of 3D-multi-Echo-data-image-combination (MEDIC) for evaluating SLAP lesions of the shoulder. The site is secure. An area of capsular irregularity (arrow) is apparent as well. In either case, the labrum can be torn off the bone. His pain is aggravated when grappling with other wrestlers and when performing push-ups. 6). 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). Posterior shoulder instability is a relatively rare phenomenon compared to anterior instability, comprising only 5-10% of all shoulder instability. Future larger studies are needed to confirm these findings. This ring of cartilage encompasses the outer rim of the glenoid to provide cushiony support around the head of the humerus. Biplanar radiographs should always be obtained when evaluating patients with suspected shoulder instability. Diagnosis . 1998 Sep;171(3):763-8. A displaced tear of the posterior labrum (arrow) is present. In addition to the discrepancy in posterior labral tear evaluations, radiologist 1 documented more pathology throughout the shoulder than radiologist 2. . The posterior labrum is stressed with an abducted arm and posterior force. Type in at least one full word to see suggestions list. Due to the tension by the anterior band of the inferior GHL labral teras will be easier to detect. The authors found that specific acromial morphology on scapular-Y x-rays is significantly associated with the direction of glenohumeral instability. The thickened middle GHL should not be confused with a displaced labrum. A common cause of a posterior labrum tear is repetitive microtrauma to the shoulder joint. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. Arch Orthop Trauma Surg. 1999 May 15;318(7194):1322-3 This is called a posterior labral tear. Radiology. Pagnani MJ, Warren RF Stabilizers of the glenohumeral joint. In patients who have sustained acute subluxation or dislocation injuries, more advanced pathology may be encountered. 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. -, Stat Med. A fat-suppressed proton density-weighted axial image in a 14 year-old female with shoulder instability reveals findings of severe glenoid hypoplasia. Pathology involving the superior labrum presents a diagnostic and therapeutic challenge for the arthroscopic surgeon. Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography? De Maeseneer M, Van Roy F, Lenchik L et al. Imaging of Posterior Shoulder Instability, Josef K. Eichinger, MD, FAOA and Joseph W. Galvin, DO, FAAOS. Look for HAGL-lesion (humeral avulsion of the glenohumeral ligament). A sublabral foramen or sublabral hole is an unattached anterosuperior labrum at the 1-3 o'clock position. They may extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. It is seen in 11% of individuals. A displaced tear of the posteroinferior labrum is present, with a torn piece of periosteum (arrow) remaining attached to the posterior labrum. The undersurface of the supraspinatus tendon should be smooth. 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. 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). 2000 Jan;214(1):267-71 Not All SLAPs Are Created Equal: A Comparison of Patients with Planned and Incidental SLAP Repair Procedures. He has positive Kim and jerk tests and reproduction of symptoms with the shoulder in forward flexion, adduction, and internal rotation. It is present in 5% of the population. Articular cartilage is maintained. Shoulder Labral Tear Repair Surgery. Typically, physical therapy will start the first week or two after surgery. A wide ligament that surrounds and stabilises the joint is known as the capsule. Notice red arrow indicating a small Perthes-lesion, which was not seen on the standard axial views. Notice the biceps anchor. Probing of the posterior labrum is needed to rule out a subtle Kim lesion. At this level also look for Bankart lesions. official website and that any information you provide is encrypted This top area is also where the biceps tendon attaches to the labrum. Patients were included in the analysis if they had a posterior labral tear repair and had preoperative MRI or magnetic resonance arthrography (MRA). Crossref, Google Scholar; 73. Our data indicated that while MRI could exclude a SLAP lesion (NPV = 95 %), MRI alone was not an accurate clinical tool. 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. Posterior labral periosteal sleeve avulsion injury (POLPSA) in a 19 year-old football player following acute injury. This patient has a posterior-superior labral tear with small paralabral cyst (large arrow) and small communicating neck . Disclaimer, National Library of Medicine Sometimes at this level labral tears at the 3-6 o'clock position can be visualized. Also. Study the inferior labral-ligamentary complex. They involve the superior glenoid labrum, where the long head of biceps tendon inserts. Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. The anterior labrum is absent in the 1-3 o'clock position and there is a thickened middle GHL. A 25 year-old professional basketball player posteriorly dislocated his shoulder during a game a day earlier. On a MR-arthtrogram a sublabral foramen should not be confused with a sublabral recess or SLAP-tear, which are also located in this region. His examination is somewhat difficult due to his large size, but no significant abnormal findings are noted. A hip (acetabular) labral tear is damage to cartilage and tissue in the hip socket. -, BMJ. Look for supraspinatus-impingement by AC-joint spurs or a thickened coracoacromial ligament. posteriorly directed force with the arm in a flexed, internally rotated and adducted position, patients with increased glenoid retroversion (~17) were 6x more likely to experience posterior instability compared to those with less glenoid retroversion (~7), helps generate cavity-compression effect of glenohumeral joint, anchors posterior inferior glenohumeral ligament (PIGHL, vague, nonspecific posterior shoulder pain, worsens with provocative activities that apply a posteriorly directed force to the shoulder, ex: pushing heavy doors, bench press, push-ups, arm