Magnetic Resonance Imaging of Glenohumeral Joint Instability

 

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ABSTRACT

Shoulder instability is common, especially anterior subluxation and dislocation. The sequelae are well seen on magnetic resonance imaging and include tears of the labrum, glenohumeral ligaments, capsule, tendons, and muscles. This article seeks to discuss and illustrate common pitfalls and lesions associated with instability. Anatomic and technical considerations, including the use of magnetic resonance arthrography, are also addressed.

REFERENCES

• 1 Seeger L L, Gold R H, Bassett L W. Shoulder instability: evaluation with MR imaging.  Radiology. 1988;  168 695-697
  PubMedGoogle Scholar
• 2 Pappas A M, Goss T P, Kleinman P K. Symptomatic shoulder instability due to lesions of the glenoid labrum.  Am J Sports Med. 1983;  11 279-288
  CrossrefPubMedGoogle Scholar
• 3 Simonet W T, Cofield R H. Prognosis in anterior shoulder dislocations.  Am J Sports Med. 1984;  12 19-24
  CrossrefPubMedGoogle Scholar
• 4 Levine W N, Flatow E L. The pathophysiology of shoulder instability.  Am J Sports Med. 2000;  28 910-917
  PubMedGoogle Scholar
• 5 Gusmer P B, Potter H G, Schatz J A et al.. Labral injuries: accuracy of detection with unenhanced MR imaging of the shoulder.  Radiology. 1996;  200 519-524
  PubMedGoogle Scholar
• 6 Chandnani V P, Yeager T D, DeBerardino T et al.. Glenoid labral tears: prospective evaluation with MR imaging, MR arthrography, and CT arthrography.  AJR Am J Roentgenol. 1993;  161 1229-1235
  PubMedGoogle Scholar
• 7 Shankman S, Bencardino J, Beltran J. Glenohumeral instability: evaluation using MR arthrography of the shoulder.  Skeletal Radiol. 1999;  28 365-382
  CrossrefPubMedGoogle Scholar
• 8 Palmer W E, Brown J H, Rosenthal D I. Labral-ligamentous complex of the shoulder: evaluation with MR arthrography.  Radiology. 1994;  190 645-651
  CrossrefPubMedGoogle Scholar
• 9 Steinbach L S, Palmer W E, Schweitzer M E. Special focus session. MR arthrography.  Radiographics. 2002;  22 1223-1246
  CrossrefPubMedGoogle Scholar
• 10 Beltran J, Rosenberg Z S, Chandnani V P, Cuomo F, Beltran S, Rokito A. Glenohumeral instability: evaluation with MR arthrography.  Radiographics. 1997;  17 657-673
  CrossrefPubMedGoogle Scholar
• 11 Chung C B, Dwek J R, Feng S, Resnick D. MR arthrography of the glenohumeral joint: a tailored approach.  AJR Am J Roentgenol. 2001;  177 217-219
  CrossrefPubMedGoogle Scholar
• 12 Tirman P FJ, Bost F W, Steinbach L S et al.. MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm.  Radiology. 1994;  192 851-856
  CrossrefPubMedGoogle Scholar
• 13 Sommer T, Vahlensieck M, Wallny T et al.. Indirect MR arthrography in the diagnosis of lesions of the labrum glenoidale.  Rofo. 1997;  167 46-51
  PubMedGoogle Scholar
• 14 Maurer J, Rudolph J, Lorenz M et al.. A prospective study on the detection of lesion of the labrum glenoidale by indirect MR arthrography of the shoulder.  Rofo. 1999;  14 307-312
  PubMedGoogle Scholar
• 15 Rockwood C A, Matsen F A, Wirth M A, Harryman D T. The Shoulder. Philadelphia; WB Saunders 1990
  Google Scholar
• 16 Neumann C H, Petersen S A, Jahnke A H. MR imaging of the labral-capsular complex: normal variations.  AJR Am J Roentgenol. 1991;  157 1015-1021
  CrossrefPubMedGoogle Scholar
