Suprascapular intraneural ganglia and glenohumeral joint connections

2006 ◽  
Vol 104 (4) ◽  
pp. 551-557 ◽  
Author(s):  
Robert J. Spinner ◽  
Kimberly K. Amrami ◽  
Michel Kliot ◽  
Shawn P. Johnston ◽  
Joaquim Casañas
Keyword(s):  
Glenohumeral Joint ◽  
Suprascapular Nerve ◽  
Symptomatic Improvement ◽  
Labral Tear ◽  
Suprascapular Neuropathy ◽  
Operative Outcomes ◽  
Labral Tears ◽  
Supraclavicular Fossa ◽  
Biceps Anchor ◽  
The Many

Object Unlike the more commonly noted paralabral cysts (extraneural ganglia), which are well known to result in suprascapular nerve compression, only four cases of suprascapular intraneural ganglia have been reported. Because of their rarity, the pathogenesis of suprascapular intraneural ganglia has been poorly understood and a pathoanatomical explanation has not been provided. In view of the growing literature demonstrating strong associations between paralabral cysts and labral (capsular) pathology, joint connections, and joint communications, the authors retrospectively reviewed the magnetic resonance (MR) imaging studies and postoperative results in the two featured patients to test a hypothesis that suprascapular intraneural ganglia would have analogous findings. Methods Two patients who presented with suprascapular neuropathy were found to have intraneural ganglia. Connections to the glenohumeral joint could be established in both patients through posterior labrocapsular complex tears. In neither patient was the joint connection identified preoperatively or intraoperatively, and cyst decompression was performed by itself without attention to the labral tear. The suprascapular intraneural ganglia extended from the glenohumeral joint as far proximally as the level of the nerves’ origin from the upper trunk in the supraclavicular fossa. Although both patients experienced symptomatic improvement after surgery, neurological recovery was incomplete. In both cases, postoperative MR images revealed cyst persistence. In addition, previously unrecognized superior labral anteroposterior (SLAP) Type II lesions (tears of the superior labrum extending anteroposterior and involving the biceps anchor at the labrum without actual extension into the tendon) were visualized. In one patient with a persistent cyst, an MR arthrogram was obtained and demonstrated a communication between the joint and the cyst. Conclusions The findings in these two patients support the synovial theory for intraneural ganglia. Based on their experience with intraneural ganglia at other sites, the authors believe that suprascapular intraneural ganglia arise from the glenohumeral joint, egress through a superior (posterior) labral tear, and dissect within the epineurium along an articular branch into the main nerve, following the path of least resistance. Furthermore, these two cases of intraneural ganglia with SLAP lesions are directly analogous to the many cases of paralabral cysts associated with these types of labral tears. By better understanding the origin of this unusual type of ganglia and drawing analogies to the more common extraneural cysts, surgical strategies can be formulated to address the underlying pathoanatomy, improve operative outcomes, and prevent recurrences.

scholarly journals Sonoarthrographic examination of posterior labrocapsular structures of the shoulder joint

2020 ◽  
Vol 93 (1106) ◽  
pp. 20190886
Author(s):  
Hayri Ogul ◽  
Nurmuhammet Tas ◽  
Mutlu Ay ◽  
Mehmet Kose ◽  
Mecit Kantarci
Keyword(s):  
Shoulder Joint ◽  
Glenohumeral Joint ◽  
Imaging Modality ◽  
Mr Arthrography ◽  
Labral Tear ◽  
Labral Tears ◽  
Significant Difference ◽  
Arthroscopic Examination ◽  
Synovial Folds ◽  
Direct Mr Arthrography

Objective: To describe the posterior labral lesions and labrocapsular abnormalities of the shoulder on sonoarthrography and to compare these findings with MR arthrography results. Methods: 82 shoulders were initially evaluated with ultrasonography and MRI and then were examined with sonoarthrography and MR arthrography following intraarticular injection of diluted gadolinium solution. The ultrasonography images were prospectively evaluated for the presence of posterior labral tear, sublabral cleft, and posterior capsular abnormalities by two radiologists. The diagnostic accuracy of sonoarthrography in the detection of posterior labral tears and posterior labrocapsular variants was compared with that of MR arthrography. Results: In sonoarthrographic examinations of 82 shoulders, 5 and 6 posterior labral tears were identified by Observer 1 and 2, respectively. Moreover, 6 and 7 posterior sublabral clefts, and 2 and 3 posterior synovial folds were identified by Observer 1 and 2, respectively. All the 82 patients were examined with MR arthrography; however, only 14 patients underwent arthroscopic examination. No significant difference was found among the 82 patients with regard to age, gender, and the prevalence of posterior labral tear, posterior labral cleft, and posterior synovial fold (p > 0.05). Interobserver variability showed substantial agreement between the sonoarthrographic and MR arthrographic results of the posterior labrocapsular structures (κ = 0.71, p < 0.05). Conclusion: Posterior labral tears and posterior synovial folds of the shoulder joint can be evaluated non-invasively by sonoarthrography. Advances in knowledge: Variations and pathologies of posterior labrocapsular structures of the glenohumeral joint are relatively uncommon. Direct (MR) arthrography is the gold-standard imaging modality to evaluate of posterior labrocapsular abnormalities of the glenohumeral joint. Sonoarthrography of the glenohumeral joint may be utilized in clinical practice in patients with contraindications to (MRI).

