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Stein P, Wuennemann F, Schneider T, Zeifang F, Burkholder I, Weber MA, Kauczor HU, Rehnitz C. 3-Tesla T2 Mapping Magnetic Resonance Imaging for Evaluation of SLAP Lesions in Patients with Shoulder Pain: An Arthroscopy-Controlled Study. J Clin Med 2023; 12:jcm12093109. [PMID: 37176550 PMCID: PMC10179291 DOI: 10.3390/jcm12093109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
This study investigated the ability of T2 mapping to assess the glenoid labrum and to differentiate between healthy labral substances and superior labral anterior posterior (SLAP) lesions using arthroscopy as the gold standard. Eighteen patients (mean age: 52.4 ± 14.72 years, 12 men) with shoulder pain were examined using 3-Tesla T2 mapping. All the patients underwent shoulder arthroscopy. Using morphological sequences for correlation, regions of interest covering the entire labral substance were placed in the corresponding T2 maps. The diagnostic cutoff values, sensitivities, and specificities, as well as the inter-reader correlation coefficients (ICCs) determined by two independent radiologists, were calculated. The mean T2 value was 20.8 ± 2.4 ms for the healthy labral substances and 37.7 ± 10.63 ms in the patients with SLAP lesions. The maximum T2 value in normal labrum (21.2 ms) was lower than the minimum T2 value in the patients with SLAP lesions (27.8 ms), leading to sensitivities, specificities, and positive and negative predictive values of 100% (95% CI 54.1-100.0) for all the cutoff values between 21.2 and 27.8 ms. The ICCs ranged from 0.91 to 0.99. In summary, the data suggest that evaluation and quantification of the labral (ultra)structural integrity using T2 mapping may allow discrimination between arthroscopically confirmed SLAP lesions and a healthy glenoid labrum. T2 mapping may therefore be helpful in diagnosing patients with suspected labral damage.
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Affiliation(s)
- Patrick Stein
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Felix Wuennemann
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Institute of Diagnostic and Interventional Radiology & Neuroradiology, Helios Dr. Horst Schmidt Clinics Wiesbaden, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany
| | - Thomas Schneider
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Felix Zeifang
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200A, 69118 Heidelberg, Germany
- Ethianum Clinic Heidelberg, Voßstraße 6, 69115 Heidelberg, Germany
| | - Iris Burkholder
- Department of Nursing and Health, University of Applied Sciences of the Saarland, 66117 Saarbruecken, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Christoph Rehnitz
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
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Kibler WB, Sciascia A, Tokish JT, Kelly JD, Thomas S, Bradley JP, Reinold M, Ciccotti M. Disabled Throwing Shoulder: 2021 Update: Part 2-Pathomechanics and Treatment. Arthroscopy 2022; 38:1727-1748. [PMID: 35307239 DOI: 10.1016/j.arthro.2022.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/15/2021] [Accepted: 02/03/2022] [Indexed: 02/02/2023]
Abstract
The purpose of this paper is to provide updated information for sports healthcare specialists regarding the disabled throwing shoulder (DTS). A panel of experts, recognized for their experience and expertise in this field, was assembled to address and provide updated information on several topics that have been identified as key areas in creating the DTS spectrum. Each panel member submitted a concise presentation on one of the topics within these areas, each of which were then edited and sent back to the group for their comments and consensus agreement in each area. Part two presents the following consensus conclusions and summary findings regarding pathomechanics and treatment, including (1) internal impingement results from a combination of scapular protraction and humeral head translation; (2) the clinically significant labral injury that represents pathoanatomy can occur at any position around the glenoid, with posterior injuries most common; (3) meticulous history and physical examination, with a thorough kinetic chain assessment, is necessary to comprehensively identify all the factors in the DTS and clinically significant labral injury; (4) surgical treatment should be carefully performed, with specific indications and techniques incorporating low profile implants posterior to the biceps that avoid capsular constraint; (5) rehabilitation should correct all kinetic chain deficits while also developing high-functioning, throwing-specific motor patterns and proper distribution of loads and forces across all joints during throwing; and (6) injury risk modification must focus on individualized athlete workload to avoid overuse. LEVEL OF EVIDENCE: V, expert opinion.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington, Kentucky, U.S.A
| | - Aaron Sciascia
- Department of Exercise and Sport Science, Eastern Kentucky University, Richmond, Kentucky, U.S.A..
| | - J T Tokish
- Orthopedic Sports Medicine Fellowship, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - John D Kelly
- Shoulder Sports Medicine, Penn Perleman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Stephen Thomas
- Department of Exercise Science, Jefferson College of Rehabilitation Science, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - James P Bradley
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Michael Reinold
- Champion PT and Performance, Boston, Massachusetts, U.S.A.; Chicago White Sox, Chicago, Illinois, U.S.A
| | - Michael Ciccotti
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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3
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Disabled Throwing Shoulder 2021 Update: Part 1-Anatomy and Mechanics. Arthroscopy 2022; 38:1714-1726. [PMID: 35307240 DOI: 10.1016/j.arthro.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/15/2021] [Accepted: 02/03/2022] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to provide updated information for sports health care specialists regarding the Disabled Throwing Shoulder (DTS). A panel of experts, recognized for their experience and expertise in this field, was assembled to address and provide updated information on several topics that have been identified as key areas in creating the DTS spectrum. Each panel member submitted a concise presentation on one of the topics within these areas, each of which were then edited and sent back to the group for their comments and consensus agreement in each area. Part 1 presents the following consensus conclusions and summary findings regarding anatomy and mechanics, including: 1) The current understanding of the DTS identifies internal impingement, resulting from a combination of causative factors, as the final common pathway for the great majority of the labral pathoanatomy; 2) intact labral anatomy is pivotal for glenohumeral stability, but its structure does not control or adapt well to shear or translational loads; 3) the biceps plays an active role in dynamic glenohumeral stability by potentiating "concavity compression" of the glenohumeral joint; 4) the ultimate function of the kinetic chain is to optimize the launch window, the precise biomechanical time, and position for ball release to most effectively allow the ball to be thrown with maximum speed and accuracy, and kinetic chain function is most efficient when stride length is optimized; 5) overhead throwing athletes demonstrate adaptive bony, capsular, and muscular changes in the shoulder with repetitive throwing, and precise measurement of shoulder range of motion in internal rotation, external rotation, and external rotation with forearm pronation is essential to identify harmful and/or progressive deficits. LEVEL OF EVIDENCE: Level V, expert opinion.
