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Wk 5, Case 4, Shoulder MR - Review

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I'll try to do these last two together. Uh,

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it's kind of the same flavor of, uh, anterior glenohumeral joint instability,

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which, you know, as we are aware, big topic, right?

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Because the shoulder, um, you know,

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the most mobile joint in the body, but, uh, with that mobility, it confers,

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uh, risk of instability. So, as we know, uh, you know, the, uh,

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the shoulder is the most common joint in the body to dislocate.

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95% of the time it's gonna be anteriorly, right? And so in this case, uh,

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the, the point of, uh, this case was to show,

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um, specifically the, uh,

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injury to the inferior glenohumeral ligament complex. Okay?

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So there's three components to the inferior glenohumeral ligament complex, okay?

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And that is the anterior band, the axillary pouch,

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and the posterior van, okay? And, um,

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there's all sorts of, uh, flavors of injuries to the, uh,

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inferior glenohumeral ligament complex. So, but you can see here that, uh,

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you know, there's some thinning and,

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and prior tear at the humeral insertion of the

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axillary pouch, uh, and, uh, potentially portions here of the, uh,

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anterior band, uh, compatible with a, uh,

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so-called haal lesion or, uh, uh, humeral avulsion of the, uh,

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glenohumeral, uh, inferior glenohumeral ligament complex here. Okay? And,

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you know, there can be a bony avulsion, uh, associated with, uh, with it,

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in which case you call it AAB hagel or a bony humeral avulsion. Uh,

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you could have a failure at the glenoid attachment, in which case, you know,

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that's called a, a gaggle or gigle, GAGL.

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You can have a bony of ocean with that, in which case it's called AB hagel,

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or AB gle, right? Uh, or you could even have failure on both sides, right?

2:01

Which is, uh, basically like a, a floating, uh, uh,

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inferior gland humeral ligament complex. Okay? So that's, uh, the finding there.

2:11

Okay? That's, that's probably an important one.

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And then the other thing is obviously that this, uh, you know, in our, this,

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uh, anterior labrum is also torn as we can see here with this, uh,

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uh, near fluid bright, uh, signal, uh, involving that, uh, labrum there.

Report

Patient History

Clinical concern for labral lesion

Findings

ROTATOR CUFF: No tendinosis or tears. Normal muscle girdle.

SUBACROMIAL/SUBDELTOID BURSA:No bursitis.

MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Normal muscle girdle.

BICEPS TENDON: Intact.

AC JOINT: Intact.

CORACOCLAVICULAR LIGAMENTS: Normal.

SUBACROMIAL ARCH/OUTLET: Type 2/curved acromion without downsloping.

SUBCORACOID ARCH: Normal. No narrowing.

GLENOHUMERAL JOINT: No arthropathy. Trace effusion.

GLENOID LABRUM: Stripping of the anteroinferior labrum involving the 3-6 o'clock positions. No Bankart lesions.

BONES: No intramedullary lesions. No fracture or dislocations.

SUBCUTANEOUS SOFT TISSUES: Focal tear at the humeral insertion of the axillary and anterior bands of the inferior glenohumeral ligament (IGHL). Stripping of the middle glenohumeral ligament (MGHL).

AXILLA: Mild inflammatory changes at the axillary pouch. No space-occupying lesions.

Impressions

1. Focal tears at the humeral attachment of the anterior and axillary bands of the inferior glenohumeral ligament (HAGL). No avulsion fractures are identified.

2. Stripping without displacement of the anteroinferior labrum. No paralabral cysts.

Case Discussion

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Gitanjali Bajaj, MD

Assistant Professor

University of Arkansas for Medical Sciences

Edward Smitaman, MD

Clinical Associate Professor

University of California San Diego

Brian Y. Chan, MD

Assistant Professor of Musculoskeletal Radiology

University of Utah

Todd D. Greenberg, MD

Radiologist

ProScan

Tags

Shoulder

Musculoskeletal (MSK)

MRI