posterior labral tear shoulder mriposterior labral tear shoulder mri

J Bone Joint Surg Am. The example of shoulder MRI demonstrates the soft tissue around the bones and joints. Popp D & Schffl V. Superior Labral Anterior Posterior Lesions of the Shoulder: Current Diagnostic and Therapeutic Standards. On the coronal-oblique and sagittal reconstruction the displaced fragment of the glenoid rim is seen in the 3-6 o'clock position. As healing progresses, exercises to strengthen the shoulder muscles and the rotator cuff will gradually be added to your program. Now you know that you have to look for a Bankart or variant. 9 Tung GA, Hou DD. Etiology, diagnosis, and treatment. Such injuries may be referred to as reverse HAGL (humeral avulsion of the glenohumeral ligament) or RHAGL lesions (Fig. Posterior ossification of the shoulder: the Bennett lesion. 37-year-old man with shoulder injury and posterior labral tear. Other described types include 6: The investigation of choice is an MR arthrogram, which is variably reported as having accuracies of 75-90%, although distinguishing between subtypes can be difficult 2. As a result, in cases of posterior shoulder instability, particularly dislocation, capsular tears are frequently identified on MR imaging.14 The posterior capsule injuries most commonly involve the humeral attachment inferiorly15, in the region known as the posterior band of the inferior glenohumeral ligament. Reference article, Radiopaedia.org (Accessed on 07 Apr 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"}. endobj The ligaments also help prevent the shoulder from dislocating. Injuries isolated to labrum and capsule can often be successfully repaired with arthroscopic techniques including capsulolabral repair, capsular shift, and capsular shrinkage. Patients most at risk for posterior instability include athletes such as weight lifters, throwers, tennis players, and swimmers. The biceps tendon is medially dislocated (short arrow). Bankart lesions with an osseus fragment are common findings in patients with an anterior dislocation and are frequently seen on the x-rays or CT-scan. View Magdalena Chmiel-Nowak's current disclosures, see full revision history and disclosures, doi:10.1148/radiographics.20.suppl_1.g00oc03s67, pain or discomfort (usually a precise point of pain cannot be located). Posterior dislocations are associated with epileptic seizures, high energy trauma, electrocution and electroconvulsive therapy.

HAGL is a Humeral Avulsion of the inferior Glenohumeral Ligament. 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. <> If this appearance is present, a capsular tear should be strongly suspected (Fig. Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum, and can often be confused with a sublabral sulcus on MRI. Normal shoulder MRI. WebTo rule out a labral tear, an MRI arthrogram needs to be ordered, not an MRI with contrast. Surgery of the Shoulder. First notice the Hill-Sachs defect indicating a prior anterior dislocation (blue arrow). 37-year-old man with shoulder injury and posterior labral tear. Posterior dislocations are associated with epileptic seizures, high energy trauma, electrocution and electroconvulsive therapy. Many SLAP tears, however, are the result of a wearing down of the labrum that occurs slowly over time. At the time the article was created Frank Gaillard had no recorded disclosures. Smith T, Drew B, Toms A. Alterations in function of the serratus anterior muscle may disrupt the scapulothoracic rhythm leading to loss of power and stability of the glenoid and variable amounts of scapular winging.6. It is the most common normal variant of the superior labrum, having an incidence as high as 73% [ 19 ]. Axial MR-arthrogram of a reverse Bankart. Notice extention of the SLAP-tear further to posterior (red arrow). Treatment options may include: Non-steroidal anti-inflammatory medication. These tears include numerous variations designated by acronyms similar to those used for the more commonly seen anterior labral tears. The yellow arrow points to the anterior glenoid rim. 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. Bankart lesions are labral tears without an osseus fragment. The arrow points to the medially displaced labroligamentous complex. WebSLAP stands for Superior labral tear, anterior to posterior, and comprises four major injury patterns as a cause of pain and instability, particularly in the overhead athlete (Ahsan et al. Locked posterior subluxation of the shoulder: diagnosis and treatment. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers.

