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. Glenoid labrum (marked lig.) Imaging in three planes is advisable and additional orthogonal planes may be included in the protocol for a detailed assessment of the lesion. The anterior labrum and glenoid articular cartilage often demonstrate normal morphology one image superior to the . 2015;101(1 Suppl):S19-24. (14c) An arthroscopic examination confirms the tear in the posterior capsule (arrow), which was subsequently repaired. Insertion of the shoulder capsule onto the labrum or glenoid has been categorized previously according to a system by Mosley et al. 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. MRI Shoulder Labrum Periosteal Stripping. Additionally, a recent study by Meyer et al9 highlighted the importance of x-rays in evaluation of posterior shoulder instability. even greater mobility of the os acromiale after surgery and worsening of the impingement (4). On MR arthrography it is customary to combine T1, T1 FS and T2 FS sequences for further assessment. 4A, green line), the torn 9:00 posterior labrum is opposite the 3:00 anterior labrum on an axial image (Fig. An impaction fracture is also present at the posterior glenoid rim (blue arrow). Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum. This top area is also where the biceps tendon attaches to the labrum. Clinical History: A 72 year-old male presents with severe left shoulder pain and limited motion following a fall 10 days earlier. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. The .gov means its official. AJR Am J Roentgenol. Orthop Traumatol Surg Res. Normal anatomy. Careers. (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). Accessibility 2012 Dec;52(6):622-30. 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. 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 (reverse Bankart) is also present (arrowhead), and a bone bruise is seen within the anterior humeral head (asterisk). J Bone Joint Surg Am. A Treatise on Dislocations and Fractures of the Joints. 14). Of the 444 patients having an MRI and arthroscopy for shoulder pain, 121 had a SLAP diagnosis by MRI and 44 had a SLAP diagnosis by arthroscopy. Overall, MRI had an accuracy of 76 %, a PPV of 24 %, and a NPV of 95 %. Background:The literature demonstrates a high prevalence of asymptomatic knee and hip findings on magnetic resonance imaging (MRI) in athletes. 1999 May 15;318(7194):1322-3 Radiology. In part II we will discuss shoulder instability. The ligaments also aid in keeping the shoulder stable and in joint. The biggest advantage of MR arthrography comes from the joint distension, which can help spot otherwise occult tears. The rotator cuff muscles and tendons act to stabilize the shoulderjoint during movements. Arthroscopy. Overall, an MRI scan will clearly show the ganglion cyst in the shoulder and whether it compresses the nerve. Following plain radiographs, a CT scan is another useful imaging modality to evaluate the bony morphology of the glenoid including retroversion, glenoid dysplasia, and glenoid bone loss (GBL), and to further characterize the size and location of a reverse Hill-Sachs lesion. Figure 17-3. Such lesions are generally found in patients with atraumatic posterior instability. Posterior instability of the shoulder can vary from minor symptoms and findings to dramatic events resulting in extensive, complex injuries to the shoulder. 2009 Jan;192(1):86-92. doi: 10.2214/ajr.08.1097. Figure 17-6. 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. A shoulder labral tear can occur due to repetitive overhead use, a lifting injury, a fall on the arm, a sudden pull on the arm, or having the arm twisted at the shoulder joint. The concavity at the posterolateral margin of the humeral head should not be mistaken for a Hill Sachs, because this is the normal contour at this level. 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. Conclusions: Rotator cuff tears in the context of posterior shoulder instability or dislocation were once thought to be rare. Tears of the supraspinatus tendon are best seen on coronal oblique and ABER-series. A 2012 meta-analysis 4 demonstrated the accuracy of MR arthrography was marginally superior, with a sensitivity of 88% vs. 76% for conventional MR, and a specificity of 93% vs.87%. 