Labral Tears Objectives Anatomy Review Anatomy Review

Labral Tears Objectives Anatomy Review Anatomy Review www.phwiki.com

Labral Tears Objectives Anatomy Review Anatomy Review

Adair, Jill, News Services Editor has reference to this Academic Journal, PHwiki organized this Journal Labral TearsBrett Gemlick, MDSportONEObjectivesReview Shoulder AnatomyDescribe types of labral injuriesReview Surgical TechniquesDiscuss post operative rehabilitationReturn to playAnatomy ReviewClavicle1st bone to ossify, last to fuse (25 y)SC joint only true joint connecting UE to axial skeletonScapulaGH: greatest ROM of all jointsgolf ball on a tee, not ball in socketProvides site as long as 17 muscle attach.Acromion: shape in addition to non-fusion predispose as long as problemsProximal HumerusRC attachmentsBicipital groove

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Anatomy ReviewRotator Cuff (RC)Supraspinatus, Infraspinatus, Subscapularis, & Teres MinorFunction: movement & center H.head in glenoidLong Head of Biceps (LHB)Superior/anterior stabilityLabrumMeniscus of GH jointShoulder Laxity vs InstabilityLaxity=symptomatic, passive translation of humeral head ; no painEx: generalized ligament laxity, hx of chronic ankle sprainsCongenital :“I’m very bendy”Some able to sublux/dislocate without injury Instability=pathologic condition w/excessive translation of humeral head on glenoid fossa; pain in addition to /or discom as long as tTraumatic/Sports related injuriesShoulder Mechanics/ForcesStatic: ligaments & tendonsLabrum“meniscus of shoulder”Cross-sectional anatomy, micro-vascularity, in addition to attachments similar to knee meniscus (Cooper 1992)capsule in addition to ligamentsRC passive tensionneg. intra-articluar pressure (vacuum)Dynamic: muscle contractionRC in addition to LHB contractionScapular retractors

Causes of labral tearsTrauma – dislocations of shoulder may cause isolated or extensive labral injury (Mazzocca 2011)Anterior labral tear or Bankart lesionsPosterior labral tears or reverse Bankhart lesionSuperior Labrum Anterior in addition to Posterior (SLAP) tearsCauses of Labral TearsOverhead throwing/hitting athletesLong head of biceps anchor at superior labrum applies traction during overhead throwing, especially during cocking in addition to deceleration phase (Yeh 2007)“peel-back mechanism” during cocking phase Typically SLAP tearswww.ptsmi.orgMore baseball

More baseball Peel –back testCauses of Labral TearsGlobal Laxity Repeated shoulder subluxations with increased capsular laxity may result in blunting or tearing of labrumwww.rpocenter.com

What was the first CD pressed in the U.S.Bruce Springsteen“Born in the USA”Clincial PresentationHistoryImportant Details / HPIPain description (location, provocative actions, etc)Acute vs. chronic, frequencyWith c/o instability: subluxation v. dislocationself-reduced v. trip to ER as long as closed reduction with conscious sedationDirection of subluxationmechanism of injurytemporary numbness/tinglingh in addition to dominanceMechanical symptoms: clicking, catching, etc.Physical ExamO’Brien’s Test – SLAP tears or AC injuryApprehension/Relocation – Anterior instability/labral injuryLoad in addition to Shift – Anterior/Posterior instabilitySulcus Sign – Inferior instabilityJanke test – posterior instabilityNote: MDI patients will likely have multiple positive tests

O’Brien’s TestApprehension TestLoad in addition to Shift TestSulcus SignImagingPlain films: AP, outlet, grashey, & AXILLARY!Cannot truly diagnose dislocation or prove reduction without axillary view Bony Bankart or Hill Sachs lesions MRI ArthrogramLabrum in addition to capsule damage seen better w/ dyeBony edema from osseous injury seen that might not show on plain film