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Shah SS, Ferkel E, Mithoefer K. High Prevalence of Superior Labral Anterior-Posterior Tears Associated With Acute Acromioclavicular Joint Separation of All Injury Grades. Orthop J Sports Med 2020; 8:2325967120941850. [PMID: 32923497 PMCID: PMC7457667 DOI: 10.1177/2325967120941850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background Despite the relatively high number of cases of acromioclavicular joint (AC) separation in the athletic population, optimal clinical outcomes are not achieved in every case. Limited data exist regarding the prevalence of intra-articular glenohumeral pathologies (IAPs) associated with acute AC separation of all injury grades. Purpose To determine the prevalence of IAPs associated with AC separation, regardless of severity. Study Design Case series; Level of evidence, 4. Methods A total of 62 patients (mean age, 37.6 years) with acute AC separation were included in this study; 41 were nonoverhead recreational athletes. All patients underwent magnetic resonance arthrography (MRA) to evaluate for IAPs. Arthroscopic data from patients undergoing surgical treatment were correlated with MRA results. Results Patients sustained acute AC separation of Rockwood grade 1 (16.1%), grade 2 (46.8%), grade 3 (25.8%), and grade 4 (11.3%). A concomitant IAP was present in 48 of 62 (77.4%) patients and included superior labral anterior-posterior tears (72.6%), anterior labral tears (24.2%), posterior labral tears (4.8%), supraspinatus tears (3.2%), and inferior glenohumeral ligament ruptures (1.6%). There were 18 (29.0%) patients who had a concomitant pathology in >1 intra-articular structure (combined IAPs). Additionally, 71.8% of patients with grade 1 and 2 AC separation had associated IAPs, and 23.1% had combined IAPs. Furthermore, in patients younger than 40 years, 64.0% of those with grade 1 to 3 AC separation demonstrated associated labral pathologies. There was no difference when comparing age or severity of AC separation and the prevalence of concomitant labral tears (P = .36 and .22, respectively). Conclusion There was a high prevalence of IAPs among patients undergoing MRA after AC separation. While an IAP has been described in association with high-grade AC separation previously, the high prevalence of IAPs in low-grade separation in our study was unexpected and suggests that a thorough evaluation and clinical follow-up for patients with all grades of AC separation may be beneficial.
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Affiliation(s)
- Sarav S Shah
- Department of Orthopaedic Surgery and Sports Medicine, New England Baptist Hospital, Boston, Massachusetts, USA
| | - Eric Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
| | - Kai Mithoefer
- Department of Orthopedics and Sports Medicine, Harvard Vanguard Medical Associates, Atrius Health, Chestnut Hill, Massachusetts, USA
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Alashkham A, Alraddadi A, Felts P, Soames R. Histology, vascularity and innervation of the glenoid labrum. J Orthop Surg (Hong Kong) 2019; 26:2309499018770900. [PMID: 29661113 DOI: 10.1177/2309499018770900] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although the glenoid labrum has an important role in shoulder stability, little is known about its composition, vascularity and innervation. The aims of this study were therefore to evaluate the histology, vascularity and innervation of the glenoid labrum. MATERIALS AND METHODS Ten glenoid labrum specimens (three male, two female: mean age 81.2 years, range 76-90 years) were detached at the glenoid neck. Following decalcification, sections were cut through the whole thickness of each specimen perpendicular to the glenoid labrum at 12 radii corresponding to a clock face superimposed on the glenoid fossa. Then they were stained using haematoxylin and eosin, a silver nitrate protocol or subjected to immunohistochemistry using anti-protein gene protein 9.5 to demonstrate neuronal processes. RESULTS The labrum was fibrocartilaginous, being more fibrous in its free margin. There was a variable distribution of blood vessels, being more vascular in its periphery, with many originating from the fibrous capsule and piercing the glenoid labrum. Immunohistochemistry revealed positive staining of nerve fibres within the glenoid labrum. CONCLUSION The glenoid labrum is fibrocartilaginous, being more fibrous in its periphery, and is vascularized, with the anterosuperior aspect having a rich blood supply. Free sensory nerve fibres were also present; no encapsulated mechanoreceptors were observed. The presence of sensory nerve fibres in the glenoid labrum could explain why tears induce pain. It is postulated that these sensory fibres could play a role in glenohumeral joint proprioception.
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Affiliation(s)
- Abduelmenem Alashkham
- 1 Centre for Human Anatomy, School of Biomedical Sciences, University of Edinburgh, Edinburgh, UK.,2 Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK.,3 Human Anatomy Department, Faculty of Medicine, University of Zawia, Zawia, Libya
| | - Abdulrahman Alraddadi
- 2 Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK.,4 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Paul Felts
- 2 Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
| | - Roger Soames
- 2 Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
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Temporiti F, Furone R, Cescon C, Barbero M, Gatti R. Dispersion of helical axes during shoulder movements in young and elderly subjects. J Biomech 2019; 88:72-77. [PMID: 30926136 DOI: 10.1016/j.jbiomech.2019.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/31/2018] [Accepted: 03/12/2019] [Indexed: 12/29/2022]
Abstract
The shoulder complex (SC) consists of joints with little congruence and its active and passive structures ensure its stability. Stability of the SC rotation centre during upper arm movements can be estimated through the analysis of Helical Axes (HAs) dispersion. The aim of this study was to describe shoulder HAs dispersion during upper limb movements performed with dominant and non-dominant arms by young and elderly subjects. Forty subjects participated in the study (20 young: age 24.8 ± 2.8 years and 20 elderly: age 71.7 ± 6.3 years). Subjects were asked to perform four cycles of 15 rotations, flexions, elevations and abductions with one arm at a time at constant speed. Reflective markers were placed on participants' arms and trunk in order to detect movements and the HAs dispersion with an optoelectronic system. Mean Distance (MD) from the HAs barycenter and Mean Angle (MA) were used as HAs dispersion indexes. Young subjects showed significant lower MD compared to the elderly during all motion ranges of rotation, flexion and elevation (p < 0.001). Moreover, the MD was lower in the dominant arm compared to the contralateral for rotation (p = 0.049) and flexion (p = 0.019). The results may be due to joint degeneration described in elderly subjects and differences in neuromuscular control of SC stability.
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Affiliation(s)
- Federico Temporiti
- Physiotherapy Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Roberta Furone
- Physiotherapy Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; BTS S.p.A., Garbagnate Milanese, Milan, Italy
| | - Corrado Cescon
- Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Marco Barbero
- Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Roberto Gatti
- Physiotherapy Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; Humanitas University, Pieve Emanuele, Milan, Italy.
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Rathi S, Taylor NF, Green RA. A comparison of glenohumeral joint translation between young and older asymptomatic adults using ultrasonography: a secondary analysis. Physiother Theory Pract 2019; 36:1354-1362. [PMID: 30704320 DOI: 10.1080/09593985.2019.1571138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The rotator cuff muscles are subject to age-related changes, but the effect of aging on glenohumeral joint stability is poorly understood. Objectives: This study aimed to compare glenohumeral joint translation in asymptomatic young and older people. Methods: Twenty young (23.6 ± 5.3 years) and twenty older (66.5 ± 7.8 years) participants with no symptomatic shoulder pathology were recruited. Anterior and posterior glenohumeral joint translations were measured using real-time ultrasound in two positions: (1) shoulder neutral; and (2) shoulder at 90 degrees' abduction and four testing conditions: (1) rest; (2) passive accessory motion testing (PAMT) force alone; (3) PAMT with isometric internal rotation contraction; and (4) PAMT with external rotation contraction. Results: In both groups, there were significant differences between the amount of translation limited by anterior and posterior rotator cuff muscles in response to anterior and posterior PAMT force (p < 0.03), indicating rotator cuff activity-limited translation in a direction-specific manner. Young participants demonstrated increased passive posterior glenohumeral joint translation in the neutral shoulder position (p < 0.001) and their rotator cuff muscle contraction led to greater reductions in glenohumeral joint translation in the neutral shoulder position (p < 0.001), as compared with older participants. Conclusions: Rotator cuff contraction limits glenohumeral joint translation in a direction-specific manner in both young and older participants. However, younger age is associated with increased passive translation but greater ability to reduce glenohumeral joint translation with rotator cuff muscle contraction. Age-related changes should be considered when assessing and treating glenohumeral joint stability.