WebThe labrum of the shoulder is made of soft tissue so it will not show up on an x-ray. What does a torn shoulder labrum 2016). 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. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, The Anterior Meniscofemoral Ligament of the Medial Meniscus, Collateral Ligament Injuries of the Fingers, Tannenbaum E and Sekiya JK. {"url":"/signup-modal-props.json?lang=us"}, Chmiel-Nowak M, Sheikh Y, Feger J, et al. In Type 2 tears, the labrum and bicep tendon are torn from the shoulder socket. The labrum is the attachment site for the shoulder ligaments and supports the ball-and-socket joint as well as the rotator cuff tendons and muscles. In the acute setting, they are most frequently seen in falls onto an outstretched arm or in throwing sports athletes. What does a torn shoulder labrum anti-clockwise. Type 1 tears are often seen in people who are middle-aged or older. Regardless of which type of surgery is performed, almost all athletes are advised to wear a sling for the first four weeks after surgery to protect the shoulder as it heals. They also have a typical location. Posterior dislocations account for 2-4% of all shoulder dislocations. These are usually minor and treatable. Arthroscopy. The shoulder, because of its wide range of motion, is anatomically predisposed to instability, but the vast majority of shoulder instability is anterior, with posterior instability estimated to affect 2-10% of unstable shoulders.1Although anterior shoulder dislocations have been recognized since the dawn of medicine, the first medical description of posterior shoulder dislocation did not occur until 1822.2In modern times, posterior shoulder instability is still a commonly missed diagnosis, in part due to a decreased index of suspicion for the entity among many physicians. It is composed of two articulations; the glenohumeral and acromioclavicular joints. Sometimes the displacement is difficult to appreciate, especially when the transscapular-Y view is slightly rotated. Webwhich situation is a security risk indeed quizlet; ABOUT US. It contributes to shoulder stability and, when torn, can lead to partial or complete shoulder dislocation. Mild glenoid hypoplasia results in a rounded contour of the posterior glenoid with normal or only mildly thickened posterior labral tissue. The shoulder joint is a joint that connects the upper limb to the axial skeleton. Superior labral anterior posterior tear. On MR arthrography it is customary to combine T1, T1 FS and T2 8. Specific exercises will restore movement and strengthen your shoulder. The physiologic groove in the humerus or cysts and erosions at the attachment site of the infraspinatus tendon can simulate a Hill-Sachs, but usually this is not a diagnostic problem (figure). 15,16). 8 Chung CB, Sorenson S, Dwek JR, Resnick D. Humeral Avulsion of the Posterior Band of the Inferior Glenohumeral Ligament: MR Arthrography and Clinical Correlation in 17 Patients. The term SLAP stands for Superior Labrum Anterior and Posterior. Arthroscopy. This imaging test creates clear pictures of dense structures, like bone. 6 1707-1715. by Michel De Maeseneer et al If the injury is a minor Bankart tear with a dislocation, the physician (or even a team coach or patient themselves) can usually pop the shoulder back into place a process called reduction and then follow up with physical therapy to strengthen the muscles. 2005;184: 984-988. Bankart tears may extend to superior, but this is uncommon. Most patients do not experience complications from shoulder arthroscopy. The ligaments also help prevent the shoulder from dislocating. The arrow points to the intact periosteum. 1994 May; 3(3):173-90. 1 Acquired recurrent posterior subluxation makes up the largest subset of patients with posterior instability. However, posterior capsular tears may also be seen in the midsubstance (Fig. Posterior labrum periosteal sleeve avulsion (POLPSA) lesion with associated posterior glenohumeral instability. 