ImagingLabral TearsMRI arthrogram: 89% sensitive, 91% specific, in addition to 90% accurate (Bencardino 2000)Non-contrast MRI vs MRI Arthrogram (Sheridan 2014)Non-contrast MRI: accuracy 85%, sensitivity 36%, PPV 13%MRI Arthrogram: accuracy 69%, sensitivity 80%, PPV 29%Bankart Tearinjury to the labrum at the point of the IGHL (90%) in addition to MGHL (10%) from the glenoid rim (Solomon)Hill Sachs Lesioncompression fracture at the posterolateral margin of the humeral headIncreased capsular volumeIrreversible stretchingRC Tearsseen typically in dislocation patients over age 40Imagingwww.orthoinfo.aaos.orgwww.craw as long as dsportsmedicine.comSLAP Types (Solomon 2011)

SLAP TypesRadiologyassistant.nlSLAP tearsImagingAnterior Labral Tearwww.bacsianh.comPosterior Labral Tearappliedradiology.com

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Hill Sachs LesionImagingAnterior Labroligamentous Periosteal Sleeve Avusion (ALPSA lesion)Associated with anterior shoulder dislocationRadiopedia.org/cases/alpsa-lesionWhat is the oldest business in the United States of America The cymbal company Zildjian which was founded in Constantinople in 1623. Source: American Heritage of Invention & Technology, Winter 2000

ALPSA lesionTreatmentSelect superior labral tearsLong Head of Biceps Tenodesis or TenotomyDepends on extent of tear in addition to age of patient Most Labral TearsArthrosciopic Labral repairUse of suture anchors or knots to fixate labrum back to glenoid rimOften per as long as med in conjunction with capsulorrhaphy if capsule is stretched/weakenedLabral Repair Arthroscopic Images

Final Question!Who was the last Division 1 college football team to finish the regular season unbeaten, untied, AND unscored uponThe University of Tennessee 1939ReferencesSolomon,D, et al. “Extensive Labral Tears – Pathology in addition to Surgical Treatment”. Shoulder Instability: A Comprehensive Approach. 36: 426-34.Weber, S. DeLee & Drez’s Orthopaedic Sports Medicine. 49: 543-49.Yeh, ML. “Stress Distribution in the Superior Labrum During Throwing Motion.” The American Journal of Sports Medicine. March 2005. 33: 395-401.Burkhart SS. :The Peel-Back Mechanism: its role in producing in addition to extending posterior type II SLAP lesions in addition to its effect on SLAP repair in addition to rehabilitation.” Arthoscopy. 1998; 14: 637-40.Mazzocca, A et al. “Traumatic Shoulder Instability Involving Anterior, Inferior, in addition to Posterior Labral Injury: A Prospective Clinical Evaluation of Arthroscopic Repair of 270 º Labral Tears.” Am J Sports Med August 2011. vol 39. 8: 1687-96.Cooper, DE et al. “Anatomy, histology, in addition to vascularity of the glenoid labrum – An anatomical Study.” J Bone Joint Surg Am, 1992 Jan; 74 (1): 46-52.Nam, E. in addition to S. Snyder. “Clinical Sports Medicine Update. The Diagnosis in addition to Treatment of Superior Labrum, Anterior in addition to Posterior (SLAP) Lesions”. Am J Sports Med. Sept 2003; 5: 798-810.ReferencesRicchetti et al. “Glenoid labral repair in Major League Baseball pitchers”. Int J Sports Med. 2010 Apr; 31(4): 265-70.Harris et al. “Return to sport following shoulder surgery in the elite pitcher: a systematic review”. Sports Health. 2013 Jul; 5(4): 367-76.Bencardino JT, Beltran J, Rosenberg ZS, et al: Superior labrum anterior-posterior lesions: Diagnosis with MR arthrography of the shoulder. Radiology 214:267 –271,2000Solomon in addition to Devine. “SLAP Tears: Pearls in addition to Pitfalls in Diagnosis in addition to Management”. Sports Medicine Update Jan/Feb 2011. p2-6.Merolla & Porcellini. “Infranspinatus strenght assessment in addition to ultrasound evaluation of posterior capsulotenodesis after arthroscopic hill-sachs remplissage in traumatic anterior glneohumeral instability: a retrosecptive controlled study protocol”. Transl Med UniSa. April 2014. 24:; 9: 27-9.Boileau et al. “Anatomical in addition to Functional Results After Arthroscopic Hill-Sachs Remplissage”. J Bone Joint Surg Am, 2012 April 04; 94 (7): 618-626.

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