All Title Author
Keywords Abstract

Anterior Glenohumeral Instability: Classification of Pathologies of Anteroinferior Labroligamentous Structures Using MR Arthrography

DOI: 10.1155/2013/473194

Full-Text   Cite this paper   Add to My Lib


We examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides classic Bankart repair are appropriate for labroligamentous lesions. The study included 35 patients (33 males and 2 females; mean age: 30.2; range: 18 to 57 years). MRA was performed in all patients. The lesions underlying patients’ instability such as Bankart, anterior labral periosteal sleeve avulsion (ALPSA), and Perthes lesions were diagnosed by two radiologists. MRA yielded 16 diagnoses of Bankart lesions, 5 of ALPSA lesions, and 14 of Perthes lesions. Albeit invasive, MRA seems to be a more reliable and accurate diagnostic imaging modality for the classification and treatment of instabilities compared to standard MRI. 1. Introduction Anterior shoulder instability is one of the most common orthopedic problems. Glenohumeral (GH) instability occurs mostly in young, active males and is usually caused by traumatic injury. Recurrent subluxations and dislocations of the GH joint occur as a result of changes in bone, cartilage, and soft tissues and are referred to as habitual dislocation of the shoulder [1, 2]. This problem, which causes severe morbidity that interferes with daily and sporting activities, is associated with many bone and soft tissue changes. The glenohumeral ligament, its inferior part in particular, is one of the most important passive stabilizers of the shoulder. The glenoid labrum contributes to stability of the shoulder by deepening the glenoid fossa with ligamentous attachments [3, 4]. A number of anterior instabilities can be associated with glenohumeral ligament lesions and with lesions of complex ligamentous structures that the glenohumeral ligament forms with neighboring tissues. The main instabilities are Bankart lesion (avulsion of the anterior glenoid labrum from the bone), glenoid edge fracture, Hill-Sachs lesion (osseous defect due to dislocation of the posterosuperior lateral humeral head), and loose body [1]. In addition, the Perthes lesion, a labroligamentous avulsion in which the scapular periosteum remains intact, and the ALPSA lesion, a medial displacement of the anteroinferior labral ligamentous complex with an intact scapular periosteum, should be considered potential causes of shoulder instability [5, 6]. The identification of anterior labral avulsion, capsular laxity, and other pathologies of the GH joint is of great significance in treatment planning. The methods used to identify these