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Affiliation(s)
- Sangeeta Rathi
- Department of Pharmacy and Applied Science, La Trobe University , Bendigo, VIC, Australia.,Department of Allied Health, St. John of God Hospital , Bendigo, VIC, Australia
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University , Bundoora, VIC Australia
| | - Rodney A Green
- Department of Pharmacy and Applied Science, La Trobe University , Bendigo, VIC, Australia
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Lansdown DA, Bendich I, Motamedi D, Feeley BT. Imaging-Based Prevalence of Superior Labral Anterior-Posterior Tears Significantly Increases in the Aging Shoulder. Orthop J Sports Med 2018; 6:2325967118797065. [PMID: 30238014 PMCID: PMC6141924 DOI: 10.1177/2325967118797065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Superior labral anterior-posterior (SLAP) tears can be associated with pain and shoulder dysfunction. Relatively little is known about the age-related prevalence of SLAP tears. Purpose To investigate the age-related prevalence of imaging-diagnosed SLAP tears in a heterogeneous grouping of shoulder conditions in a large cohort at a single institution with multiple blinded reviewers. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 281 shoulder magnetic resonance imaging (MRI) scans obtained over 8 months were reviewed by a musculoskeletal radiologist and an orthopaedic surgeon. The mean ± SD age of the group was 49.6 ± 15.5 years, and 107 of the patients were female (38.1%). Patients were divided into 4 age groups: 35 years or younger, 36 to 50 years, 51 to 65 years, and older than 65 years. Statistical analyses were completed by use of the Fisher exact test to compare proportions of SLAP tears between age groups, odds ratios to determine the likelihood of having a SLAP tear in each age group, and a logistic regression to control for associated abnormalities. Results There was a significant diffference in the proportion of SLAP tears found on the MRIs for each age group (P < .001). Patients were significantly more likely to have SLAP tears if aged 51 to 65 years (66.7%; odds ratio [OR], 2.00; 95% CI, 1.27-3.15) and if older than 65 years (81.2%; OR, 4.31; 95% CI, 2.36-7.88). No increased prevalence was observed in patients aged 35 years or younger (47.5%; OR, 0.91; 95% CI, 0.55-1.50) or 36 to 50 years (51.8%; OR, 1.08; 95% CI, 0.70-1.67). Logistic regression demonstrated that age was the only significant predictor for having a SLAP tear (P < .001). Kappa values were 0.46 to 0.65 between reviewers, indicating moderate to substantial agreement. Conclusion An increasing prevalence of MRI-based SLAP tears was observed with increasing patient age. Patients older than 50 years were significantly more likely to have superior labral abnormalities regardless of other shoulder injury or disease.
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Affiliation(s)
- Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Ilya Bendich
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daria Motamedi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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9
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Abstract
Background: SLAP lesions of the shoulder are challenging to diagnose by clinical means alone. Interpretation of MR images requires knowledge of the normal appearance of the labrum, its anatomical variants, and the characteristic patterns of SLAP lesions. In general, high signal extending anterior and posterior to the biceps anchor is the hallmark of SLAP lesions. Common diagnostic criteria for a SLAP lesion by MR or MR arthrography include the following: presence of a laterally curved, high signal intensity in the labrum on a coronal image, multiple or branching lines of high signal intensity in the superior labrum on a coronal image, full-thickness detachment with irregularly marginated high signal intensity and/or separation >2 mm on conventional MRI or 3 mm on MR arthrography between the labrum and glenoid on a coronal image, and a paralabral cyst extending from the superior labrum. Methods: MR diagnosis of SLAP tears may be improved with provocative maneuvers, such as longitudinal traction of the arm or positioning of the shoulder in abduction and external rotation during imaging. The use of intra-articular contrast distends the joint similar to what occurs during arthroscopy and forced diffusion under the labrum may improve the ability to detect SLAP lesions that might not be seen with standard MR. Improved diagnostic accuracy for SLAP tears is seen with 3-T compared with 1.5-T MR imaging, with or without intra-articular contrast material. Conclusion: Regardless of MR findings, however, physicians should be cautious when recommending surgery in the patient with a vague clinical picture. The patient’s history, physical exam, and imaging evaluation all should be considered together in making the decision to proceed with surgery.
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Affiliation(s)
- Robert D Boutin
- Department of Radiology, UC Davis School of Medicine, 4860 Y St., Suite 3100, Sacramento, CA 95817, USA
| | - Richard A Marder
- Department of Orthopaedic Surgery, UC Davis School of Medicine, 4860 Y St., Suite 3800, Sacramento, CA 95817, USA
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Gwark JY, Gahlot N, Kam M, Park HB. Is the Frozen Shoulder Classification a Reliable Assessment? Clin Shoulder Elb 2018; 21:82-86. [PMID: 33330157 PMCID: PMC7726380 DOI: 10.5397/cise.2018.21.2.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/13/2018] [Accepted: 03/01/2018] [Indexed: 11/25/2022] Open
Abstract
Background Although a common shoulder disease, there are no accepted classification criteria for frozen shoulder (FS). This study therefore aimed to evaluate the accuracy of the conventionally used FS classification system. Methods Primary FS patients (n=168) who visited our clinic from January 2010 to July 2015 were included in the study. After confirming restrictions of the glenohumeral joint motion and absence of history of systemic disease, trauma, shoulder surgery, shoulder muscle weakness, or specific x-ray abnormalities, the Zuckerman and Rokito’s classification was employed for diagnosing primary FS. Following clinical diagnosis, each patient underwent a shoulder magnetic resonance imaging (MRI) and blood tests (lipid profile, glucose, hemoglobin A1c, and thyroid function). Based on the results of the blood tests and MRIs, the patients were reclassified, using the criteria proposed by Zuckerman and Rokito. Results New diagnoses were ascertained including blood test results (16 patients with diabetes, 43 with thyroid abnormalities, and 149 with dyslipidemia), and MRI revealed intra-articular lesions in 81 patients (48.2%). After re-categorization based on the above findings, only 5 patients (3.0%) were classified having primary FS. The remaining 163 patients (97.0%) had either undiagnosed systemic or intrinsic abnormalities (89 patients), whereas 74 patients had both. Conclusions These findings demonstrate that most patients clinically diagnosed with primary FS had undiagnosed systemic abnormalities and/or intra-articular pathologies. Therefore, a modification of the Zuckerman and Rokito’s classification system for FS may be required to include the frequent combinations, rather than having a separate representation of systemic abnormalities and intrinsic causes.
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Affiliation(s)
- Ji-Yong Gwark
- Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Nitesh Gahlot
- Department of Orthopedic Surgery, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Mincheol Kam
- Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Hyung Bin Park
- Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea.,Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Changwon, Korea
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11
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Abstract
Anterior shoulder dislocations, subluxations, and recurrent instability of the shoulder joint are common problems usually affecting a young active population. However, it can be a problem for patients up to the late decades in life and can lead to major shoulder arthropathy if left untreated or improperly treated. This article discusses the natural history, pathologic morphologic changes of the shoulder joint associated with anterior instability along with normal anatomic variants. We will also discuss current treatment recommendations and possible causes of the patient with recurrent instability despite prior stabilization procedures.
