Top

Published in:

Open Access 01-12-2006 | Musculoskeletal

MR imaging in sports-related glenohumeral instability

Authors: Klaus Woertler, Simone Waldt

Published in: European Radiology | Issue 12/2006

Abstract

Sports-related shoulder pain and injuries represent a common problem. In this context, glenohumeral instability is currently believed to play a central role either as a recognized or as an unrecognized condition. Shoulder instabilities can roughly be divided into traumatic, atraumatic, and microtraumatic glenohumeral instabilities. In athletes, atraumatic and microtraumatic instabilities can lead to secondary impingement syndromes and chronic damage to intraarticular structures. Magnetic resonance (MR) arthrography is superior to conventional MR imaging in the diagnosis of labro-ligamentous injuries, intrinsic impingement, and SLAP (superior labral anteroposterior) lesions, and thus represents the most informative imaging modality in the overall assessment of glenohumeral instability. This article reviews the imaging criteria for the detection and classification of instability-related injuries in athletes with special emphasis on the influence of MR findings on therapeutic decisions.

Jobe FW, Kvitne RS, Giangarra CE (1989) Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement. Orthop Rev 18:963–975PubMed

Meister K (2000) Injuries to the shoulder in the throwing athlete. Part one: biomechanics, pathophysiology, classification of injury. Am J Sports Med 28:265–275PubMed

Burkhart SS, Craig DM, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology. Part I: pathoanatomy and biomechanics. Arthroscopy 19:404–420PubMedCrossRef

Belling Sorensen AK, Jorgensen U (2000) Secondary impingement in the shoulder: an improved terminology in impingement. Scand J Sci Sports 10:266–278CrossRef

Roger B, Skaf A, Hooper AW, Lektrakul N, Yeh L, Resnick D (1999) Imaging findings in the dominant shoulder of throwing athletes: comparison of radiography, arthrography, CT arthrography, and MR arthrography with arthroscopic correlation. Am J Roentgenol 172:1371–1380PubMed

Matsen FA, Lippit SB, Sidles JA, Harryman DT (1994) Practical evaluation and management of the shoulder. Saunders, Philadelphia, pp 59–109

Beltran J, Rosenberg ZS, Chandnani VP, Cuomo F, Beltran S, Rokito A (1997) Glenohumeral instability: evaluation with MR arthrography. Radiographics 17:657–673PubMed

Farber JM, Buckwalter KA (2002) Sports related injuries of the shoulder: instability. Radiol Clin N Am 40:235–249PubMedCrossRef

Elentuck D, Palmer WE (2004) Direct magnetic resonance arthrography. Eur Radiol 14:1956–1967PubMedCrossRef

10.

Shankman S, Bencardino J, Beltran J (1999) Glenohumeral instability: evaluation using MR arthrography of the shoulder. Skeletal Radiol 28:365–382PubMedCrossRef

11.

Tirman PF, Smith ED, Stoller DW, Fritz RC (2004) Shoulder imaging in athletes. Semin Musculoskelet Radiol 8:29–40PubMedCrossRef

12.

Cvitanic O, Tirman PF, Feller JF, Bost FW, Minter J, Carrol KW (1997) Using abduction and external rotation of the shoulder to increase the sensitivity of MR arthrography in revealing tears of the anterior glenoid labrum. Am J Roentgenol 169:837–844PubMed

13.

Armfield DR, Stickle RL, Robertson DD, Towers JD, Debski RE (2003) Biomechanical basis of common shoulder problems. Semin Musculoskelet Radiol 7:5–18PubMedCrossRef

14.

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 237:578–583PubMed

15.

O’Connell PW, Nuber GW, Mileski RA, Lautenschalger E (1990) The contribution of glenohumeral ligaments to anterior stability of the shoulder joint. Am J Sports Med 18:579–584PubMed

16.

Chandnani VP, Yeager TD, Bencardino T, Christensen K, Galgliardi JA, Heitz DR, Baird DE, Hansen MF (1993) Glenoid labral tears: prospective evaluation with MR imaging, MR arthrography, and CT arthrography. Am J Roentgenol 161:1229–1235PubMed

17.

Tirman PF, Stauffer AE, Crues JV et al (1993) Saline magnetic resonance arthrography in the evaluation of glenohumeral instability. Arthroscopy 9:550–559PubMedCrossRef

18.

