Abstract
The shoulder is the most common dislocated joint of the body with traumatic anterior instability accounting for >90% of all dislocations. Sufficient interaction between static and dynamic stabilizers is important to prevent instability. Knowledge of the imaging anatomy and the variations of the labrum and the glenohumeral ligaments is crucial to identify pathology related to shoulder instability. Particularly traumatic injury to the anteroinferior labroligamentous complex (LLC) and the biceps-labral-complex (BLC) can be detected on cross-sectional imaging. Osseous injury and wear of the anterior glenoid are common as well as impaction fracture at the posterosuperior humeral head. Quantification of glenoid bone loss is important for therapeutic decisions and should be related to the extension of the Hill-Sachs lesion by applying the on-track/off-track concept.
Microinstability is a typical phenomenon in overhead athletes in whom osseous and soft-tissue adjustments may lead to pathologic glenohumeral internal rotational deficit and/or posterosuperior impingent with a complex of certain imaging findings.
Atraumatic instability has to be clinically differentiated from non-pathologic hyperlaxity and is described to be related to shoulder complaints. The task of imaging is to rule out structural pathology in the glenohumeral joint and may allow for the documentation of redundancy of the anteroinferior LLC.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Acid S, Le Corroller T, Aswad R, Pauly V, Champsaur P (2012) Preoperative imaging of anterior shoulder instability: diagnostic effectiveness of MDCT arthrography and comparison with MR arthrography and arthroscopy. AJR Am J Roentgenol 198(3):661–667. https://doi.org/10.2214/AJR.11.7251
Backer HC, Galle SE, Maniglio M, Rosenwasser MP (2018) Biomechanics of posterior shoulder instability—current knowledge and literature review. World J Orthop 9(11):245–254. https://doi.org/10.5312/wjo.v9.i11.245
Bankart A (1938) The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Surg 26:23–29
Beltran LS, Duarte A, Bencardino JT (2018) Postoperative imaging in anterior glenohumeral instability. AJR Am J Roentgenol 211(3):528–537. https://doi.org/10.2214/AJR.17.19304
Bliven KCH, Parr GP (2018) Outcomes of the Latarjet procedure compared with Bankart repair for recurrent traumatic anterior shoulder instability. J Athl Train 53(2):181–183. https://doi.org/10.4085/1062-6050-232-16
Braun S, Kokmeyer D, Millett PJ (2009) Shoulder injuries in the throwing athlete. J Bone Joint Surg Am 91(4):966–978. https://doi.org/10.2106/JBJS.H.01341
Braun S, Millett PJ, Yongpravat C, Pault JD, Anstett T, Torry MR, Giphart JE (2010) Biomechanical evaluation of shear force vectors leading to injury of the biceps reflection pulley: a biplane fluoroscopy study on cadaveric shoulders. Am J Sports Med 38(5):1015–1024. https://doi.org/10.1177/0363546509355142
Burkart AC, Debski RE (2002) Anatomy and function of the glenohumeral ligaments in anterior shoulder instability. Clin Orthop Relat Res 400:32–39. https://doi.org/10.1097/00003086-200207000-00005
Burkhart SS (2000) The evolution of clinical applications of biodegradable implants in arthroscopic surgery. Biomaterials 21(24):2631–2634. https://doi.org/10.1016/s0142-9612(00)00131-9
Burkhart SS, Lo IK (2007) The cam effect of the proximal humerus: its role in the production of relative capsular redundancy of the shoulder. Arthroscopy 23(3):241–246. https://doi.org/10.1016/j.arthro.2006.11.018
