Magnetic Resonance Imaging of Glenohumeral Joint Instability

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.

Shoulder - MRI - instability

REFERENCES

• 1 Seeger L L, Gold R H, Bassett L W. Shoulder instability: evaluation with MR imaging.  Radiology. 1988;  168 695-697
• 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
• 3 Simonet W T, Cofield R H. Prognosis in anterior shoulder dislocations.  Am J Sports Med. 1984;  12 19-24
• 4 Levine W N, Flatow E L. The pathophysiology of shoulder instability.  Am J Sports Med. 2000;  28 910-917
• 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
• 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
• 7 Shankman S, Bencardino J, Beltran J. Glenohumeral instability: evaluation using MR arthrography of the shoulder.  Skeletal Radiol. 1999;  28 365-382
• 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
• 9 Steinbach L S, Palmer W E, Schweitzer M E. Special focus session. MR arthrography.  Radiographics. 2002;  22 1223-1246
• 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
• 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
• 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
• 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
• 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
• 15 Rockwood C A, Matsen F A, Wirth M A, Harryman D T. The Shoulder. Philadelphia; WB Saunders 1990
• 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
• 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
• 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
• 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
• 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
• 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
• 22 Detrisac D A, Johnson L L. Arthroscopic Shoulder Anatomy: Pathologic and Surgical Implications. Thorofare, NJ; Slack 1987
• 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
• 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
• 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
• 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
• 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
• 28 Moseley H F. Recurrent dislocation of the shoulder.  Postgrad Med. 1962;  31 23-29
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 41 Loredo R, Longo C, Salonen D et al.. Glenoid labrum: MR imaging with histologic correlation.  Radiology. 1995;  196 33-41
• 42 Neviaser T J. The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder.  Arthroscopy. 1993;  9 17-21
• 43 Perthes G. Uber operationen bei habitueller schulterluxation.  Deutsch Z Chir. 1906;  85 199-227
• 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
• 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
• 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
• 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
• 48 Warner J J, Beim G M. Combined Bankart and HAGL lesion associated with anterior shoulder instability.  Arthroscopy. 1997;  13 749-752
• 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
• 50 Neviaser T J. The GLAD lesion: another cause of anterior shoulder pain.  Arthroscopy. 1993;  9 22-23
• 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
• 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
• 53 Bennett G E. Shoulder and elbow lesions of the professional baseball pitcher.  JAMA. 1941;  117 510-514
• 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
• 55 Steinbach L S, Tirman P FJ, Peterfy C A, Feller J. Shoulder Magnetic Resonance Imaging. Philadelphia; Lippincott-Raven 1998
• 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
• 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
• 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
• 59 Jobe C M. Posterior superior glenoid impingement: expanded spectrum.  Arthroscopy. 1995;  11 530-536
• 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
• 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
• 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
• 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
• 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
• 65 Fritz R, Helms C A, Steinbach L S et al.. MR imaging of suprascapular nerve entrapment.  Radiology. 1992;  182 437-444
• 66 Sanders T G, Tirman P FJ. Paralabral cyst: an unusual cause of quadrilateral space syndrome.  Arthroscopy. 1999;  15 632-637
• 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