Semin Musculoskelet Radiol 2022; 26(05): 546-557
DOI: 10.1055/s-0042-1756168
Review Article

Anterior Shoulder Instability

Holly W. Christopher
1   Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
,
1   Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
› Author Affiliations

Abstract

The anatomy of the glenohumeral joint prioritizes mobility at the expense of stability and thus predisposes it to injury through dislocation. This article discusses the anatomical basis for instability and how it translates into patterns of injury, focusing on anterior instability. We suggest an approach to imaging the unstable shoulder and examine the imaging features seen in the context of anterior instability, along with consideration of postoperative appearances.



Publication History

Article published online:
19 December 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Wischer TK, Bredella MA, Genant HK, Stoller DW, Bost FW, Tirman PF. Perthes lesion (a variant of the Bankart lesion): MR imaging and MR arthrographic findings with surgical correlation. AJR Am J Roentgenol 2002; 178 (01) 233-237
  • 2 Robinson PM, Wilson J, Dalal S, Parker RA, Norburn P, Roy BR. Rotator cuff repair in patients over 70 years of age: early outcomes and risk factors associated with re-tear. Bone Joint J 2013; 95-B (02) 199-205
  • 3 Gombera MM, Sekiya JK. Rotator cuff tear and glenohumeral instability: a systematic review. Clin Orthop Relat Res 2014; 472 (08) 2448-2456
  • 4 Abballe VD, Walter WR, Lin DJ, Alaia MJ, Alaia EF. Anterior shoulder instability in the aging population: MRI injury pattern and management. AJR Am J Roentgenol 2021; 216 (05) 1300-1307
  • 5 Magee T. 3-T MRI of the shoulder: is MR arthrography necessary?. AJR Am J Roentgenol 2009; 192 (01) 86-92
  • 6 Saleem AM, Lee JK, Novak LM. Usefulness of the abduction and external rotation views in shoulder MR arthrography. AJR Am J Roentgenol 2008; 191 (04) 1024-1030
  • 7 Charousset C, Bellaïche L, Duranthon LD, Grimberg J. Accuracy of CT arthrography in the assessment of tears of the rotator cuff. J Bone Joint Surg Br 2005; 87 (06) 824-828
  • 8 Rafii M, Minkoff J. Advanced arthrography of the shoulder with CT and MR imaging. Radiol Clin North Am 1998; 36 (04) 609-633
  • 9 Rafii M, Minkoff J, Bonamo J. et al. Computed tomography (CT) arthrography of shoulder instabilities in athletes. Am J Sports Med 1988; 16 (04) 352-361
  • 10 Breighner RE, Endo Y, Konin GP, Gulotta LV, Koff MF, Potter HG. Technical developments: zero echo time imaging of the shoulder: enhanced osseous detail by using MR imaging. Radiology 2018; 286 (03) 960-966
  • 11 Bui-Mansfield LT, Taylor DC, Uhorchak JM, Tenuta JJ. Humeral avulsions of the glenohumeral ligament: imaging features and a review of the literature. AJR Am J Roentgenol 2002; 179 (03) 649-655
  • 12 Pouliart N, Gagey O. Concomitant rotator cuff and capsuloligamentous lesions of the shoulder: a cadaver study. Arthroscopy 2006; 22 (07) 728-735
  • 13 Gyftopoulos S, Carpenter E, Kazam J, Babb J, Bencardino J. MR imaging of subscapularis tendon injury in the setting of anterior shoulder dislocation. Skeletal Radiol 2012; 41 (11) 1445-1452
  • 14 Burkhart SS, De Beer JF. 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 2000; 16 (07) 677-694
  • 15 Griffith JF, Antonio GE, Yung PS. et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. AJR Am J Roentgenol 2008; 190 (05) 1247-1254
  • 16 Shin SJ, Kim RG, Jeon YS, Kwon TH. Critical value of anterior glenoid bone loss that leads to recurrent glenohumeral instability after arthroscopic Bankart repair. Am J Sports Med 2017; 45 (09) 1975-1981
  • 17 Gyftopoulos S, Beltran LS, Bookman J, Rokito A. MRI evaluation of bipolar bone loss using the on-track off-track method: a feasibility study. AJR Am J Roentgenol 2015; 205 (04) 848-852
  • 18 Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 2014; 30 (01) 90-98
  • 19 Itoi E, Yamamoto N, Kurokawa D, Sano H. Bone loss in anterior instability. Curr Rev Musculoskelet Med 2013; 6 (01) 88-94
  • 20 Walter WR, Samim M, LaPolla FWZ, Gyftopoulos S. Imaging quantification of glenoid bone loss in patients with glenohumeral instability: a systematic review. AJR Am J Roentgenol 2019 March 5 (Epub ahead of print)
  • 21 Woertler K. Multimodality imaging of the postoperative shoulder. Eur Radiol 2007; 17 (12) 3038-3055
  • 22 Wagner SC, Schweitzer ME, Morrison WB, Fenlin Jr JM, Bartolozzi AR. Shoulder instability: accuracy of MR imaging performed after surgery in depicting recurrent injury—initial findings. Radiology 2002; 222 (01) 196-203
  • 23 de Mello RAF, Ma YJ, Ashir A. et al. Three-dimensional zero echo time magnetic resonance imaging versus 3-dimensional computed tomography for glenoid bone assessment. Arthroscopy 2020; 36 (09) 2391-2400
  • 24 Stillwater L, Koenig J, Maycher B, Davidson M. 3D-MR vs. 3D-CT of the shoulder in patients with glenohumeral instability. Skeletal Radiol 2017; 46 (03) 325-331
  • 25 Green GL, Arnander M, Pearse E, Tennent D. CT estimation of glenoid bone loss in anterior glenohumeral instability: a systematic review of existing techniques. Bone Jt Open 2022; 3 (02) 114-122
  • 26 Provencher MT, Bhatia S, Ghodadra NS. et al. Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am 2010; 92 (Suppl. 02) 133-151