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12
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Hantes M, Raoulis V. Arthroscopic Findings in Anterior Shoulder Instability. Open Orthop J 2017; 11:119-132. [PMID: 28400880 PMCID: PMC5366393 DOI: 10.2174/1874325001711010119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 01/26/2023] Open
Abstract
Background: In the last years, basic research and arthroscopic surgery, have improved our understanding of shoulder anatomy and pathology. It is a fact that arthroscopic treatment of shoulder instability has evolved considerably over the past decades. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases. Methods: A review of the current literature regarding arthroscopic shoulder anatomy, anatomic variants, and arthroscopic findings in anterior shoulder instability, is presented. In addition, correlation of arthroscopic findings with physical examination and advanced imaging (CT and MRI) in order to improve our understanding in anterior shoulder instability pathology is discussed. Results: Shoulder instability represents a broad spectrum of disease and a thorough understanding of the pathoanatomy is the key for a successful treatment of the unstable shoulder. Patients can have a variety of pathologies concomitant with a traditional Bankart lesion, such as injuries of the glenoid (bony Bankart), injuries of the glenoid labrum, superiorly (SLAP) or anteroinferiorly (e.g. anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), and accompanying osseous-cartilage lesions (Hill-Sachs, glenolabral articular disruption). Shoulder arthroscopy allows for a detailed visualization and a dynamic examination of all anatomic structures, identification of pathologic findings, and treatment of all concomitant lesions. Conclusion: Surgeons must be well prepared and understanding the normal anatomy of the glenohumeral joint, including its anatomic variants to seek for the possible pathologic lesions in anterior shoulder instability during shoulder arthroscopy. Patient selection criteria, improved surgical techniques, and implants available have contributed to the enhancement of clinical and functional outcomes to the point that arthroscopic treatment is considered nowadays the standard of care.
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Affiliation(s)
- Michael Hantes
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| | - Vasilios Raoulis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
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13
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Abstract
The glenoid labrum is a critical structure within the gleno-humeral joint and commonly requires treatment by the shoulder surgeon. This review presents a concise summary of the embryology, anatomy, microscopy, biomechanical properties and clinical lesions involving the glenoid labrum. This knowledge will aid the clinician in understanding its function and pathology.
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Affiliation(s)
- Chris Smith
- University of Warwick, Clinical Sciences Research Institute, Coventry, UK
| | - Lennard Funk
- Department of Orthopaedics, Salford University, Salford, UK
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Arai R, Harada H, Tsukiyama H, Takahashi Y, Kobayashi M, Saji T, Matsuda S. An anatomical investigation of clock face landmarks around the glenoid for shoulder arthroscopy orientation. J Orthop Sci 2016; 21:727-731. [PMID: 27589914 DOI: 10.1016/j.jos.2016.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 05/12/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND For shoulder arthroscopy, few anatomical landmarks are available and inexperienced surgeons tend to be adrift due to the limited visual field of the scope. The purpose of this study was to demonstrate the useful landmarks around the glenoid for accurate orientation, and also the safe distance to avoid suprascapular nerve injury during surgical procedures around the glenoid. METHODS In 15 human solution-fixed cadavers, a cross-section of the shoulder joint on the labrum surface was created. The positions of the principal anatomical structures surrounding the glenoid were marked on the labrum and measured using our clock face indication system. In 9 shoulders the distances from the labral surface to the spinoglenoid notch were recorded. As an indicator of the scapula size, the distances between the superior and inferior angles of the scapula were also measured. RESULTS The average landmark positions in the right shoulder were as follows: center of the attachment of the long tendon 11:59, anterior edge of the supraspinatus 11:59, posterior edge of the base of the coracoid process 12:13, superior edge of the subscapularis 1:03, anterior edge of the base of the coracoid process 1:25, inferior edge of the subscapularis 5:27, inferior edge of the teres minor 6:21, border of the infraspinatus and teres minor 7:43, center of the scapula spine 10:06, border of the supra and infraspinatus 10:27. The average distance from the labral surface to the spinoglenoid notch was 23.17 mm, and that from the superior to inferior angle was 144.93 mm. The Pearson correlation coefficient for these distances was 0.007. CONCLUSIONS The locations of anatomical landmarks surrounding the glenoid were reliably demonstrated using our clock face indication system. The expected distance from the labral surface to the suprascapular nerve was approximately 23 mm, irrespective of the size of the scapula.
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Affiliation(s)
- Ryuzo Arai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto Pref., 606-8507, Japan.
| | - Hideto Harada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto Pref., 606-8507, Japan
| | - Hiroyuki Tsukiyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto Pref., 606-8507, Japan
| | - Yoshimitsu Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto Pref., 606-8507, Japan
| | - Masahiko Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto Pref., 606-8507, Japan
| | - Takahiko Saji
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto Pref., 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto Pref., 606-8507, Japan
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15
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Roldán-Jiménez C, Cuesta-Vargas AI. Age-related changes analyzing shoulder kinematics by means of inertial sensors. Clin Biomech (Bristol, Avon) 2016; 37:70-76. [PMID: 27362972 DOI: 10.1016/j.clinbiomech.2016.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 06/16/2016] [Accepted: 06/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Shoulder kinematics alteration has been previously proven in subjects suffering from shoulder damage, which is also related to shoulder degenerative changes as consequence of aging. Because of that, it would be interesting to investigate age-related kinematics. The main objective was to analyze age-related differences in shoulder kinematics by means of inertial sensors in asymptomatic subjects during shoulder abduction and flexion. METHODS Twenty-five right arms were measured (11 from the young adult group and 14 from the older adult group). In the young group, age ranged between 20 and 34years old, while in the older group age ranged between 45 and 72years old. Angular mobility and linear acceleration from the scapula, humerus and sternum as well as mobility in the glenohumeral and scapulothoracic joints were calculated by three inertial sensors. Subjects performed shoulder abduction and flexion. FINDINGS Significant differences in mobility were found in humerus and scapula in mobility and acceleration during both tasks. Those differences varied depending on the plane analyzed. A moderate negative correlation between age and humerus and scapula ranged from -0.624** to -0.409*. A positive correlation was found in some planes. INTERPRETATION The results from the present study suggest that humerus elevation and scapular protraction-retraction as well as medio-lateral rotation are more likely to present kinematics age-related differences, i.e. older: age is associated with less mobility and acceleration in some planes and axes. Results provide inertial tridimensional measures from shoulder complex comparing groups of different age. Findings also concur with previous research supporting age-related shoulder changes.
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Affiliation(s)
- Cristina Roldán-Jiménez
- Department of Psychiatry and Physiotherapy, University of Malaga, Faculty of Health Sciences, Spain.
| | - Antonio I Cuesta-Vargas
- Department of Psychiatry and Physiotherapy, University of Malaga, Faculty of Health Sciences, Spain; School of Clinical Science, Faculty of Health Science, Queensland University Technology, Australia.
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16
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Anatomy of the capsulolabral complex and rotator interval related to glenohumeral instability. Knee Surg Sports Traumatol Arthrosc 2016; 24:343-9. [PMID: 26704796 DOI: 10.1007/s00167-015-3892-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/17/2015] [Indexed: 11/27/2022]
Abstract
The glenohumeral joint with instability is a common diagnosis that often requires surgery. The aim of this review was to present an overview of the anatomy of the glenohumeral joint with emphasis on instability based on the current literature and to describe the detailed anatomy and anatomical variants of the glenohumeral joint associated with anterior and posterior shoulder instability. A review was performed using PubMed/MEDLINE using key words: Search terms were "glenohumeral", "shoulder instability", "cadaver", "rotator interval", "anatomy", and "anatomical study". During the last decade, the interest in both arthroscopic repair techniques and surgical anatomy of the glenohumeral ligament (superior, middle, and inferior), labrum, and rotator interval has increased. Understanding of the rotator interval and attachment of the inferior glenohumeral ligament on the glenoid or humeral head have evolved significantly. The knowledge of the detailed anatomy and anatomical variations is essential for the surgeon in order to understand the pathology, make a correct diagnosis of instability, and select proper treatment options. Proper understanding of anatomical variants can help us avoid misdiagnosis. Level of evidence V.