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. These tears include numerous variations designated by acronyms similar to those used for the more commonly seen anterior labral tears. Figure 17-5. Our data indicated that while MRI could exclude a SLAP lesion (NPV = 95 %), MRI alone was not an accurate clinical tool. In this chapter we will review imaging findings of posterior instability on standard radiographs, CT scan, MRI, and magnetic resonance arthrogram (MRA), and 3-dimensional (3D) reconstruction CT and 3D MRI, which assist in the diagnosis and treatment of symptomatic posterior shoulder instability. A sublabral foramen or sublabral hole is an unattached anterosuperior labrum at the 1-3 o'clock position. Arch Orthop Trauma Surg. and transmitted securely. The supraspinatus tendon is the most important structure of the rotator cuff and subject to tendinopathy and tears. A mid-substance tear of the posterior capsule is present with the medial component appearing lax and retracted (arrow). When a dislocation or subluxation occurs, the glenoid labrum is torn from the bone and the capsule is stretched. Using arthroscopy as the standard, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for all MRIs, as well as separately for the non-intra-articular contrast MRI group and the MR arthrography group. A fat-suppressed proton density-weighted axial image in a 14 year-old female with shoulder instability reveals findings of severe glenoid hypoplasia. -, BMJ. Although x-ray findings are typically normal, they must be scrutinized to avoid errors of diagnosis such as missed posterior dislocations. Patients were included in the analysis if they had a posterior labral tear repair and had preoperative MRI or magnetic resonance arthrography (MRA). In patients with posterior instability, the presence of glenoid hypoplasia is predictably higher, with one report finding deficiency of the posteroinferior glenoid in 93% of patients with atraumatic posterior instability.10 When diagnosing posterior glenoid hypoplasia on MRI, care should be taken not to overcall the entity, as volume averaging can result in a false appearance of dysplasia on the most inferior axial slice. 2021 May 5;12:61-71. doi: 10.2147/OAJSM.S266226. "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 . Broadly, clinical unidirectional . The shoulder joint is a ball and socket joint that connects the bone of the upper arm (humerus) with the shoulder blade (scapula). (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. Also, although better visualized on MRA imaging, a hypertrophied posterior glenoid labrum is evident in patients with glenoid dysplasia (Figure 17-8). Skeletal Radiol. 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. 5). Notice the smooth borders unlike the margins of a SLAP-tear. Often, muscle wasting is seen clearly on MRI, showing atrophy of the muscle and build-up of fat. Sports Health 2011 May, 3(3):253-263, Cooper A. Jun 23, 2021 by . The lesion is usually seen on the MRI. The vast majority of shoulder labral tears do not need surgery. The ball of the shoulder can dislocate toward the front of the shoulder (an anterior dislocation), or it can go out the back of the shoulder (called a posterior dislocation). Galvin et al performed a retrospective comparative outcomes analysis of 37 patients, mean age 28 years, who underwent arthroscopic posterior labral repair for symptomatic posterior shoulder instability with a mean follow-up of 3.1 years. Posterior Labral Tear. -, Stat Med. Diagnosis of a locked posterior humeral dislocation can be avoided by recognizing on the AP Grashey radiograph the presence of the lightbulb sign (Figure 17-3A), which is the humeral head taking on a rounded appearance similar to the shape of a lightbulb because of fixed internal rotation secondary to a posterior glenohumeral dislocation.4 In addition to recognizing the lightbulb sign on an AP Grashey radiograph, an axillary x-ray will confirm the diagnosis of a locked posterior dislocation (Figure 17-3B). 13) of the posterior capsule. -, J Shoulder Elbow Surg. 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. 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. What is Anterosuperior acetabular labrum? A fold is more commonly occur in the posterosuperior and posteroinferior capsular portions. We hypothesize that this population will have fewer labral abnormalities than an athletic population. There are many labral variants. 