Distinguishing Superior Labral Tears from Normal Meniscoid Insertions with Magnetic Resonance Imaging

2012 ◽  
Vol 2 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Ankur M Manvar ◽  
Sheetal M Bhalani ◽  
Grant E Garrigues ◽  
Nancy M Major
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Signal Intensity ◽  
Labral Tear ◽  
High Signal ◽  
Resonance Imaging ◽  
Superior Labrum ◽  
Labral Tears ◽  
Biceps Anchor ◽  
Labral Pathology

ABSTRACT Objective To improve the magnetic resonance imaging (MRI) and magnetic resonance arthrogram (MRA) interpretation of a ‘meniscoid-type’ superior labrum vs a superior labral tear by evaluation of a simple sign. Materials and methods Retrospective analysis of our institution's shoulder MRIs and MRAs yielded 144 patients thought to have a superior labral tear. Fifty-five patients had arthroscopy. Analysis of the orthopaedic database for superior labral repair surgeries performed in the same time frame yielded seven additional patients without prospective MRI/MRA diagnosis of superior labral tear. Results Two of 17 (11.8%) patients thought to have superior labral tears by MRI or MRA were found to have no labral pathology at arthroscopy. Both cases failed to have extension of high signal intensity behind the biceps anchor to the most posterior oblique coronal image. Nine of 38 (23.7%) patients thought to have superior labral tears by MRI or MRA were found to have no labral pathology at arthroscopy, but a meniscoid-type superior labrum. Four of seven patients known to have superior labral tears by arthroscopy but incorrectly diagnosed as meniscoid-type superior labrum on MRI or MRA, were retrospectively found to have extension of high signal intensity in the superior labrum to the most posterior image. Conclusion Signal abnormality that continues through the remainder of the superior labrum posterior to the biceps anchor indicates a superior labral tear. Absence of this sign in the setting of more anterior high signal under the labrum may indicate a meniscoid variant. Manvar AM, Bhalani SM, Garrigues GE, Major NM. Distinguishing Superior Labral Tears from Normal Meniscoid Insertions with Magnetic Resonance Imaging. The Duke Orthop J 2012;2(1):44-49.

scholarly journals Glenoid Labral Tear: follow up case series on ultrasound guided autologous platelet rich plasma in conjunction with a progressive rehabilitation program

F1000Research ◽  
2012 ◽  
Vol 1 ◽  
pp. 68 ◽  
Author(s):  
Robert Vander Kraats ◽  
Arockia Doss
Keyword(s):  
Glenohumeral Joint ◽  
Platelet Rich Plasma ◽  
Case Series ◽  
Rehabilitation Program ◽  
Labral Tear ◽  
Work Activities ◽  
Labral Tears ◽  
Autologous Platelet Rich Plasma ◽  
Autologous Platelet

Background: Labral tears commonly occur in both the general and sporting population, often leading to significant pain and dysfunction. Patients often engage in progressive rehabilitative programs, and surgical intervention may be required in severe cases. Autologous platelet rich plasma (PRP) injections have been growing in popularity in musculoskeletal medicine as an alternative to corticosteroid injections. This paper looks at the effectiveness of PRP injections in glenoid labral lesions.Methods: The clinical and radiological findings are presented for two patients who have been treated with autologous PRP into the glenohumeral joint adjacent to the labral tear, in conjunction with a progressive rehabilitative program. Follow up occurred at 18 months and 13 months, respectively.Results: Both subjects tolerated the PRP injection well with no adverse effects, and were compliant with their rehabilitative programs. On initial presentation, pain on the visual analogue scale (VAS) was 7/10 and 6/10 and at follow up it was reported as 0/10. Both subjects have now returned to normal sporting and work activities.Conclusions: The findings from this case series suggest that PRP in conjunction with appropriate rehabilitation can assist in the clinical recovery of glenoid labral tears. Further research is required with greater sample numbers and improved methodological parameters.