Palmer WE, Brown JH, Rosentahl DI (1994) Labral-ligamentous complex of the shoulder: evaluation with MR arthrography. Radiology 190:645–651PubMed

19.

Palmer WE, Caslowitz PL (1995) Anterior shoulder instability: diagnostic criteria determined from prospective analysis of 121 MR arthrograms. Radiology 197:819–825PubMed

20.

Chandnani VP, Gagliardi JA, Murnane TG et al (1995) Glenohumeral ligaments and shoulder capsular mechanism: evaluation with MR arthrography. Radiology 196:27–32PubMed

21.

Garneau RA, Renfrew DL, Moore TE, El-Khoury GY, Nepola JV, Lemke JH (1991) Glenoid labrum: evaluation with MR imaging. Radiology 179:519–522PubMed

22.

Gusmer PB, Potter HG, Schatz JA et al (1996) Labral injuries: accuracy of detection with unenhanced MR imaging of the shoulder. Radiology 200:519–524PubMed

23.

Zanetti M, Carstensen T, Weishaupt D, Jost B, Hodler J (2001) MR arthrographic variability of the arthroscopically normal glenoid labrum: qualitative and quantitative assessment. Eur Radiol 11:559–566PubMedCrossRef

24.

Beltran J, Bencardino J, Padron M, Shankman S, Beltran L, Ozkarahan G (2002) The middle glenohumeral ligament: normal anatomy, variants and pathology. Skeletal Radiol 31:253–262PubMedCrossRef

25.

Park YH, Lee JY, Moon SH, Mo JH, Yang BK, Hahn SH, Resnick D (2000) MR arthrography of the labral capsular ligamentous complex in the shoulder: imaging variations and pitfalls. Am J Roentgenol 175:667–672PubMed

26.

Waldt S, Metz S, Burkart A, Mueller D, Bruegel M, Rummeny EJ, Woertler K (2006) Variants of the superior labrum and labor-bicipital complex: a comparative study in shoulder specimen using MR arthrography, multi-slice CT arthrography, and anatomic dissection. Eur Radiol 16:451–458PubMedCrossRef

27.

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. Am J Roentgenol 178:233–237PubMed

28.

Sanders TG, Tirmann PF, Linares R, Feller JF, Richardson R (1999) The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation. Am J Roentgenol 172:171–175PubMed

29.

Bankart ASB (1938) The pathology and treatment of recurrent dislocation of the shoulder. Br J Surg 26:23–39

30.

Neviaser TJ (1993) The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder. Arthroscopy 9:17–21PubMedCrossRef

31.

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 25:306–311PubMed

32.

Norlin R (1993) Intraarticular pathology in acute, first-time shoulder dislocation: an arthroscopic study. Arthroscopy 9:546–549PubMedCrossRef

33.

Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 16:677–694PubMedCrossRef

34.

Itoi E, Lee SB, Berglund LJ, Berge LL, An KN (2000) The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am 82:35–46PubMed

35.

Blum A, Coudane H, Molé D (2000) Gleno-humeral instabilities. Eur Radiol 10:63–82PubMedCrossRef

36.

Perthes G (1906) Über Operationen mit habitueller Schulterluxation. Deutsch Z Chir 85:199–227, [Article in German]

37.

Neviaser TJ (1993) The GLAD lesion: another cause of anterior shoulder pain. Arthroscopy 9:22–23PubMedCrossRef

38.

Wolf EM, Cheng JC, Dickson K (1995) Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability. Arthroscopy 11:600–607PubMedCrossRef

39.

Bui-Mansfield LT, Taylor DC, Uhorchak JM, Tenuta JJ (2002) Humeral avulsion of the glenohumeral ligament: imaging features and a review of the literature. Am J Roentgenol 179:649–655PubMed

40.

Bokor DJ, Conboy VB, Olson C (1999) Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament: a review of 41 cases. J Bone Joint Surg Br 81:93–96PubMedCrossRef

41.

Oberlander MA, Morgan BE, Visotsky JL (1996) The BHAGL lesion: a new variant of anterior shoulder instability. Arthroscopy 12:627–633PubMedCrossRef

42.

Warner JJ, Beim JM (1997) Combined Bankart and HAGL lesion associated with anterior shoulder instability. Arthroscopy 13:749–752PubMedCrossRef

43.

Lintner SA, Speer KP (1997) Traumatic anterior glenohumeral instability: the role of arthroscopy. J Acad Orthop Surg 5:233–239

44.