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17
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Schwartzberg R, Reuss BL, Burkhart BG, Butterfield M, Wu JY, McLean KW. High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders. Orthop J Sports Med 2016; 4:2325967115623212. [PMID: 26779556 PMCID: PMC4710128 DOI: 10.1177/2325967115623212] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: The incidence of superior labral surgery has increased in the past decade in the United States, and a contributing factor could be an increased rate of superior labral tears diagnosed with magnetic resonance imaging (MRI). Prior MRI studies of the asymptomatic shoulder have focused on rotator cuff pathology or pathology in a narrow and specific group of athletes. Labral abnormalities have not previously been thoroughly evaluated in asymptomatic middle-aged individuals. Purpose: To evaluate the prevalence of superior labral tears diagnosed by MRI in the asymptomatic shoulders of middle-aged people (age range, 45-60 years). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 53 asymptomatic adults (age range, 45-60 years) with no history of surgery or injury to either shoulder were included in the study. Physical examinations of all shoulders were performed. Noncontrast MRI (1.5 T) was performed in 1 randomly determined shoulder of each subject. Two fellowship-trained musculoskeletal radiologists who were blinded to the purpose of the study and ages of the subjects evaluated each MRI. Results: Radiologists interpreted the MRIs as consistent with superior labral tears in 55% and 72% of the cohort. Comparison of the radiological evaluations of the superior labra were moderate (κ = 0.410, P = .033). There were no differences in readings for superior labral tear regarding age (P = .87), sex (P = .41), whether the dominant shoulder underwent MRI (P = .99), whether the subject worked a physical job (P = .08), or whether the subject participated in overhead sports for a period of 1 year (P = .62). Conclusion: Superior labral tears are diagnosed with high frequency using MRI in 45- to 60-year-old individuals with asymptomatic shoulders. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population. Clinical Relevance: To avoid overtreatment, physicians should realize that superior labral tears diagnosed by MRI in individuals between the ages of 45 and 60 years may be normal age-related findings.
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Affiliation(s)
| | | | | | | | - James Y Wu
- Center for Diagnostic Imaging, Winter Park, Florida, USA
| | - Kevin W McLean
- Center for Diagnostic Imaging, Winter Park, Florida, USA
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Taylor SA, O’Brien SJ. Clinically Relevant Anatomy and Biomechanics of the Proximal Biceps. Clin Sports Med 2016; 35:1-18. [DOI: 10.1016/j.csm.2015.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Yoshida M, Goto H, Nozaki M, Nishimori Y, Takenaga T, Murase A, Nagaya Y, Iguchi H, Kobayashi M, Sugimoto K, Nishiyama T, Otsuka T. Quantitative analysis of attachment of the labrum to the glenoid fossa: a cadaveric study. J Orthop Sci 2015; 20:823-9. [PMID: 26169109 DOI: 10.1007/s00776-015-0742-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study investigated the direct and continuous attachment of the labrum to the glenoid fossa, including the fibrocartilaginous tissue, using image-analysis software and histology. METHODS Twenty-six cadaveric shoulders (11 male, 15 female; mean age 80.1 years; age range 36-103 years) were used. The glenoid of each specimen was divided into six pie-slice-shaped pieces from the center perpendicular to the articular surface by radial incisions at the 2, 4, 6, 8, 10, and 12 o'clock positions. The general distribution of the labrum, including the fibrocartilage, was assessed in hematoxylin and eosin-, Safranin O- and Azan-Mallory-stained sections. The continuous length of attachment of the labrum to the glenoid was measured using image-analysis software. The width of attachment to the articular surface of the glenoid was assessed in each position. RESULTS The labrum attached to both the articular surface and the neck of the glenoid in all shoulders (100 %) in the 4 and 6 o'clock positions. The mean length of the entire attachment to the glenoid was 4.6 mm (range 3.2-6.1 mm). The width of attachment from the bony edge of the glenoid to the edge of the labrum on the articular surface ranged from 0 to 4.3 mm. The length of the entire attachment of the labrum was shortest in the 2 o'clock position (p = 0.229). Additionally, the length of the entire attachment of the labrum was longest in the 4 o'clock position. The width of attachment to the articular surface of the glenoid was greatest in the 4 o'clock position (p < 0.01). CONCLUSION In the 4 and 6 o'clock positions, the labrum attached to both the articular surface and neck of the glenoid in all of the shoulders (100 %). The length of the entire attachment to the labrum, including the fibrocartilage, was shortest in the 2 o'clock position. The width of attachment to the articular surface of the glenoid was greatest in the 4 o'clock position (p < 0.01).
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Affiliation(s)
- Masahito Yoshida
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Hideyuki Goto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yasuhiro Nishimori
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Atsunori Murase
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yuko Nagaya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Hirotaka Iguchi
- Department of Arthroplastic Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Masaaki Kobayashi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | | | - Takeshi Nishiyama
- Department of Public Health, Aichi Medical University, Nagakute, Japan
| | - Takanobu Otsuka
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
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Waterman BR, Cameron KL, Hsiao M, Langston JR, Clark NJ, Owens BD. Trends in the diagnosis of SLAP lesions in the US military. Knee Surg Sports Traumatol Arthrosc 2015; 23:1453-1459. [PMID: 24318507 DOI: 10.1007/s00167-013-2798-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 11/25/2013] [Indexed: 01/03/2023]
Abstract
PURPOSE Shoulder pathology, particularly SLAP (superior labrum anterior-posterior) lesions, is prevalent in overhead athletes and physically active individuals. The aim of this study is to quantify the burden of SLAP lesions in the military and establish risk factors for diagnosis. METHODS A retrospective analysis of all service members diagnosed with a SLAP lesion (International Classification of Disease, Ninth Revision code 840.70) in the Defense Medical Epidemiological Database between 2002 and 2009 was performed. Available epidemiological risk factors including age, sex, race, military rank, and branch of service were evaluated using multivariate Poisson regression analysis, and cumulative and subgroup incidence rates were calculated. RESULTS During the study period, approximately 23,632 SLAP lesions were diagnosed among a population at risk of 11,082,738, resulting in an adjusted incidence rate of 2.13 per 1,000 person-years. The adjusted annual incidence rate for SLAP lesions increased from 0.31 cases per 1,000 person-years in 2002 to 1.88 cases per 1,000 person-years in 2009, with an average annual increase of 21.2 % (95 % CI 20.7 %, 22.0 %, p < 0.0001) during the study period. Age, sex, race, branch of military service, and military rank were independent risk factors associated with the incidence rate of SLAP lesion (p < 0.01). Male service members were over twofold more likely (IRR, 2.12; 95 % CI 2.01, 2.23) to sustain a SLAP lesion when compared with females. Increasing age category was associated with a statistically significant increase in the incidence rate for SLAP lesions in the present study (p < 0.001). After controlling for the other variables, those individuals of white race, enlisted ranks, or Marine Corps service experienced the highest incidence rates for SLAP. CONCLUSION This is the first study to establish the epidemiology of SLAP lesions within an active military cohort in the American population. Sex, age, race, military rank, and branch of military service were all independently associated with the incidence rate of SLAP lesions in this physically active population at high risk for shoulder injury. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Brian R Waterman
- Orthopaedic Surgery Service, William Beaumont Army Medical Center, 5005 North Piedras St, El Paso, TX, 79920-5001, USA.