Acetabular Labral Tear Dimensions and Number of Suture Anchors Used to Repair in Patients with Femoroacetabular Impingement Syndrome

2021 ◽  
Author(s):  
Guillaume D. Dumont ◽  
Matthew J. Pacana ◽  
Adam J. Money ◽  
Thomas J. Ergen ◽  
Allen J. Barnes ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Impingement Syndrome ◽  
Labral Tear ◽  
Labral Repair ◽  
Suture Anchors ◽  
Labral Tears ◽  
Femoroacetabular Impingement Syndrome ◽  
The Mean ◽  
Tear Size ◽  
Anterior Extent

AbstractFemoroacetabular impingement syndrome (FAIS) is commonly associated with acetabular labral tears. Correction of impingement morphology and suture anchor repair of labral tears have demonstrated successful early and midterm patient-reported outcomes. The purpose of this study was to evaluate the posterior and anterior extent and size of labral tears in patients with FAIS undergoing arthroscopic labral repair, and to evaluate the number of suture anchors required to repair these tears. The design of this study was retrospective case series (Level 4). A single surgeon's operative database was retrospectively reviewed to identify patients undergoing primary arthroscopic hip labral repair between November 2014 and September 2019. Patient-specific factors and radiographic measurements were recorded. Arthroscopic findings including labral tear posterior and anterior extents, and the number of suture anchors utilized for the repair were recorded. Linear regression was performed to identify factors associated with labral tear size. The number of suture anchors used relative to labral tear size was calculated. Three-hundred and thirteen patients were included in the study. The mean posterior and anterior extent for labral tears were 11:22 ± 52 and 2:20 ± 34 minutes, respectively. Mean tear size was 2 hours, 58 minutes ± 45 minutes. The mean number of suture anchors utilized for labral repair was 3.1 ± 0.7. The mean number of anchors per hour of labral tear was 1.1 ± 0.3. Increased age, lateral center edge angle, and α angle were associated with larger labral tears. Our study found that acetabular labral tears associated with FAIS are, on average, 3 hours in size and centered in the anterosuperior quadrant of the acetabulum. Arthroscopic labral repair required 1.1 anchors per hour of tear size, resulting in a mean of 3.1 anchors per repair. Level of Evidence IV

Glenohumeral Translations are Only Partially Restored after Repair of a Simulated Type II Superior Labral Lesion

2003 ◽  
Vol 31 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Andreas Burkart ◽  
Richard E. Debski ◽  
Volker Musahl ◽  
Patrick J. McMahon
Keyword(s):  
Clinical Relevance ◽  
Glenohumeral Joint ◽  
Surgical Techniques ◽  
Testing System ◽  
Type Ii ◽  
Joint Stability ◽  
Anterior Translation ◽  
Labral Lesion ◽  
Force Moment ◽  
Biceps Anchor

Background The effect on joint stability of repair of type II superior labrum and biceps anchor lesions is unknown. Hypothesis Increased translations of the glenohumeral joint after a simulated type II lesion will be reduced after the lesion is repaired. Study Design Controlled laboratory study. Methods A robotic/universal force-moment testing system was used to simulate load-and-shift and apprehension tests on eight cadaveric shoulders to determine joint kinematics of the shoulder after venting, creation of a type II lesion, and repair of the lesion. Results At 30° of abduction, anterior translation of the vented joint in response to an anterior load was 18.7 ± 8.5 mm and was significantly increased to 26.2 ± 6.5 mm after simulation of a type II lesion. Repair did not restore anterior translation (23.9 ± 8.6 mm) to that of the vented joint. The inferior translation that also occurred during application of an anterior load was 3.8 ± 4.0 mm in the vented joint and increased significantly to 8.5 ± 5.4 mm with a simulated type II lesion. After repair, the inferior translation decreased significantly to 6.7 ± 5.3 mm. Conclusions Repair of a type II lesion only partially restored glenohumeral translations to that of the vented joint. Clinical Relevance Surgical techniques including improved repair of passive stabilizers injured in the type II lesion should be considered.

