Posterior shoulder labrocapsular structures in all aspects; 3D volumetric MR arthrography study

2021 ◽  
pp. 20201230
Author(s):  
Hayri Ogul ◽  
Onur Taydas ◽  
Zakir Sakci ◽  
Hasan Baki Altinsoy ◽  
Mecit Kantarci
Keyword(s):  
Shoulder Joint ◽  
Mr Arthrography ◽  
Mr Images ◽  
Glenohumeral Ligament ◽  
Posterior Shoulder ◽  
Inferior Glenohumeral Ligament ◽  
Posterior Extension ◽  
Anatomic Variants ◽  
Labral Pathology ◽  
Variant Anatomy

Pathologies of the posterior labrocapsular structures of the shoulder joint are far less common than anterior labrocapsuloligamentous lesions. Most of these pathologies have been associated with traumatic posterior dislocation. A smaller portion of the lesions include posterior extension of superior labral anteroposterior lesions, posterior superior internal impingement, and damage to the posterior band of the inferior glenohumeral ligament. Labrocapsular anatomic variations of the posterior shoulder joint can mimic labral pathology on conventional MR and occasionally on MR arthrographic images. Knowledge of this variant anatomy is key to interpreting MR images and studying MR arthrography of the posterior labrocapsular structure to avoid misdiagnosis and unnecessary surgical procedures. In this article, we review normal and variant anatomy of the posterior labrocapsular structure of the shoulder joint based on MR arthrography and discuss how to discriminate normal anatomic variants from labrocapsular damage.

scholarly journals Arthroscopic Bennett Lesion Resection: A Novel Technique

2021 ◽  
Vol 1 (4) ◽  
pp. 263502542110159
Author(s):  
Samuel C. Hammonds ◽  
R. Alexander Creighton
Keyword(s):  
Diagnostic Criteria ◽  
Glenohumeral Joint ◽  
Axillary Nerve ◽  
Accurate Diagnosis ◽  
Efficient Treatment ◽  
Glenohumeral Ligament ◽  
Posterior Shoulder ◽  
Lidocaine Injection ◽  
Inferior Glenohumeral Ligament ◽  
Labral Pathology

Background: Bennett lesion is ossification of the posterior inferior glenohumeral ligament complex. Though often asymptomatic, these lesions can become painful and interfere with throwing ability. Indications: The Bennett lesion is relatively common among elite throwers, present in 22% to 25% of asymptomatic pitchers. Suggested causes of this lesion include traction on the posterior joint and posterior impingement in the late cocking phase. These lesions can become painful due to displacement and irritation of the joint capsule and axillary nerve. Therefore, efficient arthroscopic treatment of symptomatic lesions is essential. Technique Description: The patient is positioned in the lateral decubitus position, and the glenohumeral joint is accessed via posterior and anterior portals. Once the lesion is identified, it may be probed and debrided via the posterior portal. A posterior capsular release is performed, and 4.0 mm burr resection of the lesion is started, viewing from the anterior portal with a 70° arthroscope. Direct visualization through the posterior portal can be used to verify complete lesion resection. If there is a true tear of the posterior labrum, this can be repaired with a knotless suture anchor back to the glenoid, but usually there is delamination that can be left alone after addressing the Bennett lesion. Results: We have found good success treating Bennett lesions via the above technique. This is supported by previous literature as well, with return to preinjury levels ranging from 69% to 85% following arthroscopic resection. Discussion/Conclusion: Four diagnostic criteria have been described to ensure accurate diagnosis: detection of a bony spur at the posterior glenoid rim on plain x-ray films, best seen on Stryker notch and Bennett view; posterior shoulder pain while throwing; tenderness at the posteroinferior aspect of the glenohumeral joint; and improvement in pain following lidocaine injection. Magnetic resonance imaging is also an excellent diagnostic tool to detect early enthesopathic changes in the posterior glenoid or periosteum, as well as labral pathology. Following arthroscopic resection, 88% of patients were satisfied with their treatment when using these diagnostic criteria. Accurate diagnosis and efficient treatment of Bennett lesions are imperative in the throwing athlete, and when performed correctly, our technique provides significant and lasting improvement for patients.

Technical Note. Labral-ligamentous complex of the shoulder: Evaluation with double oblique axial MR arthrography

2003 ◽  
Vol 44 (4) ◽  
pp. 435-439
Author(s):  
T. Sasaki ◽  
Y. Saito ◽  
H. Yodono ◽  
G. L. M. Prado ◽  
H. Miura ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Mr Arthrography ◽  
Technical Note ◽  
Glenoid Fossa ◽  
Glenohumeral Ligament ◽  
Inferior Glenohumeral Ligament ◽  
Scout Image ◽  
Weighted Sequences ◽  
Better Than

Purpose: To assess the ability of double oblique axial (DOA) MR arthrography in evaluating labral-ligamentous complex compared with conventional axial (CA) MR arthrography. Material and Methods: MR arthrography of 51 shoulders, subsequently examined with arthroscopy, were retrospectively reviewed. DOA imaging was performed in all 51 shoulders and both DOA and CA imaging in 37 using a 1.5 T unit with gradient recalled-echo T2*-weighted sequences. DOA imaging was performed using perpendicular planes to the long axis of the glenoid fossa obtained by an oblique sagittal scout image. We compared the ability of DOA with that of CA MR arthrography to assess labral injuries and to demonstrate the whole length of the anterior band of the inferior glenohumeral ligament (AIGHL), which were shown to be intact by arthroscopy. Results: For anterior labral injuries, sensitivity and specificity were 87% and 93% with CA, and 94% and 100% with DOA imaging, respectively. For posterior labral injuries, sensitivity and specificity were 47% and 100% with CA, and 79% and 96% with DOA imaging, respectively. There were no statistically significant differences between CA and DOA images, except for the ability to diagnose posterior labral injuries, where DOA imaging had a significant superior sensitivity ( p = 0.0327). DOA images also demonstrated the whole length of the intact AIGHL in 10 of 11 shoulders, while CA imaging showed this in only 3 of 11. Conclusion: DOA imaging was equal or better than CA imaging for evaluating the labral-ligamentous complex.