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. The anterior labrum is absent at the 1-3 o 'clock position To keep your arm from moving, you will most likely use a sling for 2 to 4 weeks after surgery. AJR 2005;184:984-88. A Meta-Analysis of the Diagnostic Test Accuracy of MRA and MRI for the Detection of Glenoid Labral Injury. Recurrent posterior subluxation is the most common form of posterior instability and is being recognized with increasing frequency. This was an incidental finding on a chest-film. The glenoid labrum serves as the primary site of attachment of the inferior glenohumeral ligaments and is firmly attached to the glenoid articular cartilage inferiorly. 10 Lamar DS, Williams GR, Iannotti JP, Ramsey ML. On the images a posterior dislocation is seen with a fracture. (2001) ISBN: 0721690270 -. This cross-section view of the shoulder socket shows a typical SLAP tear. The labrum is a cartilage disc attached to the socket or the glenoid of the shoulder. Notice the distance between the humeral head and the glenoid on the AP-view, which is abnormally wide. On MR a Hill-Sachs defect is seen at or above the level of the coracoid process. WebThe labrum can tear a few different ways: 1) completely off the bone, 2) within or along the edge of the labrum, or 3) where the bicep tendon attaches. Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. WebType 1: In this type of tear, your labrum shows signs of fraying or shredding but still functions. Webshoulder. (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. Your surgeon will determine how best to repair your SLAP injury once he or she sees it fully during arthroscopic surgery. Bankart lesions are typically located in the 3-6 o'clock position because that's where the humeral head dislocates. Because patients have varied health conditions, complete recovery time is different for everyone. If you can remember a specific injury or activity that caused your shoulder pain, it can help your doctor diagnose your shoulder problem although many patients may not remember a specific event. 2016). The labrum deepens the socket of the shoulder joint, making it a stronger fit for the head of the humerus. It contributes to shoulder stability and, when torn, can lead to partial or complete shoulder dislocation. An ALPSA-lesion is an Anterior Labral Periosteal Sleeve Avulsion. 4. Illustration of the shoulder anatomy and labrum. This in turn creates instability because the breached labrum makes it easier for the shoulder to dislocate again. Reading time: 18 minutes. Glossary of Terms for Musculoskeletal Radiology. 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. Labral variants however may mimick a SLAP tear. SLAP is an acronym that stands for 'Superior Labral tear from Anterior to Posterior'. In many cases, the initial treatment for a SLAP injury is nonsurgical. Become a Gold Supporter and see no third-party ads. Patients who undergo arthroscopic repair can expect shorter recovery times and less pain. Posterior instability of the shoulder results from excessive posterior glenohumeral translation. What is your diagnosis? Posterior dislocations account for 2-4% of all shoulder dislocations. A mid-substance tear of the posterior capsule is present with the medial component appearing lax and retracted (arrow). no financial relationships to ineligible companies to disclose. The example of shoulder plain x-ray shows bones very well. Low signal intensity blood clot (arrowhead) is present within the subscapularis recess. Illustration of the shoulder anatomy and labrum. This is a post-reduction view. 3D-reconstruction of a large bony Bankart in the 2 - 6 o'clock position. 35-year-old man with shoulder pain and decreased range of motion. 1 Hawkins RJ, Koppert G, Johnston G. Recurrent posterior instability (subluxation) of the shoulder. These symptoms may vary depending on the type of labral tear a person has. Journal of Bone and Joint Surgery 66A:169-74, 1984. WebA 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. An axial image in a 53 year-old male following an acute traumatic posterior dislocation reveals tears of the posterior labrum (arrow) and posterior capsule (arrowhead). In a SLAP injury, the top (superior) part of the labrum is injured. Due to the ABER-position the anterior band of the inferior GHL creates tension on the anteroinferior labrum and contrast fills the tear. Figure 1. An acute SLAP injury may result from: People who participate in repetitive overhead sports, such as throwing athletes or weightlifters, can experience labrum tears as a result of repeated shoulder motion. Webshoulder. 2.

