The labrum is cartilage tissue that holds the "ball" (humeral head) in the "socket" (glenoid) of your shoulder. McLaughlin, HL. Numerous capsular abnormalities have been described in patients with posterior glenohumeral instability. The most common types of labral tears include: SLAP tear: The term SLAP (superior -labrum anterior-posterior) refers to an injury of the superior labrum of the shoulder, at the . 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. . Normal Labral Anatomy. Study the cartilage. In many cases the axis of the supraspinatus tendon (arrowheads) is rotated more anteriorly compared to the axis of the muscle (yellow arrow). Non-surgical treatment tends to be most successful in patients with a history of atraumatic subluxations, whereas patients who experience an acute, traumatic posterior dislocation are much less likely to report successful outcomes from conservative therapy.19 Non-operative therapy focuses on strengthening the dynamic shoulder stabilizers and activity modification. Radiographic features MRI. Reverse-bankart lesion: Also known as a posterior labral tear, this injury affects the rear and lower ends of the labrum. 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 chondral lesion is thought to arise secondary to impaction injury from the humeral head. They involve the superior glenoid labrum, where the long head of biceps tendon inserts. of the biceps in the bicipital groove. 5,6,7 The classic MRI findings of internal impingement, as seen in this month's case, include partial articular surface tears at the posterior supraspinatus/anterior infraspinatus insertion, greater tuberosity bony changes, and tearing of the . 2017; 209: 544-551. If the arm is 3-T MRI of the shoulder: is MR arthrography necessary? It is better visualized in ABER position.Articular cartilage lesions are best demonstrated with MR arthrography. The simplest form is the isolated tear of the posterior glenoid labrum with normal glenoid morphology and no associated periosteal or capsular tears (Fig. De Maeseneer M, Van Roy F, Lenchik L et al. posterior labral tear surgery. Fluid should not lie along both sides of the shoulder capsule. Look for impingement by the AC-joint. It should always be possible to trace the middle GHL upwards to the glenoid rim and downwards to the humerus. Having a structure when assessing a Shoulder MRI is very useful. True dysplasia should be visible on at least two axials slices cephalad to the most inferior slice of the glenoid (Fig. The lesion is usually seen on the MRI. The labrum is the cartilage of the shoulder joint that encircles the socket to stabilize the shoulder. Study the attachment of the IGHL at the humerus. Notice the biceps anchor. -, J Shoulder Elbow Surg. The first part of rehabilitation labral repair involves letting the labrum heal to the bone. A Buford complex is a congenital labral variant. (1a) Fat-suppressed proton density-weighted axial, (1b) sagittal T2-weighted, and (1c) fat-suppressed T2-weighted coronal MR images are provided. A 20-year-old college football offensive lineman undergoes arthroscopic right shoulder surgery for the injury shown in Figure A. Post-operatively he complains of burning pain in the region marked in yellow on Figure B. Look for tears of the infraspinatus tendon. The labrum is the cartilage dish that sits between the ball and the socket configuration of the shoulder joint. At this level study the middle GHL and the anterior labrum. The most common symptoms of a shoulder labrum tear can occur intermittently. These are also called ganglion cysts of the shoulder. Imaging of superior labral anterior to posterior (SLAP) tears of the shoulder. 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. Types of labral tears. 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. doi: 10.1002/14651858.CD009020.pub2. His pain is aggravated when grappling with other wrestlers and when performing push-ups. Usually it is an incidental finding and regarded as a normal variant. It is a condition referred to as an internal impingement. A displaced tear of the posteroinferior labrum is present, with a torn piece of periosteum (arrow) remaining attached to the posterior labrum. This procedure greatly enhances the diagnostic accuracy by allowing tears . This ring of cartilage encompasses the outer rim of the glenoid to provide cushiony support around the head of the humerus. This is a common injury for athletes such as baseball pitchers and . True anteroposterior or Grashey x-ray. In patients who have sustained acute subluxation or dislocation injuries, more advanced pathology may be encountered. scan or magnetic resonance imaging (MRI) scan may be ordered for a glenoid labrum tear diagnosis. However,patients with acute lesions often have joint effusion, which also distends the joint space, making the contrast administration unnecessary. However, a study by Saupe et al. Small to moderate glenohumeral joint effusion with synovitis and extension of fluid in the subcoracoid recess. Without the rotator cuff, the humeral head would ride up partially out of the glenoid fossa, lessening the efficiency of the deltoid muscle. American Journal of Sports Medicine 1994, 22:2:171-176. 