| | - Kenneth L Cameron
- The John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, West Point, NY, USA
| | - Mark Hsiao
- Orthopaedic Surgery Service, William Beaumont Army Medical Center, 5005 North Piedras St, El Paso, TX, 79920-5001, USA
| | - Joseph R Langston
- Orthopaedics & Rehabilitation, Oregon Health & Sciences University, Portland, OR, USA
| | - Nicholas J Clark
- The Department of Mathematical Sciences, United States Military Academy, West Point, NY, USA
| | - Brett D Owens
- The John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, West Point, NY, USA
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Magnetic resonance arthrography assessment of the superior labrum using the BLC system: age-related changes mimicking SLAP-2 lesions. Skeletal Radiol 2014; 43:1065-70. [PMID: 24752875 DOI: 10.1007/s00256-014-1889-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/24/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of the study was to describe the variation of the superior labrum with increasing age by assessing magnetic resonance (MR) arthrograms. METHODS Inclusion criteria were used to include only the MR arthrograms of patients devoid of clinical labral pathology. Two hundred thiry-six MR arthrograms were blindly assessed for biceps-labral complex (BLC) type 1-3 and sublabral recess size by a musculoskeletal radiologist. We have chosen the BLC system, which defines normal superior labral variants, since it is established in the literature and is used by reporting musculoskeletal (MSK) radiologists. RESULTS The MR arthrograms demonstrated that the majority of patients <40 years old were BLC type 1 and showed a steady increase in BLC types 2 and 3 with increasing age. Assessments demonstrated significantly greater (p < 0.01) mean BLC types (1.62 vs 1.29) and recess size (1.35 vs 0.66 mm) in those over 40 compared with those less than 40 years of age. Furthermore, significant differences (p < 0.05) were noted between mean BLC assessments between different decades of age. CONCLUSIONS There appears to be a physiologic deepening of the superior labrum sulcus with age, which becomes significant after the age of 40. These findings can contribute to whether the superior labrum is considered abnormal when assessed radiographically. The differentiation of normal age-related changes in the shoulder, from those of a type 2 SLAP tear can reduce the rates of unnecessary SLAP-2 repairs. This is the first reported series to use the BLC system; we believe it provides a common nomenclature to allow clear communication between specialists.
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McCormick F, Bhatia S, Chalmers P, Gupta A, Verma N, Romeo AA. The management of type II superior labral anterior to posterior injuries. Orthop Clin North Am 2014; 45:121-8. [PMID: 24267213 DOI: 10.1016/j.ocl.2013.08.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Arthroscopic repair of type II superior labral anterior to posterior (SLAP) tears is currently the standard of care, with most patients obtaining good to excellent surgical results. However, overhead athletes and older patients have inferior outcomes. Recent clinical studies and biomechanical data suggest that a biceps tenodesis is a suitable alternative in select patients. This article reviews the literature to identify the biomechanical and clinical indications for performing a biceps tenodesis for type II SLAP lesions.
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Affiliation(s)
- Frank McCormick
- Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA.
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Pappas ND, Hall DC, Lee DH. Prevalence of labral tears in the elderly. J Shoulder Elbow Surg 2013; 22:e11-5. [PMID: 23237722 DOI: 10.1016/j.jse.2012.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/14/2012] [Accepted: 08/16/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prevalence of SLAP (superior labrum antero-posterior) tears in the general population is not well known. The purpose of this study is to determine the prevalence of SLAP tears in the elderly using a cadaveric population. METHODS One hundred two embalmed cadaveric shoulders were dissected by a single, experienced orthopaedic shoulder surgeon (D.H.L.). The average age of the cadavers was 80.6 years (range, 57-96). There were 40 female and 62 male shoulders. For each shoulder dissection, the labrum, rotator cuff, and glenohumeral articular cartilage were inspected. RESULTS SLAP tears were found in 10 out of 102 shoulders (9.8%), 9 (8.8%) of which were classified as type I and 1 (0.98%) as type II. Twenty-one shoulders (20.6%) were found to have an anterior sublabral foramen, which had an average length of 7 mm (range, 3-11). Seven shoulders (6.9%) had a Buford complex. CONCLUSION The prevalence of SLAP tears in the elderly is very low. However, there are a significant number of normal anatomic labral variants (eg, sublabral foramina, Buford complexes), which can resemble SLAP tears. These findings add to our knowledge of the prevalence of SLAP tears and will assist future researchers in determining both why the incidence of SLAP repair is increasing and whether it is justified.
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Affiliation(s)
- Nick D Pappas
- Greenville Hospital System/Steadman Hawkins Clinic of Carolinas/Hawkins Research Foundation, Greenville, SC, USA
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Mok D, Wang EL. Does age or gender of the patient influence the outcome of type II superior labrum anterior and posterior repair? INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2013; 6:112-5. [PMID: 23493640 PMCID: PMC3590701 DOI: 10.4103/0973-6042.106223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS To assess whether patients above 50 years of age, particularly female, would benefit from repair of their SLAP tears. SETTINGS AND DESIGN Review of patients' records followed by telephone interview at a minimum of two years after surgery. MATERIALS AND METHODS Seventy-two consecutive patients who had their SLAP repaired were retrospective reviewed by an independent examiner. Follow up was by telephone interview with pain and functional results measured according to the Oxford Shoulder Questionnaire. The patients were asked whether they would undergo the same operation if they had a similar injury. STATISTICAL ANALYSIS USED OKS - One way ANOVA, followed by Tukey HSD multiple comparisons were used to assess the Oxford Shoulder score. Kruskal-Wallis Test was used to assess the final VAS Pain Score. Student's T tests for Oxford scores before and after surgery. RESULTS Between 2007-2008, 38 male patients and 34 female patients with an average age of 53 (19-75) years had their SLAP repair. Good to excellent results in Oxford shoulder scores were reported in 94%. 68 0f 72 patients would undergo the same if they had a similar injury. No statistical correlation was found between the patient's age, gender and outcome scores. CONCLUSIONS Neither the patients' gender nor their age above 50 affected the outcome after surgery.
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Affiliation(s)
- Daniel Mok
- Shoulder and Upper Limb Unit, Epsom & St Helier NHS Trust,Epsom General Hospital, Surrey, UK
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25
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Lin T, Javidan P, McGarry MH, Gonzalez-Lomas G, Limpisvasti O, Lee TQ. Glenohumeral contact pressure in a simulated active compression test using cadaveric shoulders. J Shoulder Elbow Surg 2013; 22:365-74. [PMID: 22608927 DOI: 10.1016/j.jse.2012.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 02/15/2012] [Accepted: 02/21/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND The active compression test has been described to detect superior labrum anterior and posterior (SLAP) lesions. Some have speculated that contact between the lesser tuberosity and the superior glenoid in the testing position causes a positive test. This study evaluated the location of peak glenohumeral contact pressures during a simulated active compression test in a cadaveric model with and without SLAP lesions. MATERIALS AND METHODS Six specimens were tested. A pressure sensor was used to record glenohumeral contact, and a motion analysis system was used to measure humeral head translation. Contact pressures and translations were measured during serial deltoid and biceps loads. These were repeated for small and large SLAP lesions. RESULTS There was a notable shift in the location of peak contact pressure from the anterior-inferior glenoid to the anterior-superior glenoid with increasing deltoid load. Deltoid loading translated the humeral head posteriorly relative to the glenoid. Conversely, biceps loads countered the pull of the deltoid only when the biceps load was greater than the deltoid load. The SLAP tears did not significantly alter the degree of humeral head translation or location of the contact pressures. CONCLUSIONS In the active compression test, the posterior capsule is taut and the anterior capsule is lax, which permits the deltoid to translate the humeral head posteriorly. This shift in the peak contact pressure to the superior glenoid may elicit a positive active compression test. LEVEL OF EVIDENCE Basic Science Study, Biomechanics, Cadaver Model.