Clinical Outcomes of Physiotherapy for Patients with Acetabular Labral Tears: An Analysis According to Severity of Injury

2020 ◽  
Author(s):  
Makoto Kawai ◽  
Kenji Tateda ◽  
Yuma Ikeda ◽  
Ryosuke Motomura ◽  
Ima Kosukegawa ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Labral Tear ◽  
Stage Iii ◽  
Labral Repair ◽  
Short Term ◽  
Post Intervention ◽  
Term Outcome ◽  
Labral Tears ◽  
Acetabular Labral Tear ◽  
Severity Of Injury

Abstract Background: Arthroscopic labral repair is an effective treatment for femoroacetabular impingement (FAI) and acetabular labral injury. However, the effectiveness of physiotherapy treatment is controversial. Previous studies that analyzed the outcome of physiotherapy for patients with FAI or acetabular labral tears did not consider damaged tissues or the severity of the acetabular labral tear. This study aimed to evaluate (1) the short-term outcome of physiotherapy in patients with acetabular labral tears confirmed by magnetic resonance imaging (MRI) and (2) the effectiveness of physiotherapy according to the severity of the labral tear.Methods: Thirty-five patients who underwent physiotherapy for symptomatic acetabular labral tears from August 2013 to July 2018 were enrolled. We evaluated the severity of the acetabular labral tears, which were classified based on the Czerny classification system using 3-T MRI. Clinical findings of microinstability and extra-articular pathologies of the hip joint were also examined. Outcome scores were evaluated using the International Hip Outcome Tool 12 (iHOT12) at pre- and post-intervention.Results: The mean iHOT12 score significantly improved from 44.0 to 73.5 in 4.7 months. The post-intervention iHOT12 scores were significantly higher than the pre-intervention scores at stages I (pre 51.0, post 74.4; P=0.004) and II (pre 44.8, post 81.2; P<0.001). However, there were no significant differences between the pre-intervention and post-intervention iHOT12 scores at stage III (pre 36.6, post 60.8; P=0.061). Furthermore, 7 patients (20.0%) had positive microinstability tests, and 22 (62.9%) had findings of extra-articular pathologies. Of 35 patients, 8 (22.9%) underwent surgical treatment after failure of conservative management, of whom 4 had Czerny stage III.Conclusions: Physiotherapy significantly improved the iHOT12 score of patients with acetabular labral tears in the short-term period. In patients with severe acetabular labral tear, improvement of clinical score by physiotherapy may be poor. Identifying the severity of acetabular labral tears can be useful in determining treatment strategies.

Salvage Procedures

2018 ◽  
pp. 307-322
Author(s):  
Joaquin Sanchez-Sotelo
Keyword(s):  
Surgical Technique ◽  
Surgical Procedures ◽  
Glenohumeral Joint ◽  
Resection Arthroplasty ◽  
Successful Management ◽  
The Many ◽  
And Function ◽  
Surgical Option

The many surgical procedures summarized in previous chapters allow successful management of most shoulder conditions and result in improved pain, motion, and function. However, salvage procedures that sacrifice the glenohumeral joint or the scapulothoracic joint represent the best surgical option for a few patients. These salvage procedures are uncommon, but shoulder surgeons need to be familiar with their indications, surgical technique, and reported outcomes. This chapter addresses glenohumeral arthrodesis, scapulothoracic arthrodesis, and glenohumeral resection arthroplasty.

scholarly journals Combined and Posterior Labral Tears are More Common in a Large Military Population with Operative Shoulder Instability than Previously Reported

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0040
Author(s):  
Jeanne Patzkowski ◽  
Erin Swan
Keyword(s):  
Shoulder Instability ◽  
Labral Tear ◽  
Study Cohort ◽  
Treatment Facility ◽  
Military Population ◽  
Shoulder Stabilization ◽  
Chi Square ◽  
Medical Treatment Facility ◽  
Labral Tears ◽  
The Military

