Download PDF
Semin Musculoskelet Radiol 2022; 26(05): 558-565
DOI: 10.1055/s-0042-1754365
Review Article

Imaging Posterior Instability of the Shoulder

Gajan Rajeswaran
1   Department of Imaging, OneWelbeck Imaging & Diagnostics, London, United Kingdom
,
Subhasis Basu
2   Department of Imaging, Wrightington Hospital, Wigan, Lancashire, United Kingdom
,
Lennard Funk
3   Department of Orthopaedics, Wrightington Hospital, Wigan, Lancashire, United Kingdom
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Posterior instability of the shoulder is much less common than anterior instability with a clinical presentation that is often less obvious, making the diagnosis more challenging and more easily missed. We describe the imaging findings of posterior instability so the radiologist can make the diagnosis and provide a detailed description, enabling the surgeon to make more informed decisions regarding management and surgery.

Keywords

shoulder - imaging - instability - posterior - reverse


Publication History

Article published online:
19 December 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Drake RL, Vogl AW, Mitchell AWM. Gray's Anatomy for Students. 4th ed.. Philadelphia: PA: Elsevier; 2019
  • 2 De Coninck T, Ngai SS, Tafur M, Chung CB. Imaging the glenoid labrum and labral tears. Radiographics 2016; 36 (06) 1628-1647
    CrossrefPubMedGoogle Scholar
  • 3 Antoniou J, Duckworth DT, Harryman II DT. Capsulolabral augmentation for the management of posteroinferior instability of the shoulder. J Bone Joint Surg Am 2000; 82 (09) 1220-1230
    CrossrefPubMedGoogle Scholar
  • 4 Boyd HB, Sisk TD. Recurrent posterior dislocation of the shoulder. J Bone Joint Surg Am 1972; 54 (04) 779-786
    CrossrefPubMedGoogle Scholar
  • 5 McLaughlin HL. Posterior dislocation of the shoulder. J Bone Joint Surg Am 1952; 24 A (03) 584-590
    CrossrefPubMedGoogle Scholar
  • 6 Bottoni CR, Franks BR, Moore JH, DeBerardino TM, Taylor DC, Arciero RA. Operative stabilization of posterior shoulder instability. Am J Sports Med 2005; 33 (07) 996-1002
    CrossrefPubMedGoogle Scholar
  • 7 Sconfienza LM, Albano D, Messina C, Silvestri E, Tagliafico AS. How, when, why in magnetic resonance arthrography: an International Survey by the European Society of Musculoskeletal Radiology (ESSR). Eur Radiol 2018; 28 (06) 2356-2368
    CrossrefPubMedGoogle Scholar
  • 8 Beltran J, Bencardino J, Mellado J, Rosenberg ZS, Irish RD. MR arthrography of the shoulder: variants and pitfalls. Radiographics 1997; 17 (06) 1403-1412 ; discussion 1412–1415
    CrossrefPubMedGoogle Scholar
  • 9 Chloros GD, Haar PJ, Loughran TP, Hayes CW. Imaging of glenoid labrum lesions. Clin Sports Med 2013; 32 (03) 361-390
    CrossrefPubMedGoogle Scholar
  • 10 Sheridan K, Kreulen C, Kim S, Mak W, Lewis K, Marder R. Accuracy of magnetic resonance imaging to diagnose superior labrum anterior-posterior tears. Knee Surg Sports Traumatol Arthrosc 2015; 23 (09) 2645-2650
    CrossrefPubMedGoogle Scholar
  • 11 Bencardino JT, Beltran J, Rosenberg ZS. et al. Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder. Radiology 2000; 214 (01) 267-271
    CrossrefPubMedGoogle Scholar
  • 12 Major NM, Browne J, Domzalski T, Cothran RL, Helms CA. Evaluation of the glenoid labrum with 3-T MRI: is intraarticular contrast necessary?. AJR Am J Roentgenol 2011; 196 (05) 1139-1144
    CrossrefPubMedGoogle Scholar
  • 13 Magee T. 3-T MRI of the shoulder: is MR arthrography necessary?. AJR Am J Roentgenol 2009; 192 (01) 86-92
    CrossrefPubMedGoogle Scholar