. 12) or at the humeral attachment (Fig. Constant balancing of static and dynamic stabilizers is required to maintain glenohumeral stability. The majority of patients report improved shoulder strength and less pain after surgery for a SLAP tear. Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthroscopic findings with arthroscopic correlation. MRI . 2015;6(9):660-71. 2011 Sep;27(9):1304-7. AJR 2004; 183(2). WebThe labrum can tear a few different ways: 1) completely off the bone, 2) within or along the edge of the labrum, or 3) where the bicep tendon attaches. Saupe N, White LM, Bleakney R, et al. There is a detachment of the anteroinferior labrum (3-6 o'clock) with complete tearing of the anterior scapular periosteum. Arthroscopy. Fluid distends the joint and only lies along the inner margin of the joint capsule (arrowheads). . Notice the very large fracture of the glenoid rim with displacement. Posterior shoulder dislocation: Muscle and capsular lesions in cadaver experiments. (10a) Ossification is seen along the posterior glenoid (arrows) in a professional baseball pitcher with a history of posterior instability. Figure 1. A normal glenoid labrum has a laterally pointing edge and normal posterior labral morphology. Numerous capsular abnormalities have been described in patients with posterior glenohumeral instability. Appropriate treatment requires a thorough clinical and diagnostic evaluation focused on identifying the underlying pathology. 1. (14c) An arthroscopic examination confirms the tear in the posterior capsule (arrow), which was subsequently repaired. 7. Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum, and can often be confused with a sublabral sulcus on MRI. CT and MR Arthrography of the Normal and Pathologic Anterosuperior Labrum and Labral-Bicipital Complex. MRI() . Surrounding the outside edge of the glenoid is a rim of strong, fibrous tissue called the labrum. Operative photo courtesy of Scott Trenhaile, MD, Rockford Orthopaedic Associates. As with any surgery, however, there are some risks. Snyder S, Karzel R, Del Pizzo W, Ferkel R, Friedman M. SLAP Lesions of the Shoulder. 2 0 obj Journal of Bone and Joint Surgery 74A:53-66, 1992. 1998 Sep;171(3):763-8. Those undergoing open surgery should expect more pain, longer recovery, and in some cases incomplete shoulder rotation. Pain is usually limited to the time of subluxation. Posterior dislocation-fracture. Posterior shoulder instability tears occur in the back of the glenoid socket and are the least common type of labrum tear.

Appendicitis - Pitfalls in US and CT diagnosis, Acute Abdomen in Gynaecology - Ultrasound, Transvaginal Ultrasound for Non-Gynaecological Conditions, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, TI-RADS - Thyroid Imaging Reporting and Data System, How to Differentiate Carotid Obstructions, Usefulness of the Abduction and External Rotation Views in Shoulder MR Arthrography, MR Imaging and MR Arthrography of Paraglenoid Labral Cysts, CT and MR Arthrography of the Normal and Pathologic Anterosuperior Labrum and Labral-Bicipital Complex. It contributes to shoulder stability and, when torn, can lead to partial or complete shoulder dislocation. Imaging in three planes is advisable and additional orthogonal planes may be included in the protocol for a detailed assessment of the lesion. MR interpreters should be aware that at (6a) An axial fat-suppressed proton density weighted image demonstrates a posterior labrum periosteal sleeve avulsion (POLPSA). This is especially the case in older adults, because our cartilage becomes more brittle with age. During arthroscopy, your surgeon inserts the arthroscope and small instruments into your shoulder joint. Webwhich situation is a security risk indeed quizlet; ABOUT US. Persistent pain is not typical and may point to additional pathology of the rotator cuff or biceps tendon6. Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. Magnetic resonance imaging (MRI) scan. The results of these tests will help your doctor decide if additional testing or imaging of your shoulder is necessary. A complete evaluation of your shoulder should include regular x-rays and not just an MRI. Especially in younger patients this results in a Bankart fracture or a Bankart lesion which is a tear of the anteroinferior labrum. This type of tear occurs at the front of the upper arm where the biceps tendon connects to the shoulder. Rehabilitation. 3. WebTo rule out a labral tear, an MRI arthrogram needs to be ordered, not an MRI with contrast. Posterior instability of the shoulder can vary from minor symptoms and findings to dramatic events resulting in extensive, complex injuries to the shoulder.