Burkhart SS, Morgan C (2001) SLAP lesions in the overhead athlete. Orthop Clin North Am 32(3):431–441, viii. https://doi.org/10.1016/s0030-5898(05)70212-1
Burkhart SS, Morgan CD, Kibler WB (2000) Shoulder injuries in overhead athletes. The “dead arm” revisited. Clin Sports Med 19(1):125–158. https://doi.org/10.1016/s0278-5919(05)70300-8
Burkhart SS, Debeer JF, Tehrany AM, Parten PM (2002) Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy 18(5):488–491. https://doi.org/10.1053/jars.2002.32212
Burkhart SS, Morgan CD, Kibler WB (2003a) The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy 19(4):404–420. https://doi.org/10.1053/jars.2003.50128
Burkhart SS, Morgan CD, Kibler WB (2003b) The disabled throwing shoulder: spectrum of pathology. Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy 19(5):531–539. https://doi.org/10.1053/jars.2003.50139
Campbell SE, Dewitt RM, Cameron KL, Thompson AK, Owens BD (2014) Posterior chondrolabral cleft: clinical significance and associations with shoulder instability. HSS J 10(3):208–212. https://doi.org/10.1007/s11420-014-9404-x
Carlson CL (2004) The "J" sign. Radiology 232(3):725–726. https://doi.org/10.1148/radiol.2323021239
Chandnani VP, Yeager TD, DeBerardino T, Christensen K, Gagliardi JA, Heitz DR, Baird DE, Hansen MF (1993) Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol 161(6):1229–1235. https://doi.org/10.2214/ajr.161.6.8249731
Churchill RS, Brems JJ, Kotschi H (2001) Glenoid size, inclination, and version: an anatomic study. J Shoulder Elb Surg 10(4):327–332. https://doi.org/10.1067/mse.2001.115269
Cisternino SJ, Rogers LF, Stufflebam BC, Kruglik GD (1978) The trough line: a radiographic sign of posterior shoulder dislocation. AJR Am J Roentgenol 130(5):951–954. https://doi.org/10.2214/ajr.130.5.951
De Maeseneer M, Van Roy F, Lenchik L, Shahabpour M, Jacobson J, Ryu KN, Handelberg F, Osteaux M (2000) CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. Radiographics 20(Suppl 1):S67-81. https://doi.org/10.1148/radiographics.20.suppl_1.g00oc03s67
DePalma AF (1983) Surgery of the shoulder, 3rd edn. Lippincott, Philadelphia
Di Giacomo G, Itoi E, Burkhart SS (2014) Evolving concept of bipolar bone loss and the hill-Sachs lesion: from “engaging/non-engaging” lesion to "on-track/off-track" lesion. Arthroscopy 30(1):90–98. https://doi.org/10.1016/j.arthro.2013.10.004
Di Giacomo G, Golijanin P, Sanchez G, Provencher MT (2016) Radiographic analysis of the Hill-Sachs lesion in anteroinferior shoulder instability after first-time dislocations. Arthroscopy 32(8):1509–1514. https://doi.org/10.1016/j.arthro.2016.01.022
Dickens JF, Slaven SE, Cameron KL, Pickett AM, Posner M, Campbell SE, Owens BD (2019) Prospective evaluation of glenoid bone loss after first-time and recurrent anterior glenohumeral instability events. Am J Sports Med 47(5):1082–1089. https://doi.org/10.1177/0363546519831286
Donohue MA, Mauntel TC, Dickens JF (2017) Recurrent shoulder instability after primary Bankart repair. Sports Med Arthrosc Rev 25(3):123–130. https://doi.org/10.1097/JSA.0000000000000159
Edelson JG (1995) Localized glenoid hypoplasia. An anatomic variation of possible clinical significance. Clin Orthop Relat Res (321):189–195
Elser F, Braun S, Dewing CB, Giphart JE, Millett PJ (2011) Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy 27(4):581–592. https://doi.org/10.1016/j.arthro.2010.10.014
Escobedo EM, Richardson ML, Schulz YB, Hunter JC, Green JR 3rd, Messick KJ (2007) Increased risk of posterior glenoid labrum tears in football players. AJR Am J Roentgenol 188(1):193–197. https://doi.org/10.2214/AJR.05.0277