  • 14 Smith TO, Drew BT, Toms AP. A meta-analysis of the diagnostic test accuracy of MRA and MRI for the detection of glenoid labral injury. Arch Orthop Trauma Surg 2012; 132 (07) 905-919
    CrossrefPubMedGoogle Scholar
  • 15 Currarino G, Sheffield E, Twickler D. Congenital glenoid dysplasia. Pediatr Radiol 1998; 28 (01) 30-37
    CrossrefPubMedGoogle Scholar
  • 16 Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. Skeletal Radiol 2000; 29 (04) 204-210
    CrossrefPubMedGoogle Scholar
  • 17 Harper KW, Helms CA, Haystead CM, Higgins LD. Glenoid dysplasia: incidence and association with posterior labral tears as evaluated on MRI. AJR Am J Roentgenol 2005; 184 (03) 984-988
    CrossrefPubMedGoogle Scholar
  • 18 Abboud JA, Bateman DK, Barlow J. Glenoid dysplasia. J Am Acad Orthop Surg 2016; 24 (05) 327-336
    CrossrefPubMedGoogle Scholar
  • 19 Albano D, Messina C, Sconfienza LM. Posterior shoulder instability: what to look for. Magn Reson Imaging Clin N Am 2020; 28 (02) 211-221
    CrossrefPubMedGoogle Scholar
  • 20 Wirth MA, Lyons FR, Rockwood Jr CA. Hypoplasia of the glenoid. A review of sixteen patients. J Bone Joint Surg Am 1993; 75 (08) 1175-1184
    CrossrefPubMedGoogle Scholar
  • 21 Owens BD, Campbell SE, Cameron KL. Risk factors for posterior shoulder instability in young athletes. Am J Sports Med 2013; 41 (11) 2645-2649
    CrossrefPubMedGoogle Scholar
  • 22 Budge MD, Lewis GS, Schaefer E, Coquia S, Flemming DJ, Armstrong AD. Comparison of standard two-dimensional and three-dimensional corrected glenoid version measurements. J Shoulder Elbow Surg 2011; 20 (04) 577-583
    CrossrefPubMedGoogle Scholar
  • 23 Daggett M, Werner B, Gauci MO, Chaoui J, Walch G. Comparison of glenoid inclination angle using different clinical imaging modalities. J Shoulder Elbow Surg 2016; 25 (02) 180-185
    CrossrefPubMedGoogle Scholar
  • 24 Scalise JJ, Codsi MJ, Bryan J, Brems JJ, Iannotti JP. The influence of three-dimensional computed tomography images of the shoulder in preoperative planning for total shoulder arthroplasty. J Bone Joint Surg Am 2008; 90 (11) 2438-2445
    CrossrefPubMedGoogle Scholar
  • 25 Sharifi A, Siebert MJ, Chhabra A. How to measure glenoid bone stock and version and why it is important: a practical guide. Radiographics 2020; 40 (06) 1671-1683
    CrossrefPubMedGoogle Scholar
  • 26 Rouleau DM, Kidder JF, Pons-Villanueva J, Dynamidis S, Defranco M, Walch G. Glenoid version: how to measure it? Validity of different methods in two-dimensional computed tomography scans. J Shoulder Elbow Surg 2010; 19 (08) 1230-1237
    CrossrefPubMedGoogle Scholar
  • 27 Friedman RJ, Hawthorne KB, Genez BM. The use of computerized tomography in the measurement of glenoid version. J Bone Joint Surg Am 1992; 74 (07) 1032-1037
    CrossrefPubMedGoogle Scholar
  • 28 Shah N, Tung GA. Imaging signs of posterior glenohumeral instability. AJR Am J Roentgenol 2009; 192 (03) 730-735
    CrossrefPubMedGoogle Scholar
  • 29 Meyer DC, Ernstbrunner L, Boyce G, Imam MA, El Nashar R, Gerber C. Posterior acromial morphology is significantly associated with posterior shoulder instability. J Bone Joint Surg Am 2019; 101 (14) 1253-1260
    CrossrefPubMedGoogle Scholar
  • 30 Howell SM, Galinat BJ. The glenoid-labral socket. A constrained articular surface. Clin Orthop Relat Res 1989; (243) 122-125
    PubMedGoogle Scholar
  • 31 Bencardino JT, Beltran J. MR imaging of the glenohumeral ligaments. Radiol Clin North Am 2006; 44 (04) 489-502 , vii
    CrossrefPubMedGoogle Scholar