Objectives: Shoulder instability is endemic in military and young athletic populations. Anterior shoulder instability is the most prevalent instability in civilian populations, but the unique physical demands placed upon military service members shoulders likely result in a different injury pattern. The purpose of the current investigation was to examine the distribution of labral tears across multiple military medical centers. We hypothesized there would be a higher incidence of posterior and combined labral tears treated operatively as compared to the civilian literature. Methods: The Military Orthopaedics Tracking Injuries and Outcomes Network’s (MOTION) prospective Wounded Ill and Injured Registry (WIIR) was queried for all patients who had undergone a surgical stabilization procedure (CPT 29806, 23455, 23462) from October 2016 to January 2019. Patients with isolated superior labral repairs were excluded. Labral tear location was abstracted from intraoperative data collection forms. Chi-Square analyses (X2) compared the percentage of patients with isolated anterior, isolated posterior, isolated inferior, or combined labral tears between individuals in the current study cohort with a previously reported civilian Norway shoulder instability registry, a reported prevalence at the National Football League scouting combine, and with operative shoulder instability patients at a single military treatment facility. Chi-square analyses also compared differences in labral tear location between males and females. Statistical significance was set a priori at α ≤ 0.05. Results: Three hundred fourteen patients (n=314) were identified who had undergone primary shoulder stabilization during the study period. Three patients were excluded due to insufficient data. Of the 311 remaining patients, 41 (13%) were female, 269 (87%) were male, 1 patient did not report a gender. All 311 patients’ military status was either active duty or active reserve (301 and 10, respectively). Ninety-four patients (30.23%) had isolated anterior labral tears (21 female, 73 male), 76 patients (24.44%) had isolated posterior labral tears (7 female, 69 male), 5 patients (1.61%) had isolated inferior tears, and 136 patients (43.73%) had combined labral tears. The number of posterior and combined labral tears in our data differed from previously reported percentages in the civilian literature (9.90% and 6.93%, respectively; X2(2)=208.94, p<0.00001). We also observed a higher percentage of combined tears than was previously reported from a military institution (18.61%; X2(2)=48.20, p<0.00001). The NFL combine cohort had 31% of players with anterior, 35% of players with posterior, and 35% with combined anterior/posterior labral tears (X2(2)=9.54, p=0.0085). Significantly more females (51.22%) had an isolated anterior labral tear, as compared to males (25.65%; X2(2)=9.25, p=0.009). Conclusion: The rate of posterior and combined labral tears in a military population with shoulder instability is higher than what is reported in the civilian literature, which is in keeping with a previous study at one Army medical treatment facility, although the rate of combined tears was even higher in the current cohort than previously reported in either population. The distribution of tear location is most similar tothat of an NFL combine population, supporting the thought that the military population should be thought of and treated as a population of athletes. Labral tears in females were more consistent with the civilian literature in that they had significantly more isolated anterior tears than posterior orcombined, which significantly differed from males. Military shoulder surgeons should be prepared to address multiple labral tears at the time of shoulder stabilization and be aware of the difference in tear location in females versus males.

Anterosuperior Labral Tear Without Biceps Anchor Involvement: A Subtle Isolated Cause of a Painful Shoulder

2011 ◽  
Vol 27 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Raffaele Garofalo ◽  
Nicole Pouliart ◽  
Enzo Vinci ◽  
Giorgio Franceschi ◽  
Roberto Aldegheri ◽  
...  
Keyword(s):  
Labral Tear ◽  
Painful Shoulder ◽  
Biceps Anchor

The 7-o'clock Posteroinferior Portal for Shoulder Arthroscopy

2002 ◽  
Vol 30 (5) ◽  
pp. 693-696 ◽  
Author(s):  
Philip A. Davidson ◽  
Dennis W. Rivenburgh
Keyword(s):  
Glenohumeral Joint ◽  
Shoulder Arthroscopy ◽  
Suprascapular Nerve ◽  
Skin Incision ◽  
Axillary Nerve ◽  
Anatomic Study ◽  
Effective Technique ◽  
Alternative Approach ◽  
Flexion Extension ◽  
Differential Distance

Background: Access to the inferior glenohumeral joint of the shoulder is very limited through the traditional 2- or 3-o'clock anterior portals. Hypothesis: The 7-o'clock posteroinferior portal offers an excellent alternative approach. Study Design: Descriptive anatomic study. Methods: Six paired cadaveric shoulders were used to arthroscopically develop and test a 7-o'clock posteroinferior portal. The distances between the portal and the subscapular and axillary nerves were measured with the arm in six different positions, combining flexion, extension, abduction, and adduction. Results: The distance from the 7-o'clock posteroinferior portal to the axillary nerve was 39 ± 4 mm and to the suprascapular nerve was 28 ± 2 mm. There was no statistically significant nerve-to-portal differential distance when the arm was placed in flexion, extension, abduction, or adduction. The inside-to-outside technique produced a 7-o'clock posteroinferior portal approximately 5 mm further from both the axillary and suprascapular nerves than did the outside-to-inside method. The angle of divergence from the 7-o'clock posterior portal skin incision to the axillary nerve was 47° and to the suprascapular nerve was 33°. Conclusions: The 7-o'clock portal affords safe, direct working access to the inferior capsular recess of the glenohumeral joint. Clinical Relevance: The 7-o'clock portal is a safe and effective technique for use by shoulder surgeons.

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