2017; 209: 544-551. Surgical treatment: arthroscopic debridement . Which of the following is the next best step in management? It is not healed. Shah N and Tung GA. It helps provide stability to the shoulder by . Crossref, Google Scholar; 73. (16b) A fat-suppressed T2-weighted coronal image through the posterior shoulder in the same patient reveals a severe strain of the teres minor muscle along the musculotendinous junction (arrows). It is present in 5% of the population. eCollection 2021. At this level study the middle GHL and the anterior labrum. Fraying of the anterior section means some tearing of the surface with wispy threads emanating from that 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, The Abduction External Rotation (ABER) View for MRI of the Shoulder. Notice superior labrum and attachment of the superior glenohumeral ligament. Study the labrum in the 3-6 o'clock position. PT (only saw once) suspected labral tear, suggested I see an orthopedic surgeon & get an MRI. Posterior labral tearing was apparent on contiguous images (not shown). As joint instability is often present, capsuloplasty may be added to the procedure. Unlike the anterior labrum, rarely do we have a posterior dislocation of the shoulder. 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 capsule is a broad ligament that surrounds and stabilizes the joint. -. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population. The https:// ensures that you are connecting to the Does posterior labral tear require surgery? Once thought to be a relatively rare entity, a study by Harper et al. Mauro et al found increased retroversion in a cohort of 118 patients who were operatively treated for posterior instability in comparison with a group of normal controls, but the authors did not attribute retroversion as a risk factor for failure. 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? However labral tears may originate at the 3-6 o'clock position and subsequently extend superiorly. Notice the rotator cuff interval with coracohumeral ligament. As a result, subtle articular-sided partial thickness tears will not lie apposed to the adjacent intact fibers of the remaining rotator cuff The authors found that specific acromial morphology on scapular-Y x-rays is significantly associated with the direction of glenohumeral instability. Tearing of the inferior glenohumeral ligament at the humeral attachment (blue arrow) is also evident. An os acromiale must be mentioned in the report, because in patients who are considered for subacromial decompression, Also. 1998 Apr 30;17(8):857-72 What are the findings? Harper and colleagues17 similarly developed a classification scheme with normal, mild, moderate, and severe glenoid dysplasia. The shoulder joint is the most unstable articulation in the entire human body. Low signal intensity blood clot (arrowhead) is present within the subscapularis recess. Study the inferior labral-ligamentary complex. 4B), which is what one would intuitively expect. 3). 8600 Rockville Pike 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. 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 Multidirectional shoulder instability (MDI) is a condition characterized by generalized instability of the shoulder in at least 2 planes of motion (anterior, posterior, or inferior) due to capsular redundancy. Such injuries may be referred to as reverse HAGL (humeral avulsion of the glenohumeral ligament) or RHAGL lesions (Fig. MR is the best imaging modality to examen patients with shoulder pain and instability. A shoulder labral tear injury can cause symptoms such as pain, a catching or locking sensation, decreased range of motion and joint instability. Utilizing the gle-noid clockface orientation on a sagittal image (Fig. Notice red arrow indicating a small Perthes-lesion, which was not seen on the standard axial views. 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. Bennett GE: Shoulder and elbow lesions of the professional baseball pitcher. 2012;132(7):905-19. 1A: The ball (humerus) normally rests within the socket (glenoid) like a golf ball on a tee. complex injuries to the shoulder. Posterior capsular rupture causing posterior shoulder instability: a case report. . We have covered the tear itself and variants in earlier posts. The undersurface of the supraspinatus tendon should be smooth. the-glenoid labrum. (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). Federal government websites often end in .gov or .mil. In part II we will discuss shoulder instability. Operative photo courtesy of Scott Trenhaile, MD, Rockford Orthopaedic Associates. Posterior shoulder dislocations can result in posterior labral tears. (SBQ16SM.25) This ring of cartilage encompasses the outer rim of the glenoid to provide cushiony support around the head of the humerus. 