Calandra JJ, Baker CL, Uribe J (1989) The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy 5:254–257PubMedCrossRef

45.

Richards RD, Sartoris DJ, Pathria MN, Resnick D (1994) Hill-Sachs lesion and normal humeral groove: MR imaging features allowing their differentiation. Radiology 190:665–668PubMed

46.

Sanders TG, Morrison WB, Miller MD (2000) Imaging techniques for the evaluation of glenohumeral instability. Am J Sports Med 28:414–434PubMed

47.

Jobe CM (1995) Posterior superior glenoid impingement: expanded spectrum. Arthroscopy 11:530–536PubMedCrossRef

48.

Jobe CM (1996) Superior glenoid impingement. Current concepts. Clin Orthop Rel Res 330:98–107CrossRef

49.

Walch G, Liotard JP, Boileau P, Noel E (1991) Postero-superior glenoid impingement. Another impingement of the shoulder. Rev Chir Orthop Reparatrice Appar Mot 77:571–574 [Article in French]PubMed

50.

Tirman PF, Bost FW, Gravin GJ, Peterfy CG, Mall JC, Steinbach LS, Feller JF, Crues JV 3rd (1994) Posterosuperior glenoid impingement of the shoulder: findings at MR imaging and MR arthrography with arthroscopic correlation. Radiology 193:431–436PubMed

51.

Kaplan LD, McMahon PJ, Towers J, Irrgang JJ, Rodowsky MW (2004) Internal impingement on magnetic resonance imaging and arthroscopic evaluation. Arthroscopy 7:701–704

52.

Giaroli EL, Major NM, Higgins LD (2005) MRI of internal impingement of the shoulder. Am J Roentgenol 185:925–929PubMedCrossRef

53.

Palmer WE, Brown JH, Rosenthal DI (1993) Rotator cuff: evaluation with fat-suppressed MR arthrography. Radiology 188:683–687PubMed

54.

Ferrari FS, Governi S, Burresi F, Vigni F, Stefani P (2002) Supraspinatus tendon tears: comparison of US and MR arthrography with surgical correlation. Eur Radiol 12:1211–1217PubMedCrossRef

55.

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. Am J Roentgenol 182:1271–1278PubMed

56.

Snyder SJ, Karzel RP, Del-Pizzo W, Ferkel RD, Friedmann MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6:274–279PubMedCrossRef

57.

Tuite MJ, Cirillo RL, De Smet AA, Orwin JF (2000) Superior labrum anterior-posterior (SLAP) tears: evaluation of three MR signs on T2-weighted images. Radiology 215:841–845PubMed

58.

Yoneda M, Izawa K, Hirooka A, Hayashida K, Wakitani S (1998) Indicators of superior glenoid labral detachment on magnetic resonance imaging and computed tomography arthrography. J Shoulder Elbow Surg 7:2–12PubMedCrossRef

59.

Jee WH, McCauley TR, Katz LD, Matheny JM, Ruwe PA, Daigneault JP (2001) Superior labral anterior posterior (SLAP) lesions of the glenoid labrum: reliability and accuracy of MR arthrography for diagnosis. Radiology 218:127–132PubMed

60.

Kreitner KF, Botchen K, Rude J, Bittinger F, Krummenauer F, Thelen M (1998) Superior labrum and labral-bicipital complex: MR imaging with pathologic-anatomic and histologic correlation. Am J Roentgenol 170:599–605PubMed

Title: MR imaging in sports-related glenohumeral instability
Authors: Klaus Woertler
Simone Waldt
Publication date: 01-12-2006
Publisher: Springer-Verlag
Published in: European Radiology / Issue 12/2006
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-006-0258-6

At a glance: The STEP trials

Springer Medicine

MR imaging in sports-related glenohumeral instability

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2006

The correlation of mammographic-and histologic patterns of breast cancers in BRCA1 gene mutation carriers, compared to age-matched sporadic controls

Gadolinium contrast media are more nephrotoxic than iodine media. The importance of osmolality in direct renal artery injections

Assessment of Crohn’s disease in the small bowel: prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis

Cardiac stress MR imaging with dobutamine

Impact of the introduction of 16-row MDCT on image quality and patient dose: phantom study and multi-centre survey

Potential role of Calogen as an oral contrast medium in the evaluation of the gastric wall at MRI