Gleno-humeral instabilities

Abstract

The purpose of this review is to highlight the most efficient imaging exploratory techniques depicting shoulder instability, to describe its various forms and to point out the findings which can simulate instability. In anterior recurrent dislocation, surgery is indicated and the procedure essentially depends on the importance of glenoid rim lesions. In this case, a standard X-ray evaluation is usually sufficient. The CT arthrography or MRI techniques give more specific details as to the severity of the lesions, particularly soft tissues alterations; however, these data do not alter standard therapeutic protocol. In fixed posterior dislocations, CT scan represents the most pertinent technique to evaluate the size of the humeral head defect and to determine the therapeutic follow-up. In subtle forms of instability, diagnosis or instability direction are not clearly assessed clinically and standard X-ray evaluation is usually unremarkable. In this case, further exploration, such as CT arthrography, MR imaging or MR arthrography, are recommended to confirm the diagnosis of instability and to evaluate its direction. The technique of choice is undoubtedly MR arthrography. Atraumatic voluntary painless subluxations associated with hyperlaxity of the shoulder do not require any specific exploratory method because the findings are generally limited to a capacious axillary pouch.

Cartilage lesions of the glenohumeral joint: diagnostic effectiveness of multidetector spiral CT arthrography and comparison with arthroscopy

“…The vast majority of imaging studies dedicated to the shoulder have focused on the use of MR imaging, CT arthrography or MR arthrography (MRa) to analyze lesions of the rotator cuff and of the glenoid labrum [1][2][3][4][19][20][21][22]. In contrast to this fibrocartilage, the hyaline cartilage of the shoulder has barely been studied by modern imaging techniques.…”

Low-field MR arthrography of the shoulder joint: technique, indications, and clinical results

“…Generally, glenohumeral instability is present when symptoms occur due to the translation of the humeral head out of the glenoid fossa. There exist many forms of glenohumeral instability; however, from a clinical point of view, there are two main categories to be differentiated which require different forms of treatment [22]:…”

The anterior glenohumeral joint capsule: macroscopic and MRI anatomy of the fasciculus obliquus or so-called ligamentum glenohumerale spirale

“…Direct MR arthrography has proven to be a useful method in the evaluation of the normal anatomy as well as pathologies of the shoulder joint [22,23,[29][30][31]. The enhanced soft tissue contrast and controlled distension of the joint cavity provides better delineation and assessment of the glenohumeral intra-articular structures.…”