The glenoid labrum, an important static stabilizer of the shoulder joint, has several normal labral variants that can be difficult to discriminate from labral tears and is subject to specific pathologic lesions (anteroinferior, posteroinferior, and superior labral anteroposterior lesions) with characteristic imaging features. The shoulder joint is composed of the glenoid (the shallow shoulder "socket") and the head of the upper arm bone known as the humerus (the "ball"). The coronal images shows the medially displaced labrum (red arrow). The only exception to this rule is the reverse Bankart, which is the result of a posterior dislocation and injury to the inferoposterior labrum. Although athletes are most prone to labral tears, people who experience a traumatic event such as falling down a flight of stairs are also at risk. Surg Clin North Am. Musculoskeletal MRI. Any work activities or sports that aggravate your shoulder are also important to mention, as well as the location of the pain, and what treatment, if any, you have had. Figure 1. They include: Your doctor will talk with you about your symptoms and when they first began. On the transscapular-Y view the humeral head is displaced posteriorly. Surgeons will usually conduct a physical exam and order MRI or X-ray imaging, if necessary, to determine the severity of the injury and the appropriate treatment. This exercise program can be continued anywhere from 3 to 6 months, and usually involves working with a qualified physical therapist. The image on the right shows a cartilage defect in the 4 o'clock position. This typically occurs 4 to 6 weeks after surgery. However, a study by Saupe et al. Your doctor may recommend surgery if your pain does not improve with nonsurgical methods. Exercises to strengthen the muscles that support your shoulder can relieve pain and prevent further injury. SLAP tears start at the 12 o'clock position where the biceps anchor is located, which tears the labrum off the glenoid. It represents a patial tear of the anteroinferior labrum with adjacent cartilage damage. There are many labral variants that may simulate a labral tear. MR interpreters should be aware that at Once the initial pain and swelling has settled down, your doctor will start you on a physical therapy program that is tailored specifically to you and your injury. MRA( ) . 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). In a 20 year-old football player following acute injury, a reverse Bankart lesion is present. (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). This cyst can also cause posterior shoulder pain, and when it is large, it can compress the suprascapular nerve, causing weakness of shoulder rotation. American Journal of Roentgenology. Both types of tears are usually accompanied by aching pain and difficulty performing normal shoulder movements. Posterior labral periosteal sleeve avulsion injury (POLPSA) in a 19 year-old football player following acute injury. Modern imaging techniques, in particular MRI, have greatly increased our ability to accurately diagnose posterior glenohumeral instability, and accurate recognition and characterization of the relevant abnormalities are critical for proper diagnosis and patient management.5, Multiple shoulder structures are important in resisting shoulder instability. When the ball slips toward the back of the body, it leads to "posterior instability.". There is an osseus Bankart lesion (curved red arrow). Patients with periosteal sleeve avulsions, such as the POLPSA, are more likely to be symptomatic.9. In patients with traumatic posterior subluxation or dislocation, injuries to labrum, capsule, bone and rotator cuff may be found, and accurate diagnosis with MRI allows the most appropriate treatment pathway to be chosen.

WebIt is associated with posterior labral tear, Circle is center of humeral head. They can extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. On conventional MR labral tears are best seen on fat-saturated fluid-sensitive sequences. It is, however, becoming more frequently recognized, particularly in athletes such as football players and weightlifters, in which posterior glenohumeral instability has achieved increased awareness.3 As McLaughlin stated in 19634, the clinical diagnosis is clear-cut and unmistakable, but only when the posterior subluxation is suspected. Transaxial T1-weighted MR image (779/12) shows posterior humeral translation of 10 mm. A locked posterior shoulder dislocation is perhaps the most dramatic example of posterior glenohumeral instability. Bennett GE: Shoulder and elbow lesions of the professional baseball pitcher. Increased posterior translation has consistently been shown to require a lesion of the posterior capsule, particularly the posterior band of the inferior glenohumeral ligament.2, 2.The rotator interval capsule also appears to play an important role in posterior stability. Musculoskeletal Imaging,The Requisites (Expert Consult- Online and Print),4. Become a Gold Supporter and see no third-party ads. . Snyder et al. The anterior labrum is absent on the glenoid rim. The labrum helps to deepen the socket and stabilize the shoulder joint. Normal shoulder MRI. 5 Blasier RB, Soslowsky LJ, Malicky DM, et al. At the time the article was last revised Yusra Sheikh had no recorded disclosures. (14a) Normal capsular appearance on an axial fat-suppressed T1-weighted MR arthrographic image. "If physical therapy fails and the athlete still cant complete overhead motions, or the shoulder continues to dislocate, surgical treatment might be required to reattach the torn ligaments and labrum to the bone," says Dr. Fealy. In general, a therapy program focuses first on flexibility. There is discontinuity of the IGHL attachment on the humerus with leakage of contrast.