Ferrari JD, Ferrari DA, Coumas J, Pappas AM (1994) Posterior ossification of the shoulder: the Bennett lesion. Etiology, diagnosis, and treatment. Am J Sports Med 22(2):171–175; discussion 175–176. https://doi.org/10.1177/036354659402200204
Fessa CK, Peduto A, Linklater J, Tirman P (2015) Posterosuperior glenoid internal impingement of the shoulder in the overhead athlete: pathogenesis, clinical features and MR imaging findings. J Med Imaging Radiat Oncol 59(2):182–187. https://doi.org/10.1111/1754-9485.12276
Franceschi F, Papalia R, Del Buono A, Vasta S, Maffulli N, Denaro V (2011) Glenohumeral osteoarthritis after arthroscopic Bankart repair for anterior instability. Am J Sports Med 39(8):1653–1659. https://doi.org/10.1177/0363546511404207
Galvin JW, Ernat JJ, Waterman BR, Stadecker MJ, Parada SA (2017) The epidemiology and natural history of anterior shoulder instability. Curr Rev Musculoskelet Med 10(4):411–424. https://doi.org/10.1007/s12178-017-9432-5
Gerber C, Nyffeler RW (2002) Classification of glenohumeral joint instability. Clin Orthop Relat Res 400:65–76. https://doi.org/10.1097/00003086-200207000-00009
Gibbs DB, Lynch TS, Nuber ED, Nuber GW (2015) Common shoulder injuries in American football athletes. Curr Sports Med Rep 14(5):413–419. https://doi.org/10.1249/JSR.0000000000000190
Gor DM (2002) The trough line sign. Radiology 224(2):485–486. https://doi.org/10.1148/radiol.2242010352
Gottschalk LJ, Bois AJ, Shelby MA, Miniaci A, Jones MH (2017) Mean glenoid defect size and location associated with anterior shoulder instability: a systematic review. Orthop J Sports Med 5(1):2325967116676269. https://doi.org/10.1177/2325967116676269
Gowd AK, Liu JN, Cabarcas BC, Garcia GH, Cvetanovich GL, Provencher MT, Verma NN (2019) Management of recurrent anterior shoulder instability with bipolar bone loss: a systematic review to assess critical bone loss amounts. Am J Sports Med 47(10):2484–2493. https://doi.org/10.1177/0363546518791555
Gyftopoulos S, Beltran LS, Bookman J, Rokito A (2015) MRI evaluation of bipolar bone loss using the on-track off-track method: a feasibility study. AJR Am J Roentgenol 205(4):848–852. https://doi.org/10.2214/AJR.14.14266
Harper KW, Helms CA, Haystead CM, Higgins LD (2005) Glenoid dysplasia: incidence and association with posterior labral tears as evaluated on MRI. AJR Am J Roentgenol 184(3):984–988. https://doi.org/10.2214/ajr.184.3.01840984
Harris JD, Gupta AK, Mall NA, Abrams GD, McCormick FM, Cole BJ, Bach BR Jr, Romeo AA, Verma NN (2013) Long-term outcomes after Bankart shoulder stabilization. Arthroscopy 29(5):920–933. https://doi.org/10.1016/j.arthro.2012.11.010
Hartzler RU, Bui CN, Jeong WK, Akeda M, Peterson A, McGarry M, Denard PJ, Burkhart SS, Lee TQ (2016) Remplissage of an off-track Hill-Sachs lesion is necessary to restore biomechanical glenohumeral joint stability in a bipolar bone loss model. Arthroscopy 32(12):2466–2476. https://doi.org/10.1016/j.arthro.2016.04.030
Ho AG, Gowda AL, Michael Wiater J (2016) Evaluation and treatment of failed shoulder instability procedures. J Orthop Traumatol 17(3):187–197. https://doi.org/10.1007/s10195-016-0409-8
Holzapfel K, Waldt S, Bruegel M, Paul J, Heinrich P, Imhoff AB, Rummeny EJ, Woertler K (2010) Inter- and intraobserver variability of MR arthrography in the detection and classification of superior labral anterior posterior (SLAP) lesions: evaluation in 78 cases with arthroscopic correlation. Eur Radiol 20(3):666–673. https://doi.org/10.1007/s00330-009-1593-1
Howell SM, Galinat BJ (1989) The glenoid-labral socket. A constrained articular surface. Clin Orthop Relat Res (243):122–125