[1]  S. H. Liu and M. H. Henry, “Anterior shoulder instability: current review,” Clinical Orthopaedics and Related Research, no. 323, pp. 327–337, 1996.
[2]  F. A. Matsen, S. C. Thomas, C. A. Rockwood, and M. A. Wirth, “Glenohumeral instability,” in The Shoulder, C. A. Rockwood and F. A. Matsen, Eds., vol. 2, pp. 611–689, W.B. Saunders, Philadelphia, Pa, USA, 2nd edition, 1998.
[3]  P. W. O'Connell, G. W. Nuber, R. A. Mileski, and E. Lautenschlager, “The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint,” American Journal of Sports Medicine, vol. 18, no. 6, pp. 579–584, 1990.
[4]  J. Ovesen and S. Nielsen, “Stability of the shoulder joint: cadaver study of stabilizing structures,” Acta Orthopaedica Scandinavica, vol. 56, no. 2, pp. 149–151, 1985.
[5]  T. J. Neviaser, “The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder,” Arthroscopy, vol. 9, no. 1, pp. 17–21, 1993.
[6]  T. J. Neviaser, “The GLAD lesion: another cause of anterior shoulder pain,” Arthroscopy, vol. 9, no. 1, pp. 22–23, 1993.
[7]  A. Blum, H. Coudane, and D. Molé, “Gleno-humeral instabilities,” European Radiology, vol. 10, no. 1, pp. 63–82, 2000.
[8]  M. Rafii, H. Firooznia, and J. J. Bonamo, “Athlete shoulder injuries: CT arthrographic findings,” Radiology, vol. 162, no. 2, pp. 559–564, 1987.
[9]  M. Rafii and J. Minkoff, “Advanced arthrography of the shoulder with CT and MR imaging,” Radiologic Clinics of North America, vol. 36, no. 4, pp. 609–633, 1998.
[10]  B. Roger, A. Skaf, A. W. Hooper, N. Lektrakul, L. Yeh, and D. Resnick, “Imaging findings in the dominant shoulder of throwing athletes: comparison of radiography, arthrography, CT arthrography, and MR arthrography with arthroscopic correlation,” American Journal of Roentgenology, vol. 172, no. 5, pp. 1371–1380, 1999.
[11]  K. J. Stevens, B. J. Preston, W. A. Wallace, and R. W. Kerslake, “CT imaging and three-dimensional reconstructions of shoulders with anterior glenohumeral instability,” Clinical Anatomy, vol. 12, pp. 326–336, 1999.
[12]  W. E. Palmer and P. L. Caslowitz, “Anterior shoulder instability: diagnostic criteria determined from prospective analysis of 121 MR arthrograms,” Radiology, vol. 197, no. 3, pp. 819–825, 1995.
[13]  S. Waldt, A. Burkart, A. B. Imhoff, M. Bruegel, E. J. Rummeny, and K. Woertler, “Anterior shoulder instability: accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries,” Radiology, vol. 237, no. 2, pp. 578–583, 2005.
[14]  C. R. Rowe, B. Zarins, and J. V. Ciullo, “Recurrent anterior dislocation of the shoulder after surgical repair: apparent causes of failure and treatment,” Journal of Bone and Joint Surgery A, vol. 66, no. 2, pp. 159–168, 1984.
[15]  S. J. Turkel, M. W. Panio, J. L. Marshall, and F. G. Girgis, “Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint,” Journal of Bone and Joint Surgery A, vol. 63, no. 8, pp. 1208–1217, 1981.
[16]  L. Pancione, G. Gatti, and B. Mecozzi, “Diagnosis of Hill-Sachs lesion of the shoulder: comparison between ultrasonography and arthro-CT,” Acta Radiologica, vol. 38, no. 4, part 1, pp. 523–526, 1997.
[17]  V. P. Chandnani, T. D. Yeager, T. DeBerardino et al., “Glenoid labral tears: prospective evaluation with MR imaging, MR arthrography, and CT arthrography,” American Journal of Roentgenology, vol. 161, no. 6, pp. 1229–1235, 1993.
[18]  M. Gary and M. D. Gartsman, Shoulder Arthroscopy, Chapter Glenohumeral Instability, 2nd edition, 2008.
[19]  M. T. Provencher, “Glenoid bone loss in patients with instability: the significance of an ALPSA lesion,” in Proceedings of the American Academy of Orthopaedic Surgeons Annual Meeting, New Orleans, La, USA, 2010.
[20]  P. Habermeyer, P. Gleyze, and M. Rickert, “Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study,” Journal of Shoulder and Elbow Surgery, vol. 8, no. 1, pp. 66–74, 1999.
[21]  M. Ozbaydar, B. Elhassan, D. Diller, D. Massimini, L. D. Higgins, and J. J. P. Warner, “Results of arthroscopic capsulolabral repair: bankart lesion versus anterior labroligamentous periosteal sleeve avulsion lesion,” Arthroscopy, vol. 24, no. 11, pp. 1277–1283, 2008.
[22]  A. Bernhardson, “Glenoid bone loss in patients with shoulder instability: the significance of the ALPSA(anterior labroligamentous periosteal sleeve avulsion) lesion,” in Proceedings of the American Academy of Orthopaedic Surgeons Annual Meeting, New Orleans, La, USA, 2010.
[23]  M. T. Provencher and A. A. Romeo, Shoulder Instability, A Comprehensive Approach, Chapter 6 Findings and Pathology Associated with Anterior Shoulder Instability, 2010.
[24]  M. T. Provencher and A. A. Romeo, Shoulder Instability, A Comprehensive Approach, Chapter 8 Radiographic Studies and Findings, 2010.


comments powered by Disqus