Essential Radiology for Sports Medicine. The negative impact that posterior labral injuries have on a combine participants early NFL performance is important to consider especially because of how often these injuries occur among elite football players. A small chondral defect is present (arrowhead) adjacent to the free edge of the posterior labrum. Consecutive fat-suppressed proton density-weighted axial images at the mid glenoid in a football player with persistent shoulder pain reveals mild glenoid dysplasia, with a rounded contour of the posterior glenoid rim (arrows). A number of biomechanical studies have demonstrated the importance of both posterior and anterior capsuloligamentous structures in maintaining static posterior stability. The red arrow points to the absent labrum - Buford complex. dekalb county circuit clerk forms; zander capital management fargo, nd; patricia mcpherson interview Sometimes an axillary view can be of help, but when in doubt go to CT. Posterior dislocations are associated with epileptic seizures, high energy trauma, electrocution and electroconvulsive therapy. The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. 2020;49(Suppl 1):1-33. What are the findings? The major restraints to posterior instability include the posterior capsule and glenohumeral ligaments, the rotator interval, the labrum, the glenoid, and the musculature of the rotator cuff and shoulder. It also serves as an attachment point for many of the ligaments of the shoulder, as well as one of the tendons from the biceps muscle in the arm. Snyder et al. Many of these athletes have inherent laxity of the shoulder, which may be advantageous to their sport. An area of capsular irregularity (arrow) is apparent as well. Sometimes this makes it easier to understand the anatomy. The ligaments also help prevent the shoulder from dislocating. Journal of Bone and Joint Surgery 79A:433-40, 1997. The biceps tendon can be involved in the injury, as well. Images of another patient with an ALPSA-lesion. MRA( ) . 35-year-old man with shoulder pain and decreased range of motion. 6,11,16,17 In the current study, 244 of the shoulders that underwent shoulder MRI demonstrated a posterior glenoid labral tear An impaction fracture is also present at the posterior glenoid rim (blue arrow). Fluid should not lie along both sides of the shoulder capsule. (16a) An axial image in a 17 year-old female following posterior subluxation during a basketball game demonstrates humeral sided avulsion of the capsule (arrow). Skeletal Radiol. Examples include the reverse Bankart lesion, the POLPSA lesion, and the posterior GLAD lesion (sometimes referred to as a PLAD lesion) (Figs. A displaced tear of the posteroinferior labrum is present, with a torn piece of periosteum (arrow) remaining attached to the posterior labrum. 5). This is a Buford complex, which is a normal variant. Labral Tear( ) 93%, Labral detachment( ) 46%. MR interpreters should be aware that at Tearing of the inferior glenohumeral ligament at the humeral attachment (blue arrow) is also evident. Diagnosing a labrum tear involves a physical examination and most likely an Arch Orthop Trauma Surg. 2004;12(1):97-109, vi-vii. The appearance is thought to be due to failure of ossification of the more inferior of the two ossification centers of the glenoid, resulting in a cartilage cap replacing the bone defect.11 The presence of the hypertrophied tissue and associated labral tears is well demonstrated on MRI (Fig. The importance of these structures is reviewed in the following: 1.