Hsu YC, Pan RY, Shih YY, Lee MS, Huang GS (2010) Superior-capsular elongation and its significance in atraumatic posteroinferior multidirectional shoulder instability in magnetic resonance arthrography. Acta Radiol 51(3):302–308. https://doi.org/10.3109/02841850903524421
Ide J, Maeda S, Takagi K (2004) Normal variations of the glenohumeral ligament complex: an anatomic study for arthroscopic Bankart repair. Arthroscopy 20(2):164–168. https://doi.org/10.1016/j.arthro.2003.11.005
Ilahi OA, Labbe MR, Cosculluela P (2002) Variants of the anterosuperior glenoid labrum and associated pathology. Arthroscopy 18(8):882–886. https://doi.org/10.1053/jars.2002.36119
Imhoff FB, Camenzind RS, Obopilwe E, Cote MP, Mehl J, Beitzel K, Imhoff AB, Mazzocca AD, Arciero RA, Dyrna FGE (2019) Glenoid retroversion is an important factor for humeral head centration and the biomechanics of posterior shoulder stability. Knee Surg Sports Traumatol Arthrosc 27(12):3952–3961. https://doi.org/10.1007/s00167-019-05573-5
Jaggi A, Alexander S (2017) Rehabilitation for shoulder instability—current approaches. Open Orthop J 11:957–971. https://doi.org/10.2174/1874325001711010957
Kandeel AA (2020) Type V superior labral anterior-posterior (SLAP) lesion in recurrent anterior glenohumeral instability. J Shoulder Elb Surg 29(1):95–103. https://doi.org/10.1016/j.jse.2019.05.038
Kay J, Kirsch JM, Bakshi N, Ekhtiari S, Horner N, Gichuru M, Alolabi B, Khan M, Bedi A (2018) Humeral retroversion and capsule thickening in the overhead throwing athlete: a systematic review. Arthroscopy 34(4):1308–1318. https://doi.org/10.1016/j.arthro.2017.10.049
Kim SH, Ha KI, Yoo JC, Noh KC (2004) Kim’s lesion: an incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy 20(7):712–720. https://doi.org/10.1016/j.arthro.2004.06.012
Kirchhoff C, Imhoff AB (2010) Posterosuperior and anterosuperior impingement of the shoulder in overhead athletes-evolving concepts. Int Orthop 34(7):1049–1058. https://doi.org/10.1007/s00264-010-1038-0
Kuhn JE (2010) A new classification system for shoulder instability. Br J Sports Med 44(5):341–346. https://doi.org/10.1136/bjsm.2009.071183
Laudner KG, Myers JB, Pasquale MR, Bradley JP, Lephart SM (2006) Scapular dysfunction in throwers with pathologic internal impingement. J Orthop Sports Phys Ther 36(7):485–494. https://doi.org/10.2519/jospt.2006.2146
Lee HJ, Kim NR, Moon SG, Ko SM, Park JY (2013) Multidirectional instability of the shoulder: rotator interval dimension and capsular laxity evaluation using MR arthrography. Skelet Radiol 42(2):231–238. https://doi.org/10.1007/s00256-012-1441-2
Liavaag S, Stiris MG, Svenningsen S, Enger M, Pripp AH, Brox JI (2011) Capsular lesions with glenohumeral ligament injuries in patients with primary shoulder dislocation: magnetic resonance imaging and magnetic resonance arthrography evaluation. Scand J Med Sci Sports 21(6):e291–e297. https://doi.org/10.1111/j.1600-0838.2010.01282.x
Lin DJ, Wong TT, Kazam JK (2018) Shoulder injuries in the overhead-throwing athlete: epidemiology, mechanisms of injury, and imaging findings. Radiology 286(2):370–387. https://doi.org/10.1148/radiol.2017170481
Lintner D, Noonan TJ, Kibler WB (2008) Injury patterns and biomechanics of the athlete's shoulder. Clin Sports Med 27(4):527–551. https://doi.org/10.1016/j.csm.2008.07.007
Lo IK, Parten PM, Burkhart SS (2004) The inverted pear glenoid: an indicator of significant glenoid bone loss. Arthroscopy 20(2):169–174. https://doi.org/10.1016/j.arthro.2003.11.036