• 17 Park Y H, Lee J Y, Moon S H et al.. MR arthrography of the labral capsular ligamentous complex in the shoulder: imaging variations and pitfalls.  AJR Am J Roentgenol. 2000;  175 667-672
  CrossrefPubMedGoogle Scholar
• 18 Williams M M, Snyder S J, Buford D. The Buford complex-the cord-like middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant.  Arthroscopy. 1994;  10 241-247
  CrossrefPubMedGoogle Scholar
• 19 Tirman P FJ, Feller J F, Palmer W E, Carroll K W, Steinbach L S, Cox I. The Buford complex-a variation of normal shoulder anatomy. MR arthrographic imaging features.  AJR Am J Roentgenol. 1996;  166 869-873
  PubMedGoogle Scholar
• 20 Tuite M J, Orwin J F. Anterosuperior labral variants of the shoulder: appearance on gradient-recalled-echo and fast spin-echo MR images.  Radiology. 1996;  199 537-540
  CrossrefPubMedGoogle Scholar
• 21 Tuite M, Blankenbaker D G, Siefert M, Aiegert A J, Orwin J F. Sublabral foramen and Buford complex: Inferior extent of the unattached or absent labrum in 50 patients.  Radiology. 2002;  223 137-142
  CrossrefPubMedGoogle Scholar
• 22 Detrisac D A, Johnson L L. Arthroscopic Shoulder Anatomy: Pathologic and Surgical Implications. Thorofare, NJ; Slack 1987
  Google Scholar
• 23 Smith D K, Chopp T M, Aufdemorte T B et al.. Sublabral recess of the superior glenoid labrum: study of cadavers with conventional nonenhanced MR imaging, MR arthrography, anatomic dissection, and limited histologic examination.  Radiology. 1996;  201 251-256
  CrossrefPubMedGoogle Scholar
• 24 Yeh L, Kwak S, Kim Y S et al.. Anterior labroligamentous structures of the glenohumeral joint: correlation and anatomic dissection in cadavers.  AJR Am J Roentgenol. 1998;  171 1229-1236
  CrossrefPubMedGoogle Scholar
• 25 Beltran J, Bencardino J, Mellado J, Rosenberg Z S, Irish R D. MR arthrography of the shoulder: variations and pitfalls.  Radiographics. 1997;  17 1403-1412
  PubMedGoogle Scholar
• 26 Ferrari J D, Ferrari D A, Coumas J, Pappas A M. Posterior ossification of the shoulder: the Bennett lesion.  Am J Sports Med. 1994;  22 171-176
  PubMedGoogle Scholar
• 27 Beltran J, Bencardino J, Padron M, Shankman S, Beltran L, Ozkarahan G. The middle glenohumeral ligament: normal anatomy, variants and pathology.  Skeletal Radiol. 2002;  31 253-262
  CrossrefPubMedGoogle Scholar
• 28 Moseley H F. Recurrent dislocation of the shoulder.  Postgrad Med. 1962;  31 23-29
  PubMedGoogle Scholar
• 29 Turkel S J, Panio M W, Marshall J L, Girgis F G. Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint.  J Bone Joint Surg Am. 1981;  63 1208-1217
  PubMedGoogle Scholar
• 30 Flannigan B, Kursunoglu-Brahme S, Snyder S et al.. MR arthrography of the shoulder: comparison with conventional MR imaging.  AJR Am J Roentgenol. 1990;  155 829-832
  PubMedGoogle Scholar
• 31 Kieft G J, Bloem J L, Rozing P M, Obermann W R. MR imaging of recurrent anterior dislocation of the shoulder: comparison with CT arthrography.  AJR Am J Roentgenol. 1988;  150 1083-1087
  PubMedGoogle Scholar
• 32 Seeger L L, Gold R H, Bassett L W, Ellman H. Shoulder impingement syndrome: MR findings in 53 shoulders.  AJR Am J Roentgenol. 1988;  150 343-347
  PubMedGoogle Scholar
• 33 Wilson A J, Totty W G, Murphy W et al.. Shoulder joint: arthrographic CT and long-term follow-up, with surgical correlation.  Radiology. 1989;  173 329-333