positioned with shoulder forward flexed 90 and adducted, apply posteriorly directed force to shoulder through humerus, positive if patient experiences sense of instability or pain, grasp the proximal humerus and apply a posteriorly directed force, assess distance of translation and patient response, grade 2 = over edge of glenoid but spontaneously relocates, grade 3 = over edge of glenoid, does not spontaneously relocate, arm positioned with shoulder abducted 90 and fully internally rotated, axially load humerus while adducting the arm across the body, arm positioned with shoulder abducted 90 and forward flexed 45, apply posteriorly and inferiorly directed force to shoulder through humerus, posterior shoulder dislocations may be missed on AP radiographs alone, arthroscopic and open techniques may be used, suture anchor repair and capsulorrhaphy results in fewer recurrences and revisions than non-anchored repairs, return to previous level of function in overhead throwing athletes not as reproducible as other athletes, failure risk increases if adduction and internal rotation are not avoided in the acute postoperative period, posterior branch of the axillary nerve is at risk during arthroscopic stabilization, travels within 1 mm of the inferior shoulder capsule and glenoid rim, at risk during suture passage at the posterior inferior glenoid, can lead to anterior subluxation or coracoid impingement, Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics, Traumatic Anterior Shoulder Instability (TUBS), Humeral Avulsion Glenohumeral Ligament (HAGL), Posterior Shoulder Instability & Dislocation, Multidirectional Shoulder Instability (MDI), Luxatio Erecta (Inferior Glenohumeral Joint Dislocation), Glenohumeral Internal Rotation Deficit (GIRD), Brachial Neuritis (Parsonage-Turner Syndrome), Glenohumeral Arthritis (Shoulder Arthritis), Shoulder Arthroscopy: Indications & Approach, Valgus Extension Overload (Pitcher's Elbow), Lateral Ulnar Collateral Ligament Injury (PLRI), Elbow Arthroscopy: Indications & Approach. Posterior labral tears will demonstrate the absence of the labrum or morphologic distortion, contrast, or fluid infiltration [].Four primary diagnostic characteristics can determine pathologic tearing versus an anatomic variant: intrasubstance signal intensity, margins, orientation, and extension. MR interpreters should be aware that at times capsular tears are quite subtle. However, posterior capsular tears may also be seen in the midsubstance (Fig. 2006; 240(1):152-160. That is, the labrum helps the shoulder from slipping out of its joint. 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 Examples include the reverse Bankart lesion, the POLPSA lesion, and the posterior GLAD lesion (sometimes referred to as a PLAD lesion) (Figs. 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. ALPSA lesions are . The rotator cuff is made of the tendons of subscapularis, supraspinatus, infraspinatus and teres minor muscle. MR arthrography had a large number of false-positive readings in this study. 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. Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthrographic findings with arthroscopic correlation. Sensitivity was 66 %, and specificity was 77 %. Posterior periosteum (arrowheads) is extensively stripped but remains attached to the posterior labrum. Major NM, Browne J, Domzalski T, Cothran RL, Helms CA. 1963 Dec. 43:1621-2. MRI is not uncommonly the key to the diagnosis as patients may present with vague clinical findings that are not prospectively diagnosed, in part because of the relatively less common incidence and awareness of this entity. J Am Med Assoc 117: 510-514, 1941. doi: 10.1002/14651858.CD009020.pub2. AJR Am J Roentgenol. The labrum in the shoulder joint is a vital component that helps stabilize the humerus and shoulder blade during movement. 2016;36(6):1628-47. 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? 3-T MRI of the shoulder: is MR arthrography necessary? The posterior labrum is avulsed, and stripped scapular periosteum remains attached to the posterior labrum (arrowhead). Burkhart et al. Shoulder dislocations account for 90% of shoulder instability cases and usually occur after a fall during sport or work activities ().This glenohumeral joint instability has been defined with the acronyms TUBS (traumatic, unidirectional, Bankart, surgery is the main treatment) ().Associated injuries to the labrum, to the glenoid bone, described in up to 40% of the cases (), and . Wuennemann F, Kintzel L, Zeifang F, Maier MW, Burkholder I, Weber MA, Kauczor HU, Rehnitz C. BMC Musculoskelet Disord. There is an ongoing debate on whether direct MR arthrography is superior to conventional MR in detecting labral tears. The findings are compatible with a posterior GLAD lesion (glenolabral articular disruption). (B) Axillary radiograph demonstrating severe glenoid dysplasia with hypoplasia of the posterior glenoid and severe retroversion. The general approach will include an X-ray, ultrasound, MRI, or CT scan of the shoulder joint to assess the cause of the symptom. 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. 2020 Aug 27;8(8):2325967120941850. doi: 10.1177/2325967120941850. Occasionally, a SLAP (superior labrum, anterior and posterior) fracture, which represents a superior humeral head compression . The chondral lesion is thought to arise secondary to impaction injury from the humeral head. 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. Figure 17-6. Dougherty MC, Kulenkamp JE, Boyajian H, Koh JL, Lee MJ, Shi LL. [ 41] Findings are usually normal. Ultrasound will also show a shoulder ganglion cyst and the effects of muscle wasting. Notice MGHL, which has an oblique course through the joint and study the relation to the subscapularis tendon. 2005;184: 984-988. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. However, a study by Saupe et al. We concluded that even with intra-articular contrast, MRI had limitations in the ability to diagnose surgically proven SLAP lesions. In the shoulder, this pain is located posterior (behind) and superior (above).