Locher J, Wilken F, Beitzel K, Buchmann S, Longo UG, Denaro V, Imhoff AB (2016) Hill-Sachs off-track lesions as risk factor for recurrence of instability after arthroscopic Bankart repair. Arthroscopy 32(10):1993–1999. https://doi.org/10.1016/j.arthro.2016.03.005
Longo UG, Loppini M, Rizzello G, Ciuffreda M, Maffulli N, Denaro V (2014) Latarjet, Bristow, and Eden-Hybinette procedures for anterior shoulder dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy 30(9):1184–1211. https://doi.org/10.1016/j.arthro.2014.04.005
Longo UG, Rizzello G, Loppini M, Locher J, Buchmann S, Maffulli N, Denaro V (2015) Multidirectional instability of the shoulder: a systematic review. Arthroscopy 31(12):2431–2443. https://doi.org/10.1016/j.arthro.2015.06.006
Maffet MW, Gartsman GM, Moseley B (1995) Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med 23(1):93–98. https://doi.org/10.1177/036354659502300116
McLaughlin HL (1952) Posterior dislocation of the shoulder. J Bone Joint Surg Am 24 A(3):584–590
McNeil JW, Beaulieu-Jones BR, Bernhardson AS, LeClere LE, Dewing CB, Lynch JR, Golijanin P, Sanchez G, Provencher MT (2017) Classification and analysis of attritional glenoid bone loss in recurrent anterior shoulder instability. Am J Sports Med 45(4):767–774. https://doi.org/10.1177/0363546516677736
Mihata T, Gates J, McGarry MH, Lee J, Kinoshita M, Lee TQ (2009) Effect of rotator cuff muscle imbalance on forceful internal impingement and peel-back of the superior labrum: a cadaveric study. Am J Sports Med 37(11):2222–2227. https://doi.org/10.1177/0363546509337450
Mihata T, Gates J, McGarry MH, Neo M, Lee TQ (2015) Effect of posterior shoulder tightness on internal impingement in a cadaveric model of throwing. Knee Surg Sports Traumatol Arthrosc 23(2):548–554. https://doi.org/10.1007/s00167-013-2381-7
Millett PJ, Clavert P, Hatch GF 3rd, Warner JJ (2006) Recurrent posterior shoulder instability. J Am Acad Orthop Surg 14(8):464–476. https://doi.org/10.5435/00124635-200608000-00004
Modarresi S, Motamedi D, Jude CM (2011) Superior labral anteroposterior lesions of the shoulder: part 1, anatomy and anatomic variants. AJR Am J Roentgenol 197(3):596–603. https://doi.org/10.2214/AJR.10.7236
Mohana-Borges AV, Chung CB, Resnick D (2003) Superior labral anteroposterior tear: classification and diagnosis on MRI and MR arthrography. AJR Am J Roentgenol 181(6):1449–1462. https://doi.org/10.2214/ajr.181.6.1811449
Moroder P, Resch H, Schnaitmann S, Hoffelner T, Tauber M (2013) The importance of CT for the pre-operative surgical planning in recurrent anterior shoulder instability. Arch Orthop Trauma Surg 133(2):219–226. https://doi.org/10.1007/s00402-012-1656-7
Moroder P, Runer A, Kraemer M, Fierlbeck J, Niederberger A, Cotofana S, Vasvari I, Hettegger B, Tauber M, Hurschler C, Resch H (2015) Influence of defect size and localization on the engagement of reverse Hill-Sachs lesions. Am J Sports Med 43(3):542–548. https://doi.org/10.1177/0363546514561747
Moroder P, Plachel F, Tauber M, Habermeyer P, Imhoff A, Liem D, Lill H, Resch H, Gerhardt C, Scheibel M (2017) Risk of engagement of bipolar bone defects in posterior shoulder instability. Am J Sports Med 45(12):2835–2839. https://doi.org/10.1177/0363546517714456
Motamedi D, Everist BM, Mahanty SR, Steinbach LS (2014) Pitfalls in shoulder MRI: part 1—normal anatomy and anatomic variants. AJR Am J Roentgenol 203(3):501–507. https://doi.org/10.2214/AJR.14.12848
Murray IR, Goudie EB, Petrigliano FA, Robinson CM (2013) Functional anatomy and biomechanics of shoulder stability in the athlete. Clin Sports Med 32(4):607–624. https://doi.org/10.1016/j.csm.2013.07.001