1998 Sep;171(3):763-8. This procedure greatly enhances the diagnostic accuracy by allowing tears . An anteroposterior (AP) Grashey image (also known as a true AP view because the beam is oriented perpendicular to the scapula, which is oriented 30 degrees anterior to the coronal plane) (Figure 17-1) along with an axillary x-ray (Figure 17-2), are the minimum radiographs that should be obtained. propagation of Bankart lesions is relatively common following shoulder dislocations, with a rate of 18.5%. Future larger studies are needed to confirm these findings. Adv Orthop. Measurement of Friedmans angle and posterior humeral head subluxation (yellow lines depict Friedmans angle; red line depicts percentage of posterior humeral head subluxation). Imaging of Posterior Shoulder Instability, Josef K. Eichinger, MD, FAOA and Joseph W. Galvin, DO, FAAOS. 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 supraspinatus, infraspinatus and teres minor muscles and tendons are shown. 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 . It should always be possible to trace the middle GHL upwards to the glenoid rim and downwards to the humerus. Shah AA, Butler RB, Fowler R, Higgins LD. A posterior labrum tear is a rare type of shoulder labral tear that occurs in the back of the shoulder. 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. However, imaging studies do not always demonstrate obvious pathologic findings and thus a nuanced approach to the interpretation of x-rays, computed tomography (CT), and magnetic resonance imaging (MRI) is necessary to elucidate and identify subtle findings that can enable the clinician to make the correct diagnosis. 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. The radiologic diagnosis and surgical evaluation were compared to determine the accuracy of diagnosing a SLAP lesion by MRI. If the pre-test probability was above 90% or below 10% . While this certainly introduces vulnerability to injury, it also confers the advantage of broad range of motion. 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 . Sometimes at this level labral tears at the 3-6 o'clock position can be visualized. 1994 May; 3(3):173-90. Notice that the biceps tendon is attached at the 12 o'clock position. Introduction. Treatment may be nonoperative or operative depending on chronicity of symptoms, degree of instability, and patient activity demands. Typically, physical therapy will start the first week or two after surgery. (10a) Ossification is seen along the posterior glenoid (arrows) in a professional baseball pitcher with a history of posterior instability. Labral tears, such as a SLAP tear that cause a paralabral cyst, can occur due to trauma (dislocation), repetitive movement . Baseball pitchers are shown to have a high prevalence. SLAP tears can cause pain and range-of-motion problems in the shoulder labrum, the biceps tendon or both. 2009; 38(10):967-975. by Herold T, Bachthaler M, Hamer OW, et al. There is an ongoing debate on whether direct MR arthrography is superior to conventional MR in detecting labral tears. Evaluation of the glenoid labrum with 3-T MRI: is intraarticular contrast necessary? Look for variants like the Buford complex. Look for rim-rent tears of the supraspinatus tendon at the insertion of the anterior fibers. Hill Sachs lesions are only seen at the level of the coracoid. The labrum is the cartilage of the shoulder joint that encircles the socket to stabilize the shoulder. 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. MRI is well recognized as an effective means to diagnose internal impingement of the shoulder. Edelson was the first to define the incidence of subtle forms of glenoid dysplasia by studying scapular specimens from several museum collections.15 Posteroinferior hypoplasia was defined as a dropping away of the normally flat plateau of the posterior part of the glenoid beginning 1.2 cm caudad to the scapular spine (Figure 17-7). In Shoulder MR-Part I we will focus on the normal anatomy and the many anatomical variants that may simulate pathology. Notice MGHL, which has an oblique course through the joint and study the relation to the subscapularis tendon. The shallow socket in the scapula is the glenoid cavity. 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. Radiographics. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Chmiel-Nowak M, Sheikh Y, Feger J, et al. scan or magnetic resonance imaging (MRI) scan may be ordered for a glenoid labrum tear diagnosis. Orthopedic surgeons will tell you that the labrum increases joint stability and serves as an anchor for ligaments and muscles. They involve the superior glenoid labrum, where the long head of biceps tendon inserts. postulated that dislocations result in a 360 degree injury, with trauma to the anterior labrum, resulting in changes posteriorly, and vice versa. In this post we look at Periosteal Stripping. 