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Affiliation(s)
- Tony Lin
- Orthopaedic Biomechanics Laboratory, Veterans Administration Long Beach Healthcare System, Long Beach, CA, USA
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Bain GI, Galley IJ, Singh C, Carter C, Eng K. Anatomic study of the superior glenoid labrum. Clin Anat 2012; 26:367-76. [DOI: 10.1002/ca.22145] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 07/13/2012] [Accepted: 07/09/2012] [Indexed: 11/06/2022]
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Ockert B, Braunstein V, Sprecher CM, Shinohara Y, Milz S. Fibrocartilage in various regions of the human glenoid labrum. An immunohistochemical study on human cadavers. Knee Surg Sports Traumatol Arthrosc 2012; 20:1036-41. [PMID: 21971940 DOI: 10.1007/s00167-011-1686-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 09/15/2011] [Indexed: 01/02/2023]
Abstract
PURPOSE The nature and the distribution of fibrocartilage at the human glenoid labrum are unclear, and a better understanding may help to restore its function in open and arthroscopic Bankart repair. Aim of this study was to describe the fibrocartilage extent within the labrum at clinically relevant sites of the glenoid in order to relate the molecular composition of the labrum to its mechanical environment. METHODS Twelve fresh frozen human cadaveric shoulders (mean age 38 years) were obtained, and sections perpendicular to the glenoid rim at the 12, 2, 3, 4, 6 and 9 o' clock position were labelled with antibodies against collagen I and II, aggrecan and link protein. RESULTS A fibrocartilaginous transition zone with a characteristic collagen fibre orientation was found in 81% of cases, evenly distributed (83-92%) around the glenoid rim. The percentage of labrum cross-sectional area comprised of fibrocartilage averaged 28% and ranged from 26% at 12 o'clock on the glenoid clock face to 30% at 3 o'clock. The highest amount of fibrocartilage (82%) was found in the region neighbouring the hyaline articular cartilage. In the region beyond the bony edge of the glenoid, fibrocartilage cross-sectional area did not exceed 12-17%. CONCLUSION Fibrocartilage is present at all examined positions around the glenoid rim and constitutes up to 1/3 of the cross-sectional area of the labrum. In turn, the percentage of fibrocartilage in different regions of its cross-section varies considerably. The findings suggest that the penetration of fibrocartilaginous tissue may be reduced by avoiding the highly fibrocartilage transition zone during restoration of labral detachment.
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Affiliation(s)
- Ben Ockert
- AO Research Institute Davos, AO Foundation, Davos, Switzerland.
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Tischer T, Vogt S, Kreuz PC, Imhoff AB. Arthroscopic anatomy, variants, and pathologic findings in shoulder instability. Arthroscopy 2011; 27:1434-43. [PMID: 21871774 DOI: 10.1016/j.arthro.2011.05.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 04/22/2011] [Accepted: 05/31/2011] [Indexed: 02/02/2023]
Abstract
Shoulder instability is a common diagnosis that often requires surgical treatment. A detailed knowledge of the shoulder anatomy and its stabilizing structures is of utmost importance for successful treatment of shoulder instabilities. Identifying anatomic variants (e.g., sublabral hole, meniscoid labrum, cordlike middle glenohumeral ligament, and Buford complex) and distinguishing them from pathologic findings may be especially difficult, as shown by the high interobserver variability. Over the last decade, basic research and arthroscopic surgery have improved our understanding of the shoulder anatomy and pathology. In the context of shoulder instability, injuries of the glenoid (bony Bankart), injuries of the glenoid labrum superiorly (SLAP) or anteroinferiorly (e.g., Bankart, anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), accompanying cartilage lesions (Hill-Sachs, glenolabral articular disruption), and rotator interval and pulley lesions, as well as signs of dynamic instability impingement (posterior-superior impingement, anterior-superior impingement) can be exactly diagnosed (magnetic resonance imaging with intra-articular gadolinium, arthroscopy) and treated (arthroscopy). Therefore the purpose of this article is to review the current literature concerning shoulder anatomy/pathology related to shoulder stability/instability to improve clinical diagnosis and surgical treatment of our patients.
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Affiliation(s)
- Thomas Tischer
- Department of Orthopaedic Surgery, University of Rostock, Rostock, Germany
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Drury NJ, Ellis BJ, Weiss JA, McMahon PJ, Debski RE. The Impact of Glenoid Labrum Thickness and Modulus on Labrum and Glenohumeral Capsule Function. J Biomech Eng 2010; 132:121003. [DOI: 10.1115/1.4002622] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The glenoid labrum is an integral component of the glenohumeral capsule’s insertion into the glenoid, and changes in labrum geometry and mechanical properties may lead to the development of glenohumeral joint pathology. The objective of this research was to determine the effect that changes in labrum thickness and modulus have on strains in the labrum and glenohumeral capsule during a simulated physical examination for anterior instability. A labrum was incorporated into a validated, subject-specific finite element model of the glenohumeral joint, and experimental kinematics were applied simulating application of an anterior load at 0 deg, 30 deg, and 60 deg of external rotation and 60 deg of glenohumeral abduction. The radial thickness of the labrum was varied to simulate thinning tissue, and the tensile modulus of the labrum was varied to simulate degenerating tissue. At 60 deg of external rotation, a thinning labrum increased the average and peak strains in the labrum, particularly in the labrum regions of the axillary pouch (increased 10.5% average strain) and anterior band (increased 7.5% average strain). These results suggest a cause-and-effect relationship between age-related decreases in labrum thickness and increases in labrum pathology. A degenerating labrum also increased the average and peak strains in the labrum, particularly in the labrum regions of the axillary pouch (increased 15.5% strain) and anterior band (increased 10.4% strain). This supports the concept that age-related labrum pathology may result from tissue degeneration. This work suggests that a shift in capsule reparative techniques may be needed in order to include the labrum, especially as activity levels in the aging population continue to increase. In the future validated, finite element models of the glenohumeral joint can be used to explore the efficacy of new repair techniques for glenoid labrum pathology.
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Affiliation(s)
- Nicholas J. Drury
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15219
| | - Benjamin J. Ellis
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112
| | - Jeffrey A. Weiss
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112
| | - Patrick J. McMahon
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15219
| | - Richard E. Debski
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15219
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Smith CD, Masouros SD, Hill AM, Wallace AL, Amis AA, Bull AMJ. The compressive behavior of the human glenoid labrum may explain the common patterns of SLAP lesions. Arthroscopy 2009; 25:504-9. [PMID: 19409308 DOI: 10.1016/j.arthro.2008.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 10/29/2008] [Accepted: 12/20/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the study was to define the normalized compressive stiffness (modulus) of the glenoid labrum around its circumference and to characterize the difference in modulus between different areas. METHODS Sixteen fresh-frozen cadaveric shoulders were harvested and dissected down to the glenoid labrum. Any specimens with significant degenerative changes were discarded, leaving 8 labra for testing. The labrum was divided into 8 segments, to allow comparison around its circumference. A uniform testing specimen was produced from each area by use of a microtome. Each specimen measured 3 x 1 mm in cross section and was 6 mm in length. Indentation testing was conducted in a controlled environment of 100% humidity at 37 degrees C +/- 1 degrees C. RESULTS We obtained 52 test samples from 8 labra. The mean modulus of the glenoid labrum was 69.7 megapascal (standard deviation, 36.2 megapascal). The anterosuperior portion of the labrum had a higher modulus than the posteroinferior portion (P = .0075). CONCLUSIONS This study has shown that the human glenoid labrum's compressive behavior varies around its circumference. The greater modulus of the anterosuperior portion of the labrum supports the theory that this area is anatomically different from the rest of the labrum and resists compressive loads. CLINICAL RELEVANCE These results may explain why the common type of SLAP lesions seen show failure at the interface between the labrum and the glenoid rather than within the substance of the labrum itself.