2009; 38(10):967-975. by Herold T, Bachthaler M, Hamer OW, et al. Our data indicated that while MRI could exclude a SLAP lesion (NPV = 95 %), MRI alone was not an accurate clinical tool. The vast majority of shoulder labral tears do not need surgery. Wirth MA, Lyons FR, Rockwood CA Jr. Hypoplasia of the glenoid: a review of sixteen patients. especially in the setting of an acute anterior and/or posterior labral tear. CT and MR Arthrography of the Normal and Pathologic Anterosuperior Labrum and Labral-Bicipital Complex. An impaction fracture is also present at the posterior glenoid rim (blue arrow). In a 34 year-old male following an acute subluxation event, a tear is present along the base of the posterior labrum with edema and irregularity noted at adjacent posterior periosteum (arrow). Notice rotator cuff muscles and look for atrophy. 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. Also, although better visualized on MRA imaging, a hypertrophied posterior glenoid labrum is evident in patients with glenoid dysplasia (Figure 17-8). J Bone Joint Surg Am. X-rays also demonstrate evidence of glenoid dysplasia (increased retroversion and hypoplasia), arthritic changes, and posterior humeral head subluxation or decentering of the humeral head. Labral tears 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). The shallow socket in the scapula is the glenoid cavity. (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. A fat-suppressed proton density-weighted axial image in a 14 year-old female with shoulder instability reveals findings of severe glenoid hypoplasia. The following algorithm has been previously proposed 25. De Coninck T, Ngai S, Tafur M, Chung C. Imaging the Glenoid Labrum and Labral Tears. Recurrent posterior shoulder instability: diagnosis and treatment. The image shows the typical findings of a sublabral recess. Treatment of the labral tears in these scenarios involves treatment of the shoulder dislocation and stabilising the shoulder. There are many labral variants. (SBQ16SM.25) The posterior labrum is enlarged to replace the deficient glenoid rim. Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. As a result posterior shoulder instability may present with vague shoulder pain, and a clinical examination is less demonstrative than anterior shoulder instability and may therefore be more difficult to diagnose. MRI is well recognized as an effective means to diagnose internal impingement of the shoulder. Although x-ray findings are typically normal, they must be scrutinized to avoid errors of diagnosis such as missed posterior dislocations. A Meta-Analysis of the Diagnostic Test Accuracy of MRA and MRI for the Detection of Glenoid Labral Injury. Plain radiographs in patients with posterior shoulder instability are an important and critical adjunct to making the diagnosis of posterior shoulder instability. What is Anterosuperior acetabular labrum? (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. (14a) Normal capsular appearance on an axial fat-suppressed T1-weighted MR arthrographic image. 1994 May; 3(3):173-90. The Management of Superior Labrum Anterior-Posterior Tears in the Thrower's Shoulder. 1998 Sep;171(3):763-8. Burkhart et al. The shoulder is primarily a ball and socket joint made up of the humerus (ball) and the glenoid (socket). The shoulder capsule, including the glenohumeral ligaments, is one of the most important structures for restricting posterior translation of the humeral head.6The subscapularis, and to a lesser extent the infraspinatus and teres minor muscles, provide dynamic restriction of posterior humeral head translation.7The rotator interval is also thought to play a role, though its significance is somewhat controversial.8. 2021 May 5;12:61-71. doi: 10.2147/OAJSM.S266226. A Treatise on Dislocations and Fractures of the Joints. In our retrospective study of 444 patients, sensitivity, specificity, and accuracy were all lower than previously reported in the literature for diagnosing SLAP lesions. Etiology, diagnosis, and treatment. There is an ongoing debate on whether direct MR arthrography is superior to conventional MR in detecting labral tears. 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. Overall, an MRI scan will clearly show the ganglion cyst in the shoulder and whether it compresses the nerve. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Chmiel-Nowak M, Sheikh Y, Feger J, et al. Federal government websites often end in .gov or .mil. Insertion of the shoulder capsule onto the labrum or glenoid has been categorized previously according to a system by Mosley et al. There are 3 types of attachment of the superior labrum at the 12 o'clock position where the biceps tendon inserts. 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. Pagnani MJ, Warren RF Stabilizers of the glenohumeral joint. Posterior instability most often occurs either as a result of high force direct trauma to the shoulder such as from a motor vehicle accident or indirect trauma such as from seizures or electrocution. We have covered the tear itself and variants in earlier posts. 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. 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