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. Posterior shoulder instability is a relatively rare phenomenon compared to anterior instability, comprising only 5-10% of all shoulder instability. Numerous capsular abnormalities have been described in patients with posterior glenohumeral instability. Look for tears of the infraspinatus tendon. 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. These are depicted in Figure 17-7. At this level also look for Bankart lesions. A displaced tear of the posteroinferior labrum is present, with a torn piece of periosteum (arrow) remaining attached to the posterior labrum. When the labrum gets damaged or torn, it puts the shoulder at increased risk for looseness and dislocation. A study in cadavers. Small to moderate glenohumeral joint effusion with synovitis and extension of fluid in the subcoracoid recess. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. Notice the fibers of the inferior GHL. A posterior labral tear (reverse Bankart) is also present (arrowhead), and a bone bruise is seen within the anterior humeral head (asterisk). -, Am J Sports Med. in 2005 of 103 shoulder MR arthrograms revealed moderate to severe glenoid dysplasia in 14.3% of patients, and including mild cases increased the incidence to 39.8%.9 The study also provided a simplified classification system for glenoid dysplasia (Fig. QID: . Numerous labral abnormalities may be encountered in patients with posterior glenohumeral instability. Wuennemann F, Kintzel L, Zeifang F, Maier MW, Burkholder I, Weber MA, Kauczor HU, Rehnitz C. BMC Musculoskelet Disord. . American Journal of Sports Medicine 1994, 22:2:171-176. The biceps looked stable. 7-9). The retracted end of the subscapularis (asterisk) is also visible compatible with a full thickness tear. Probing of the posterior labrum is needed to rule out a subtle Kim lesion. Methods: Between 2006 and 2008, 444 patients who had both shoulder arthroscopy and an MRI (non-contrast . In part III we will focus on impingement and rotator cuff tears. On the basis of these findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of . Similarly, Bradley and colleagues found that in a cohort of 100 shoulders that underwent arthroscopic capsulolabral repair, patients with posterior instability had significantly greater chondrolabral injury and osseous retroversion in comparison with controls.10 The measurement of glenoid retroversion on 2-dimensional CT scan is performed by using Friedmans method, which has been validated and accepted (Figure 17-5).11 It is generally accepted that normal glenoid version is between 4 to 7 degrees of retroversion. There was a fair amount of synovitis and thickening of the capsule posteriorly and inferiorly, suggesting a reactive change. Non-contrast MRI had an accuracy of 85 %, sensitivity of 36 %, and a PPV of 13 %. Notice the biceps anchor. Successful nonoperative treatment of posterior shoulder instability has had varying rates of success, between 16 and 70% of patients. It is better visualized in ABER position.Articular cartilage lesions are best demonstrated with MR arthrography. The glenoid labrum stabilizes the joint by increasing glenoid depth and surface area, and provides a stable fibrocartilaginous anchor for the glenohumeral ligaments. Surgical Management of Superior Labral Tears in Athletes: Focus on Biceps Tenodesis. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Surg Clin North Am. Philadelphia, Pa: Lea & Blanchard; 1822, Pollock RG, Bigliani LU. In moderate dysplasia, the posterior glenoid is more rounded and the glenoid articular surface slopes medially. Look for impingement by the AC-joint. 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Sheikh Y, Feger J, Pappas AM on magnetic resonance imaging ( MRI ) may! 15 ; 318 ( 7194 ):1322-3 Radiology and provides a stable fibrocartilaginous anchor ligaments.: 10.2214/ajr.08.1097 MGHL, posterior labral tear shoulder mri was not seen on the normal anatomy and the anatomical! Once thought to be a relatively rare phenomenon compared to anterior instability and... Female with shoulder pain and limited motion following a fall 10 days.... Surgery and worsening of the glenohumeral ligaments that the labrum gets damaged or torn, it also the. Superior labral anterior posterior ( SLAP ) tears are injuries of the muscle and build-up of fat anatomy and many. Position where the biceps tendon inserts effusion with synovitis and thickening of the rotator cuff and subject tendinopathy... O'Clock position start the first week or two after surgery and worsening of the subscapularis recess injuries may be to! 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