Superior Labrum Anterior and Posterior Lesions and Microinstability

Chang, Eric Y.; Fliszar, Evelyne; Chung, Christine B.

doi:10.1016/j.mric.2012.01.002

Cited by 18 publications

(26 citation statements)

References 117 publications

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“…In high-performance overhead athletes, upper extremity symptoms attributable to NTOS may only be evident during vigorous exercise, often characterized as a “dead arm” sensation, for which other diagnoses must be carefully considered (eg, shoulder microinstability, type II superior labral anterior and posterior [SLAP] lesions, and rotator cuff weakness). 4,6,18,19 Even when clinical suspicion of NTOS is high, the absence of symptoms at rest in such cases can make the clinical diagnosis and interpretation of ASM/PMM blocks quite difficult. 24,31 We describe here a modification of ultrasound-guided ASM/PMM blocks to augment the clinical diagnosis of NTOS in 2 high-performance overhead athletes, who each undertook vigorous sports-specific upper extremity exercise immediately after completion of the anesthetic injection.…”

mentioning

confidence: 99%

Exercise-Enhanced, Ultrasound-Guided Anterior Scalene Muscle/Pectoralis Minor Muscle Blocks Can Facilitate the Diagnosis of Neurogenic Thoracic Outlet Syndrome in the High-Performance Overhead Athlete

et al. 2016

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mentioning

confidence: 99%

Exercise-Enhanced, Ultrasound-Guided Anterior Scalene Muscle/Pectoralis Minor Muscle Blocks Can Facilitate the Diagnosis of Neurogenic Thoracic Outlet Syndrome in the High-Performance Overhead Athlete

et al. 2016

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“…A generally agreed on and specific definition of microinstability refers to instability related to injury of anterosuperior structures of the glenohumeral joint that include the superior labrum, biceps anchor, biceps interval, anterosuperior rotator cuff, coracohumeral ligament, and superior glenohumeral ligament. This subtle anterosuperior instability allows for abnormal translation of humeral head on the glenoid and can in turn lead to subacromial impingement (74,79,80).…”

Section: Secondary Impingementmentioning

confidence: 99%

Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder

Roy¹,

Cheyne²,

Andrews³

et al. 2016

Radiology

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Shoulder disease is common in the athletic population and may arise as a consequence of a single traumatic episode or multiple repeated events. Associated labroligamentous injuries can result in substantial disability. Specific athletic and occupational activities result in predictable injury patterns. Imaging in general and magnetic resonance (MR) imaging, in particular, are vital in establishing the correct diagnosis and excluding common mimicking conditions, to ensure timely and appropriate management. In this review, the utility of MR imaging and MR arthrography will be explored in evaluation of shoulder disease, taking into account normal variants of the labroligamentous complex. Subsequently, broad categories of labral lesions and instability, external and internal impingement, as well as nerve entrapment syndromes, will be discussed, while emphasizing their imaging findings in the clinical context and illustrating key features. More recent concepts of internal impingement and secondary subacromial impingement will also be clarified.

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“…This approach is consistent with previous reports on the glenoid clockface position both in the orthopaedic and the radiologic literature. 3 , 4 , 18 , 19 On each glenoid cross section, 2 anchors were superimposed having a common entry point on the rim of the glenoid: one bounded by the glenoid articular surface and the other bounded by the cortex of the glenoid neck. These 2 positions represented the extreme angles in which the anchor could be placed without perforating through the bone.…”

Section: Methodsmentioning

confidence: 99%

Glenoid Rim Anatomy

Levy

Williamson²,

Flores‐Hernandez

et al. 2014

Orthopaedic Journal of Sports Medicine

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Background:Injuries to the glenoid labrum frequently require repair with anchors. Placing anchor devices arthroscopically can be challenging, and anchor malpositioning can complicate surgical outcomes.Purpose:To determine the safe insertion range and optimal insertion angle of glenoid labral anchors at various positions on the glenoid rim and to establish surgical guidelines that minimize risk of anchor perforation.Study Design:Descriptive laboratory study.Methods:Three-dimensional computed tomography scans of 30 normal cadaveric specimens were obtained. A virtual model of a generic labral anchor was inserted into the rim of the glenoid at the clockface positions represented by 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00, and 10:30. At each position, the safe insertion range was the maximal range measured, and the optimal insertion angle was identified as the angle between the bisector of the safe insertion range and the glenoid face.Results:Progressing in the clockwise direction, beginning at the 12:00 position, the safe insertion ranges (mean ± SD ) were 55.9° ± 10.6°, 63.6° ± 17.6°, 47.7° ± 9.1°, 46.1° ± 8°, 73.9° ± 9.7°, 40.9° ± 6.5°, 40.4° ± 7.4°, and 39.9° ± 7.1°, respectively. The optimal insertion angles were 47.9° ± 7.6°, 53.1° ± 10.9°, 35.0° ± 4.4°, 42.4° ± 4.9°, 60.9° ± 8.4°, 36.6° ± 5.9°, 31.2° ± 4.9°, 34.8° ± 4.6°, respectively.Conclusion:Optimal insertion angles and safe insertion ranges varied significantly with respect to the position on the glenoid face. The safe insertion range and optimal insertion angle were found to be wider at the anterior glenoid as compared with the posterior glenoid. A posterolateral insertion angle was safer than an anterior insertion angle at the 10:30 position.Clinical Relevance:Proper arthroscopic technique resulting in anchor insertion at the correct angle, depth, and location will prevent anchor-related glenohumeral complications such as glenoid perforation, cartilage damage, persistent pain, decreased range of motion, and failure of the reconstruction.

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Superior Labrum Anterior and Posterior Lesions and Microinstability

Cited by 18 publications

References 117 publications

Exercise-Enhanced, Ultrasound-Guided Anterior Scalene Muscle/Pectoralis Minor Muscle Blocks Can Facilitate the Diagnosis of Neurogenic Thoracic Outlet Syndrome in the High-Performance Overhead Athlete

Exercise-Enhanced, Ultrasound-Guided Anterior Scalene Muscle/Pectoralis Minor Muscle Blocks Can Facilitate the Diagnosis of Neurogenic Thoracic Outlet Syndrome in the High-Performance Overhead Athlete

Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder

Glenoid Rim Anatomy

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