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Affiliation(s)
- Chris D Smith
- Department of Bioengineering, Imperial College London, London, England
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Oh JH, Kim JY, Kim WS, Gong HS, Lee JH. The evaluation of various physical examinations for the diagnosis of type II superior labrum anterior and posterior lesion. Am J Sports Med 2008; 36:353-9. [PMID: 18006674 DOI: 10.1177/0363546507308363] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many types of physical examinations have been used to diagnose superior labrum anterior and posterior lesions; no decisive clinical test is available for confirming the diagnosis. HYPOTHESIS A selection from 10 well-established physical tests, alone or in combination, can be used to differentiate lesions with biceps anchor detachment from those with an intact biceps anchor with arthroscopic correlation. STUDY DESIGN Case control study (diagnosis); Level of evidence, 3. METHODS Among 297 patients who underwent shoulder arthroscopy between January 2004 and July 2005, 146 patients were enrolled in the study as a type II superior labrum anterior and posterior lesion group and an age-matched control group. Sensitivity, specificity, and predictive values of each test and all possible combinations of 2 and 3 tests were analyzed. The same procedures were repeated in patients younger than and older than 40 years. RESULTS The sensitivities of the Whipple, O'Brien, apprehension, and compression-rotation tests and the specificities of the Yergason, biceps load II, and Kibler tests were relatively high. No single physical examination was found to be simultaneously highly sensitive and specific for the diagnosis of a type II superior labrum anterior and posterior lesion. When 2 of the 3 relatively sensitive tests (O'Brien, apprehension, or compression-rotation test) were combined with 1 of the 3 relatively specific tests (Speed, Yergason, or biceps load II test), sensitivity and specificity reached approximately 70% and 95%, respectively. Similar trends were noted in the younger and older patient groups and in the isolated type II superior labrum anterior and posterior lesion group. CONCLUSION The data suggest that some combinations of 2 relatively sensitive clinical tests and 1 relatively specific clinical test increase the diagnostic efficacy of superior labrum anterior and posterior lesions. Requiring 1 of the 3 chosen tests to be positive will result in a sensitivity of about 75%, whereas requiring all 3 to be positive will result in a specificity of about 90%.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Smith CD, Masouros SD, Hill AM, Wallace AL, Amis AA, Bull AMJ. Tensile properties of the human glenoid labrum. J Anat 2007; 212:49-54. [PMID: 18031481 DOI: 10.1111/j.1469-7580.2007.00832.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Human fresh-frozen cadaveric glenoid labrae from 16 donors were harvested and ten of these had no gross degeneration. These ten were divided into eight equal circumferential sections. Each section was cut to produce test-samples from the core layer with a cross-section of 1 x 1 mm. Tensile testing was performed within a controlled environment unit at 37 +/- 1 degrees C and 100% relative humidity. Each test-sample was precycled to a quasi-static state to alleviate the effects of deep-freezing, prior to final testing. The tangent modulus was calculated for each test-sample before and after a 5-min period of stress relaxation and at yield. The mean elastic modulus and yield stress of the glenoid labrum were 22.8 +/- 11.4 and 2.5 +/- 2.1 MPa, respectively. The anterosuperior portion had a lower elastic modulus and lower yield stress than the inferior portion (both P < 0.02). The pre-stress relaxation tangent modulus was significantly lower than the post-stress relaxation tangent modulus for all portions of the labrum. The glenoid labrum has similar tensile material properties to articular cartilage. Its elastic modulus varies around its circumference. This suggests that the labrum may encounter different forces at different positions.
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Affiliation(s)
- C D Smith
- Department of Bioengineering, and Department of Mechanical Engineering, Imperial College London, UK
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Rowan KR, Andrews G, Spielmann A, Leith J, Forster BB. MR shoulder arthrography in patients younger than 40 years of age: Frequency of rotator cuff tear versus labroligamentous pathology. ACTA ACUST UNITED AC 2007; 51:257-9. [PMID: 17504318 DOI: 10.1111/j.1440-1673.2007.01722.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to compare the frequency of rotator cuff pathology versus labroligamentous pathology in patients younger than 40 years and to determine whether routine MR arthrography is justified in all patients in this age group, regardless of the clinical symptoms. The MR arthrography was carried out on 332 patients 40 years of age and younger. Two hundred and forty-three patients had clinical history of instability and possible labroligamentous pathology. Eighty-nine patients had no history or physical signs of instability and were referred for reasons other than instability, such as assessment for rotator cuff tear. In the 243 patients younger than 40 years with clinical history of potential labral pathology, 39% (95/243) showed a labral tear and 2.1% (5/243) had a full-thickness rotator cuff tendon tear. In the 89 patients with no history suggesting labral pathology, 19% (17/89) showed an unsuspected labral tear and 4.5% (4/89) had a full-thickness rotator cuff tear. These findings suggest that, regardless of the clinical indication for referral, patients aged 40 and less referred for shoulder MRI should be imaged using MR arthrography because of the significant risk that symptoms are related to unsuspected labral pathology.
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Affiliation(s)
- K R Rowan
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Harwood MI, Smith CT. Superior labrum, anterior-posterior lesions and biceps injuries: diagnostic and treatment considerations. Prim Care 2005; 31:831-55. [PMID: 15544823 DOI: 10.1016/j.pop.2004.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Proximal biceps tendon rupture, biceps tendinitis, and medical biceps subluxation are injuries that occur alone and in association with other pathologic conditions of the shoulder. The literature describes various strategies for imaging and treating these biceps tendon complex injuries but offers no clear consensus on a gold-standard approach. The keys to successful treatment are an accurate diagnosis, identification of associated pathologic conditions, and assessment of functional limitations of the injury.
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Affiliation(s)
- Marc I Harwood
- Department of Family Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Mihata T, McGarry MH, Tibone JE, Abe M, Lee TQ. Type II SLAP lesions: a new scoring system--the sulcus score. J Shoulder Elbow Surg 2005; 14:19S-23S. [PMID: 15726081 DOI: 10.1016/j.jse.2004.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A new scoring system-the sulcus score-was developed to differentiate between a large superior labral sulcus and a type II superior labrum anterior-posterior (SLAP) lesion. The sulcus scoring system permits quantification of the size of the superior labral sulcus and the severity of a type II SLAP lesion. Specifically, the depth of the superior labral sulcus was classified into 4 grades, and the length was recorded by clock position. The sulcus score was then calculated by multiplying the depth (grade) by the length (the number of "hours" from the clock position). After stretching of the anterior capsule into excessive humeral external rotation at 60 degrees glenohumeral abduction, the sulcus score of cadaveric shoulders increased significantly (before, 3.4; after, 6.8), indicating the extension of the superior labral sulcus and resulting in a pathologically created type II SLAP lesion. The intraclass correlation coefficient and mean difference were 0.77 and 0.8 +/- 0.7, respectively, for intraobserver repeatability and 0.72 and 0.9 +/- 0.6, respectively, for interobserver reproducibility. The sulcus score provided a consistent and objective means for quantitatively describing the size and severity of type II SLAP lesions. Clinical assessment of the superior labral sulcus by use of the sulcus score may be useful for the diagnosis and treatment of type II SLAP lesions.
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Affiliation(s)
- Teruhisa Mihata
- Orthopaedic Biomechanics Laboratory, VA Healthcare System, 5901 E. 7th Street, Long Beach, CA 90822, USA
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