Nacca C, Gil JA, Badida R, Crisco JJ, Owens BD (2018) Critical glenoid bone loss in posterior shoulder instability. Am J Sports Med 46(5):1058–1063. https://doi.org/10.1177/0363546518758015
Nakagawa S, Ozaki R, Take Y, Mizuno N, Mae T (2014) Enlargement of glenoid defects in traumatic anterior shoulder instability: influence of the number of recurrences and type of sport. Orthop J Sports Med 2(4):2325967114529920. https://doi.org/10.1177/2325967114529920
Neviaser TJ (1993a) The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder. Arthroscopy 9(1):17–21. https://doi.org/10.1016/s0749-8063(05)80338-x
Neviaser TJ (1993b) The GLAD lesion: another cause of anterior shoulder pain. Arthroscopy 9(1):22–23. https://doi.org/10.1016/s0749-8063(05)80339-1
Oberlander MA, Morgan BE, Visotsky JL (1996) The BHAGL lesion: a new variant of anterior shoulder instability. Arthroscopy 12(5):627–633. https://doi.org/10.1016/s0749-8063(96)90205-4
Omori Y, Yamamoto N, Koishi H, Futai K, Goto A, Sugamoto K, Itoi E (2014) Measurement of the glenoid track in vivo as investigated by 3-dimensional motion analysis using open MRI. Am J Sports Med 42(6):1290–1295. https://doi.org/10.1177/0363546514527406
Owens BD, Campbell SE, Cameron KL (2013) Risk factors for posterior shoulder instability in young athletes. Am J Sports Med 41(11):2645–2649. https://doi.org/10.1177/0363546513501508
Park JY, Noh YM, Chung SW, Moon SG, Ha DH, Lee KS, Chung SW (2016) Bennett lesions in baseball players detected by magnetic resonance imaging: assessment of association factors. J Shoulder Elb Surg 25(5):730–738. https://doi.org/10.1016/j.jse.2015.11.062
Pfahler M, Haraida S, Schulz C, Anetzberger H, Refior HJ, Bauer GS, Bigliani LU (2003) Age-related changes of the glenoid labrum in normal shoulders. J Shoulder Elb Surg 12(1):40–52. https://doi.org/10.1067/mse.2003.3
Probyn LJ, White LM, Salonen DC, Tomlinson G, Boynton EL (2007) Recurrent symptoms after shoulder instability repair: direct MR arthrographic assessment--correlation with second-look surgical evaluation. Radiology 245(3):814–823. https://doi.org/10.1148/radiol.2453061329
Reinold MM, Curtis AS (2013) Microinstability of the shoulder in the overhead athlete. Int J Sports Phys Ther 8(5):601–616
Richards RD, Sartoris DJ, Pathria MN, Resnick D (1994) Hill-Sachs lesion and normal humeral groove: MR imaging features allowing their differentiation. Radiology 190(3):665–668. https://doi.org/10.1148/radiology.190.3.8115607
Ruiz Santiago F, Martinez Martinez A, Tomas Munoz P, Pozo Sanchez J, Zarza Perez A (2017) Imaging of shoulder instability. Quant Imaging Med Surg 7(4):422–433. https://doi.org/10.21037/qims.2017.08.05
Saupe N, White LM, Bleakney R, Schweitzer ME, Recht MP, Jost B, Zanetti M (2008) Acute traumatic posterior shoulder dislocation: MR findings. Radiology 248(1):185–193. https://doi.org/10.1148/radiol.2481071003
Schaeffeler C, Waldt S, Holzapfel K, Kirchhoff C, Jungmann PM, Wolf P, Stat D, Schroder M, Rummeny EJ, Imhoff AB, Woertler K (2012) Lesions of the biceps pulley: diagnostic accuracy of MR arthrography of the shoulder and evaluation of previously described and new diagnostic signs. Radiology 264(2):504–513. https://doi.org/10.1148/radiol.12112007
Schaeffeler C, Waldt S, Bauer JS, Kirchhoff C, Haller B, Schroder M, Rummeny EJ, Imhoff AB, Woertler K (2014) MR arthrography including abduction and external rotation images in the assessment of atraumatic multidirectional instability of the shoulder. Eur Radiol 24(6):1376–1385. https://doi.org/10.1007/s00330-014-3133-x