scholarly journals Effects of arthroscopic capsular and inferior glenohumeral ligament release on function and stability for patients with frozen shoulder

2020 ◽  
Author(s):  
Yao Zhang ◽  
Shichao Cao ◽  
Mingsheng Liu ◽  
Wenyong Fei ◽  
Jingcheng Wang
Keyword(s):  
Shoulder Joint ◽  
External Rotation ◽  
Constant Score ◽  
Frozen Shoulder ◽  
Joint Stability ◽  
Postoperative Rehabilitation ◽  
Glenohumeral Ligament ◽  
Vas Score ◽  
Inferior Glenohumeral Ligament ◽  
And Function

Abstract Background The inferior glenohumeral ligament (IGHL) plays an important role in maintaining shoulder joint stability. However, no systematic studies on shoulder stability and function of patients with FS after IGHL release exist. This study assessed the functional and clinical outcomes of IGHL release for FS.Methods Forty-seven patients underwent arthroscopic capsule and IGHL release with the same postoperative rehabilitation procedure. Five functional parameters were measured postoperatively at 4, 8, 12 and 28 weeks: the apprehension test result, American Shoulder and Elbow Surgeons Score (ASES), Constant score, visual analog scale (VAS) score and active range of motion (ROM).Results All patients improved in the aforementioned evaluations. At 28 weeks, the ASES, Constant score and VAS score improved from 31.30±6.41 to 92.43±3.89, 30.15±6.85 to 90.71±4.27 and 6.73±0.72 to 0.60±0.74, respectively (p<0.05). Forward flexion (FF) and abduction (ABD) improved from 73.85±14.94 to 166.70±7.23 and from 69.65±12.74 to 165.03±6.36, respectively (p<0.05). External rotation (ER) and internal rotation (IR) also significantly improved. In total, 95% of the patients were able to perform full elevation, and 97.5% of the patients could place the dorsum of their hands between their shoulder blades. All patients had negative apprehension tests, and no dislocations occurred. No other serious postoperative complications were observed.Conclusions Arthroscopic capsule and IGHL release was effective and could improve the active ROM and relieve pain in patients with FS. This surgical procedure did not cause instability or dislocations in the shoulder joint.

High origin of the anterior band of the inferior glenohumeral ligament: MR arthrography with anatomic and histologic correlation in cadavers

2011 ◽  
Vol 41 (5) ◽  
pp. 525-530 ◽  
Author(s):  
Francisco Alejandro Ramirez Ruiz ◽  
Beatriz Cristina Baranski Kaniak ◽  
Parviz Haghighi ◽  
Debra Trudell ◽  
Donald L. Resnick
Keyword(s):  
Mr Arthrography ◽  
Glenohumeral Ligament ◽  
Inferior Glenohumeral Ligament

scholarly journals Mapping of the Inferior Glenohumeral Ligament for Suture Pullout Strength: A Biomechanical Analysis

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712096964
Author(s):  
Sumit Raniga ◽  
Joseph Cadman ◽  
Danè Dabirrahmani ◽  
David Bui ◽  
Richard Appleyard ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Biomechanical Study ◽  
Labral Repair ◽  
Pullout Strength ◽  
Recurrent Instability ◽  
Glenohumeral Ligament ◽  
Time Zero ◽  
Capsular Plication ◽  
Inferior Glenohumeral Ligament ◽  
The Impact

Background: Suture pullout during rehabilitation may result in loss of tension in the inferior glenohumeral ligament (IGHL) and contribute to recurrent instability after capsular plication, performed with or without labral repair. To date, the suture pullout strength in the IGHL is not well-documented. This may contribute to recurrent instability. Purpose/Hypothesis: A cadaveric biomechanical study was designed to investigate the suture pullout strength of sutures in the IGHL. We hypothesized that there would be no significant variability of suture pullout strength between specimens and zones. Additionally, we sought to determine the impact of early mobilization on sutures in the IGHL at time zero. We hypothesized that capsular plication sutures would fail under low load. Study Design: Descriptive laboratory study. Methods: Seven fresh-frozen cadaveric shoulders were dissected to isolate the IGHL complex, which was then divided into 18 zones. Sutures in these zones were attached to a linear actuator, and the resistance to suture pullout was recorded. A suture pullout strength map of the IGHL was constructed. These loads were used to calculate the load applied at the hand that would initiate suture pullout in the IGHL. Results: Mean suture pullout strength for all specimens was 61.6 ± 26.1 N. The maximum load found to cause suture pullout through tissue was found to be low, regardless of zone of the IGHL. Calculations suggest that an external rotation force applied to the hand of only 9.6 N may be sufficient to tear capsular sutures at time zero. Conclusion: This study did not provide clear evidence of desirable locations for fixation in the IGHL. However, given the low magnitude of failure loads, the results suggest the timetable for initiation of range-of-motion exercises should be reconsidered to prevent suture pullout through the IGHL. Clinical Relevance: From this biomechanical study, the magnitude of force required to cause suture pullout through the IGHL is met or surpassed by normal postoperative early range-of-motion protocols.

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