  PubMedGoogle Scholar
• 34 Coumas J M, Waite R J, Goss T P, Ferrari D A, Kanzaria P K, Pappas A M. CT and MR evaluation of the labral capsular ligamentous complex of the shoulder.  AJR Am J Roentgenol. 1992;  158 591-597
  PubMedGoogle Scholar
• 35 Garneau R A, Renfrew D L, Moore T E, El-Khoury G Y, Nepola J V, Lemke J H. Glenoid labrum: evaluation with MR imaging.  Radiology. 1991;  179 519-522
  PubMedGoogle Scholar
• 36 Legan J M, Burkhard T K, Goff W B II et al.. Tears of the glenoid labrum: MR imaging of 88 arthroscopically confirmed cases.  Radiology. 1991;  179 241-246
  CrossrefPubMedGoogle Scholar
• 37 McCauley T R, Pope C F, Jokl P. Normal and abnormal glenoid labrum: assessment with multiplanar gradient-echo MR imaging.  Radiology. 1992;  183 35-37
  CrossrefPubMedGoogle Scholar
• 38 Tirman P FJ, Stauffer A E, Crues J V et al.. Saline magnetic resonance arthrography in the evaluation of glenohumeral instability.  Arthroscopy. 1993;  9 550-559
  PubMedGoogle Scholar
• 39 Roger B, Skaf A, Hooper A W, Lektrakul N, Yeh L, Resnick D. Imaging findings in the dominant shoulder of throwing athletes: comparison of radiography, arthrography, CT arthrography, and MR arthrography with arthroscopic correlation.  AJR Am J Roentgenol. 1999;  172 1371-1380
  PubMedGoogle Scholar
• 40 Kwak S M, Brown R R, Trudell D, Resnick D. Glenohumeral joint: comparison of shoulder positions at MR arthrography.  Radiology. 1998;  208 375-380
  CrossrefPubMedGoogle Scholar
• 41 Loredo R, Longo C, Salonen D et al.. Glenoid labrum: MR imaging with histologic correlation.  Radiology. 1995;  196 33-41
  CrossrefPubMedGoogle Scholar
• 42 Neviaser T J. The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder.  Arthroscopy. 1993;  9 17-21
  CrossrefPubMedGoogle Scholar
• 43 Perthes G. Uber operationen bei habitueller schulterluxation.  Deutsch Z Chir. 1906;  85 199-227
  PubMedGoogle Scholar
• 44 Tirman P FJ, Steinbach L S, Feller J F. AE S. Humeral avulsion of the anterior shoulder stabilizing structures after anterior shoulder dislocation: demonstration by MR and MR arthrography.  Skeletal Radiol. 1996;  25 743-748
  CrossrefPubMedGoogle Scholar
• 45 Neviaser R J, Neviaser T H, Neviaser J S. Anterior dislocation of the shoulder and rotator cuff rupture.  Clin Orth Rel Res. 1993;  291 103-106
  PubMedGoogle Scholar
• 46 Neviaser R J, Neviaser T J, Neviaser J S. Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient.  J Bone Joint Surg Am. 1988;  70 1308-1311
  PubMedGoogle Scholar
• 47 Oberlander M A, Morgan B E, Visotsky J L. The BHAGL lesion: a new variant of anterior shoulder instability.  Arthroscopy. 1996;  12 627-633
  CrossrefPubMedGoogle Scholar
• 48 Warner J J, Beim G M. Combined Bankart and HAGL lesion associated with anterior shoulder instability.  Arthroscopy. 1997;  13 749-752
  CrossrefPubMedGoogle Scholar
• 49 Sanders T G, Tirman P FJ, Linares R, Feller J F, Richardson R. The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation.  AJR Am J Roentgenol. 1999;  172 171-175
  CrossrefPubMedGoogle Scholar
• 50 Neviaser T J. The GLAD lesion: another cause of anterior shoulder pain.  Arthroscopy. 1993;  9 22-23
  CrossrefPubMedGoogle Scholar
• 51 Simons P, Joekes E, Melissen R GHH, Bloem J L. Posterior labrocapsular periosteal sleeve avulsion complicating locked posterior shoulder dislocation.  Skeletal Radiol. 1998;  27 588-590
