Shoulder: Instability

Glenohumeral instability is the inability to keep the humeral head centered in the glenoid fossa. Glenohumeral instability can be classified according to etiology and direction of instability. The glenoid labrum, the glenohumeral ligaments, and the bony structures contribute to the stability glenohumeral joint and need to be addressed with imaging. One of the difficulties with accurately diagnosing labral tears on MR imaging is the normal labral variants, which can sometimes appear similar to tears. The location and extent of a Hill-Sachs lesion and glenoid rim defects need to be related to recognize engaging Hill-Sachs lesions or off-track situations. There are several types of labral tears that are not associated with a prior dislocation. SLAP tears are one of the more common tears of the labrum and can sometimes be difficult to distinguish from a normal variant superior sublabral recess. Labral tears in overhead thrower occur in the posterosuperior labrum, adjacent to the posterior rotator cuff tears in these athletes. Tears in the posterosuperior labrum are also associated with spinoglenoid notch paralabral cysts, which can be painful and cause external rotation weakness.

Age related morphometric changes of the glenoid labrum

Objectives: Although the glenoid labrum is linked to glenohumeral joint stability, its anatomy remains controversial. This study aimed to investigate the shape, consistency of the glenoid labrum, and whether these and its thickness and depth are age related. Methods: A total of 140 shoulders were dissected to expose the glenoid labrum. the shape and consistency of the glenoid labrum were assessed at a gross level. Measurements were taken of the labrum depth and thickness, using callipers, in the superior, anterior, inferior and posterior regions. ANOVA and chi-square tests were conducted to determine statistical significance, which was set at p<0.05. Results: The consistency of the superior half of the labrum was rubbery in 97.9% of specimens and firm in the remaining 2.1%, whereas the entire inferior half was firm. There was a significant difference (p=0.043) in the consistency of the superior half between males and females. The superior half was triangular in 95.7% of specimens, flat in 2.1% and flat to triangular in 2.1%, whereas the shape of the inferior half was rounded in 99.3% of specimens and flat in 0.7%. The labrum was observed to be thicker in younger individuals, with the differences being significant superiorly (p=0.011), anteriorly (p=0.050), inferiorly (p=0.001) and posteriorly (p=0.047). It was also observed to be deeper in younger individuals, but only significantly so superiorly (p=0.044). Conclusion: Labrum thickness and depth significantly decreased with increasing age, suggesting that these observations could be age-related.

Shoulder pain syndrome in patients engaged in physical culture and sports: modern aspects of rehabilitation

The aim of the study was to estimate rehabilitation efficiency in the sportsmen and physical culture professionals with a shoulder pain syndrome. Materials and methods: 980 patients with a shoulder pain syndrome undergo rehabilitation treatment. The reasons of acute or chronic shoulder pain syndrome were: acute trauma (7% of cases) or chronic microtraumatization (93% of cases) of shoulder tissues during the physical culture activities and sport. Rotary cuff pathology was diagnosed in 88% of patients, long head of biceps pathology - in 5%, acromioclavicular joint pathology - in 4%, the subacromial bursitis in 2% of cases, damage of the glenoid labrum (Bankarta) in 1%. Clinical methods (including the quality of life questionnaire -DASH) and instrumental methods (USD and MRI) were used. The differentiated rehabilitation programs (with the use of modern physical therapy methods) were recommended considering features of shoulder pathology, a patients clinical condition and their physical (including sports) activity. Results: Excellent and good results were stated in 98% of patients with a shoulder pain syndrome. 2% of patients were directed for the surgical intervention (rotary cuff and glenoid labrum restoration). Compensation of a shoulder pain syndrome was stated in 82% of patients; in 16% of patients the pain syndrome had significantly decreased. In 87% of patients function of the injured shoulder joint was restored, in 11% of patients - it significantly improved. Strength of shoulder muscles and a humeroscapular rhythm were restored and the quality of life (according to the DASH questionnaire) improved in 98% of patients. Conclusion. Use of the differentiated programs of rehabilitation using modern physical techniques allows to receive excellent and good results in all patients with a shoulder pain syndrome involved physical culture and sport.

Role of MRI Arthrography Compared to Conventional MRI in Assessment of Shoulder Joint Disorders

Glenohumeral joint instability is extremely common. With regard to primary anterior shoulder dislocations, the incidence is between 8.2 and 23.9 per 100 000 person-years, with an estimated prevalence of 1.7%. Many imaging methods, including arthrography, CT arthrography, MR arthrography, have been used to image the glenoid labrum and the associated structures of the capsular mechanism. The aim of the study is to prove MR arthrography is the preferred imaging technique for the investigation of patients with shoulder instability. MR arthrography reliably shows subtle lesions of the labroligamentous complex, providing information essential to the surgeon concerning the surgery or arthroscopic repair .Thirty Patients with clinically evident or suspected shoulder impingemint or glenohumeral instability.of both sexes were included , conventional MRI was performed for all patients followed by CT guided intraarticular contrast injection then MRI Arthrography images taken within thirty minutes. Data were collected, revised, coded and entered to the Statistical Package for Social Science (IBM SPSS) version 20.