Shaha JS, Cook JB, Song DJ, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM (2015) Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med 43(7):1719–1725. https://doi.org/10.1177/0363546515578250
Sheehan SE, Gaviola G, Gordon R, Sacks A, Shi LL, Smith SE (2013) Traumatic shoulder injuries: a force mechanism analysis-glenohumeral dislocation and instability. AJR Am J Roentgenol 201(2):378–393. https://doi.org/10.2214/AJR.12.9986
Shin SJ, Kim RG, Jeon YS, Kwon TH (2017) Critical value of anterior glenoid bone loss that leads to recurrent glenohumeral instability after arthroscopic Bankart repair. Am J Sports Med 45(9):1975–1981. https://doi.org/10.1177/0363546517697963
Smith TO (2006) Immobilisation following traumatic anterior glenohumeral joint dislocation: a literature review. Injury 37(3):228–237. https://doi.org/10.1016/j.injury.2005.06.005
Smith DK, Chopp TM, Aufdemorte TB, Witkowski EG, Jones RC (1996) Sublabral recess of the superior glenoid labrum: study of cadavers with conventional nonenhanced MR imaging, MR arthrography, anatomic dissection, and limited histologic examination. Radiology 201(1):251–256. https://doi.org/10.1148/radiology.201.1.8816553
Snyder SJ (1994) Shoulder arthroscopy. McGraw-Hill, Health Professions Division, New York
Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6(4):274–279. https://doi.org/10.1016/0749-8063(90)90056-j
e Souza PM, Brandao BL, Brown E, Motta G, Monteiro M, Marchiori E (2014) Recurrent anterior glenohumeral instability: the quantification of glenoid bone loss using magnetic resonance imaging. Skelet Radiol 43 (8):1085–1092. doi:https://doi.org/10.1007/s00256-014-1894-6
Stillwater L, Koenig J, Maycher B, Davidson M (2017) 3D-MR vs. 3D-CT of the shoulder in patients with glenohumeral instability. Skelet Radiol 46(3):325–331. https://doi.org/10.1007/s00256-016-2559-4
Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A (2003) Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 85(5):878–884. https://doi.org/10.2106/00004623-200305000-00016
Sugimoto H, Suzuki K, Mihara K, Kubota H, Tsutsui H (2002) MR arthrography of shoulders after suture-anchor Bankart repair. Radiology 224(1):105–111. https://doi.org/10.1148/radiol.2241011128
Taylor DC, Arciero RA (1997) Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 25(3):306–311. https://doi.org/10.1177/036354659702500306
Thomas SC, Matsen FA 3rd (1989) An approach to the repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability. J Bone Joint Surg Am 71(4):506–513
Tian CY, Cui GQ, Zheng ZZ, Ren AH (2013) The added value of ABER position for the detection and classification of anteroinferior labroligamentous lesions in MR arthrography of the shoulder. Eur J Radiol 82(4):651–657. https://doi.org/10.1016/j.ejrad.2012.11.038
Tuite MJ, Petersen BD, Wise SM, Fine JP, Kaplan LD, Orwin JF (2007) Shoulder MR arthrography of the posterior labrocapsular complex in overhead throwers with pathologic internal impingement and internal rotation deficit. Skelet Radiol 36(6):495–502. https://doi.org/10.1007/s00256-007-0278-6
Walch G, Boileau P, Noel E, Donell ST (1992) Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elb Surg 1(5):238–245. https://doi.org/10.1016/S1058-2746(09)80065-7
Waldt S, Burkart A, Lange P, Imhoff AB, Rummeny EJ, Woertler K (2004) Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. AJR Am J Roentgenol 182(5):1271–1278. https://doi.org/10.2214/ajr.182.5.1821271
Waldt S, Burkart A, Imhoff AB, Bruegel M, Rummeny EJ, Woertler K (2005) Anterior shoulder instability: accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries. Radiology 237(2):578–583. https://doi.org/10.1148/radiol.2372041429