  • 32 Gustas CN, Tuite MJ. Imaging update on the glenoid labrum: variants versus tears. Semin Musculoskelet Radiol 2014; 18 (04) 365-373
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Nourissat G, Radier C, Aim F, Lacoste S. Arthroscopic classification of posterior labrum glenoid insertion. Orthop Traumatol Surg Res 2014; 100 (02) 167-170
    CrossrefPubMedGoogle Scholar
  • 34 McCauley TR. MR imaging of the glenoid labrum. Magn Reson Imaging Clin N Am 2004; 12 (01) 97-109 , vi–vii
    CrossrefPubMedGoogle Scholar
  • 35 Fitzpatrick D, Grubin J. Navigating the alphabet soup of labroligamentous pathology of the shoulder. Am J Orthop 2016; 45 (02) 58-60
    PubMedGoogle Scholar
  • 36 Harish S, Nagar A, Moro J, Pugh D, Rebello R, O'Neill J. Imaging findings in posterior instability of the shoulder. Skeletal Radiol 2008; 37 (08) 693-707
    CrossrefPubMedGoogle Scholar
  • 37 Farshad-Amacker NA, Jain Palrecha S, Farshad M. The primer for sports medicine professionals on imaging: the shoulder. Sports Health 2013; 5 (01) 50-77
    CrossrefPubMedGoogle Scholar
  • 38 Kim SH, Ha KI, Yoo JC, Noh KC. Kim's lesion: an incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy 2004; 20 (07) 712-720
    CrossrefPubMedGoogle Scholar
  • 39 Chung CB, Sorenson S, Dwek JR, Resnick D. Humeral avulsion of the posterior band of the inferior glenohumeral ligament: MR arthrography and clinical correlation in 17 patients. AJR Am J Roentgenol 2004; 183 (02) 355-359
    CrossrefPubMedGoogle Scholar
  • 40 Magnani MJ, Warren RF. Stabilizers of the glenohumeral joint. J Shoulder Elbow Surg 1994; 3 (03) 173-190
    CrossrefPubMedGoogle Scholar
  • 41 Brown T, Barton RS, Savoie III FH. Reverse humeral avulsion glenohumeral ligament and infraspinatus rupture with arthroscopic repair: a case report. Am J Sports Med 2007; 35 (12) 2135-2139
    CrossrefPubMedGoogle Scholar
  • 42 Rebolledo BJ, Nwachukwu BU, Konin GP, Coleman SH, Potter HG, Warren RF. Posterior humeral avulsion of the glenohumeral ligament and associated injuries: assessment using magnetic resonance imaging. Am J Sports Med 2015; 43 (12) 2913-2917
    CrossrefPubMedGoogle Scholar
  • 43 Maalouly J, Aouad D, Ayoubi R, Dib N, El Rassi G. Posterior shoulder instability due to isolated reverse HAGL lesion in a young gymnast: a rare mechanism of injury and surgical technique. Trauma Case Rep 2020; 28: 100312
    CrossrefPubMedGoogle Scholar
  • 44 Ferrari JD, Ferrari DA, Coumas J, Pappas AM. Posterior ossification of the shoulder: the Bennett lesion. Etiology, diagnosis, and treatment. Am J Sports Med 1994; 22 (02) 171-175 ; discussion 175–176
    CrossrefPubMedGoogle Scholar
  • 45 Galvin JW, Parada SA, Li X, Eichinger JK. Critical findings on magnetic resonance arthrograms in posterior shoulder instability compared with an age-matched controlled cohort. Am J Sports Med 2016; 44 (12) 3222-3229
    CrossrefPubMedGoogle Scholar
  • 46 Dewing CB, McCormick F, Bell SJ. et al. An analysis of capsular area in patients with anterior, posterior, and multidirectional shoulder instability. Am J Sports Med 2008; 36 (03) 515-522
    CrossrefPubMedGoogle Scholar
  • 47 Harryman II DT, Sidles JA, Clark JM, McQuade KJ, Gibb TD, Matsen III FA. Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am 1990; 72 (09) 1334-1343
    CrossrefPubMedGoogle Scholar
  • 48 Blasier RB, Soslowsky LJ, Malicky DM, Palmer ML. Posterior glenohumeral subluxation: active and passive stabilization in a biomechanical model. J Bone Joint Surg Am 1997; 79 (03) 433-440
    CrossrefPubMedGoogle Scholar