  CrossrefPubMedGoogle Scholar
• 52 Yu J S, Ashman C J, Jones G. The POLPSA lesion: MR imaging findings with arthroscopic correlation in patients with posterior instability.  Skeletal Radiol. 2002;  31 396-399
  CrossrefPubMedGoogle Scholar
• 53 Bennett G E. Shoulder and elbow lesions of the professional baseball pitcher.  JAMA. 1941;  117 510-514
  PubMedGoogle Scholar
• 54 De Maeseneer M, Jaovisidha S, Jacobson J A et al.. The Bennett lesion of the shoulder.  J Comput Assist Tomogr. 1998;  22 31-34
  CrossrefPubMedGoogle Scholar
• 55 Steinbach L S, Tirman P FJ, Peterfy C A, Feller J. Shoulder Magnetic Resonance Imaging. Philadelphia; Lippincott-Raven 1998
  Google Scholar
• 56 Hottya G A, Tirman P FJ, Bost F W, Montgomery W H, Wolf E M, Genant H K. Tear of the posterior shoulder stabilizers after posterior dislocation: MR imaging and MR arthrographic findings with arthroscopic correlation.  AJR Am J Roentgenol. 1998;  171 763-768
  PubMedGoogle Scholar
• 57 Workman T K, Burkhard T K, Resnick D et al.. Hill-Sachs lesion: comparison of detection with MR imaging, radiography, and arthroscopy.  Radiology. 1992;  185 847-852
  PubMedGoogle Scholar
• 58 Richards R D, Sartoris D J, Pathria M N, Resnick D. Hill-Sachs lesion and normal humeral groove: MR imaging features allowing their differentiation.  Radiology. 1994;  190 665-668
  PubMedGoogle Scholar
• 59 Jobe C M. Posterior superior glenoid impingement: expanded spectrum.  Arthroscopy. 1995;  11 530-536
  CrossrefPubMedGoogle Scholar
• 60 Walch G, Boileau P, Noel E, Donell S T. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study.  J Shoulder Elbow Surg. 1992;  1 238-245
  CrossrefPubMedGoogle Scholar
• 61 Liu S H, Boynton E. Posterior superior impingement of the rotator cuff on the glenoid rim as a cause of shoulder pain in the overhead athlete.  Arthroscopy. 1993;  9 697-699
  PubMedGoogle Scholar
• 62 Tirman P FJ, Bost F, Garvin G J et al.. Posterosuperior glenoid impingement of the shoulder: findings at MR imaging and MR arthrography with arthroscopic correlation.  Radiology. 1994;  193 431-436
  CrossrefPubMedGoogle Scholar
• 63 Weishaupt D, Zanetti M, Nyffeler R W et al.. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability.  Skeletal Radiol. 2000;  29 204-210
  CrossrefPubMedGoogle Scholar
• 64 Tirman P FJ, Feller J F, Janzen D L, Peterfy C G, Bergman A G. Association of glenoid labral cysts with labral tears and glenohumeral instability: radiologic findings and clinical significance.  Radiology. 1994;  190 653-658
  CrossrefPubMedGoogle Scholar
• 65 Fritz R, Helms C A, Steinbach L S et al.. MR imaging of suprascapular nerve entrapment.  Radiology. 1992;  182 437-444
  CrossrefPubMedGoogle Scholar
• 66 Sanders T G, Tirman P FJ. Paralabral cyst: an unusual cause of quadrilateral space syndrome.  Arthroscopy. 1999;  15 632-637
  PubMedGoogle Scholar
• 67 Visser C P, Coene L N, Brand R, Tavy D L. The incidence of nerve injury in anterior dislocation of the shoulder and its influence on functional recovery. A prospective clinical and EMG study.  J Bone Joint Surg Br. 1999;  81 679-685
  CrossrefPubMedGoogle Scholar

Lynne S SteinbachM.D. 

Chief, Musculoskeletal Imaging, University of California, San Francisco

505 Parnassus, Suite M392

San Francisco, CA 94143-0628