Waldt S, Metz S, Burkart A, Mueller D, Bruegel M, Rummeny EJ, Woertler K (2006) Variants of the superior labrum and labro-bicipital complex: a comparative study of shoulder specimens using MR arthrography, multi-slice CT arthrography and anatomical dissection. Eur Radiol 16(2):451–458. https://doi.org/10.1007/s00330-005-2864-0
Waldt S, Bruegel M, Mueller D, Holzapfel K, Imhoff AB, Rummeny EJ, Woertler K (2007) Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. Eur Radiol 17(2):491–498. https://doi.org/10.1007/s00330-006-0370-7
Wall MS, O’Brien SJ (1995) Arthroscopic evaluation of the unstable shoulder. Clin Sports Med 14(4):817–839
Walter WR, Samim M, LaPolla FWZ, Gyftopoulos S (2019) Imaging quantification of glenoid bone loss in patients with glenohumeral instability: a systematic review. AJR Am J Roentgenol 212:1–10. https://doi.org/10.2214/AJR.18.20504
Warby SA, Watson L, Ford JJ, Hahne AJ, Pizzari T (2017) Multidirectional instability of the glenohumeral joint: etiology, classification, assessment, and management. J Hand Ther 30(2):175–181. https://doi.org/10.1016/j.jht.2017.03.005
Weber AE, Kontaxis A, O’Brien SJ, Bedi A (2014) The biomechanics of throwing: simplified and cogent. Sports Med Arthrosc Rev 22(2):72–79. https://doi.org/10.1097/JSA.0000000000000019
Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J (2000) Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. Skelet Radiol 29(4):204–210. https://doi.org/10.1007/s002560050594
Wilk KE, Meister K, Andrews JR (2002) Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med 30(1):136–151. https://doi.org/10.1177/03635465020300011201
Willemot L, De Boey S, Van Tongel A, Declercq G, De Wilde L, Verborgt O (2019) Analysis of failures after the Bristow-Latarjet procedure for recurrent shoulder instability. Int Orthop 43(8):1899–1907. https://doi.org/10.1007/s00264-018-4105-6
Williams MM, Snyder SJ (1994) A sublabral foramen must not be confused with a Bankart lesion. Arthroscopy 10(5):586. https://doi.org/10.1016/s0749-8063(05)80022-2
Williams MM, Snyder SJ, Buford D Jr (1994) The Buford complex—the “cord-like” middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthroscopy 10(3):241–247. https://doi.org/10.1016/s0749-8063(05)80105-7
Wischer TK, Bredella MA, Genant HK, Stoller DW, Bost FW, Tirman PF (2002) Perthes lesion (a variant of the Bankart lesion): MR imaging and MR arthrographic findings with surgical correlation. AJR Am J Roentgenol 178(1):233–237. https://doi.org/10.2214/ajr.178.1.1780233
Woertler K (2007) Multimodality imaging of the postoperative shoulder. Eur Radiol 17(12):3038–3055. https://doi.org/10.1007/s00330-007-0649-3
Wolf EM, Cheng JC, Dickson K (1995) Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability. Arthroscopy 11(5):600–607. https://doi.org/10.1016/0749-8063(95)90139-6
Wright RW, Paletta GA Jr (2004) Prevalence of the Bennett lesion of the shoulder in major league pitchers. Am J Sports Med 32(1):121–124. https://doi.org/10.1177/0363546503260712
Yiannakopoulos CK, Mataragas E, Antonogiannakis E (2007) A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 23(9):985–990. https://doi.org/10.1016/j.arthro.2007.05.009
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Schäffeler, C. (2020). Shoulder Instability. In: Vanhoenacker, F.M., Maas, M., Gielen, J.L. (eds) Imaging of Orthopedic Sports Injuries. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2020_245
Download citation
DOI: https://doi.org/10.1007/174_2020_245
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-75361-0
Online ISBN: 978-3-030-75362-7
eBook Packages: MedicineMedicine (R0)