0:00

Now the Perthe lesion is slightly different.

0:04

It's an anterior labral avulsion with an intact periosteum,

0:09

no stripping of that periosteum or minimal stripping.

0:14

And so that labrum is either non-displaced

0:17

or minimally displaced.

0:19

So when you look at your standard planes,

0:22

you may not see much.

0:23

If you're lucky, you'll see a little abnormal signal here,

0:27

but it's in the a bear position abducted, externally rotated

0:31

where you put tension on that anterior band that you may

0:36

increase the degree of displacement.

0:38

So I tend to call a per face lesion

0:41

where the most dramatic abnormalities,

0:44

and particularly maybe the only abnormalities are in

0:48

the ABE projection.

0:49

Let me show you a couple of cases.

0:53

Here's what it looks like in this case.

0:54

You can see some stripping of

0:57

that anterior scapular periosteum, minimal displacement

1:01

of the labrum, but a lot of similarities to the acute ssa.

1:05

Here's what it looks like in the abducted,

1:08

externally rotated position, abnormal contrast right here

1:12

beneath the detached labrum.

1:14

That is a Perth phase lesion. Here's another one.

1:18

Now I can agree in this case that as I look at this,

1:22

there is abnormality in the uh, axial plane,

1:26

but it's in this ABE position where I see that better.

1:30

That to me would be more likely a Perth phase lesion

1:35

than an ole lesion.

1:37

But clearly there is an overlap.

1:38

Here's another one, A bear position, two different images.

1:43

You can see the detached labrum,

1:46

the strip periosteum,

1:48

although it's not stripped over a long distance,

1:51

this is a Perth lesion.

1:54

I wanted to show you this case to point out.

1:57

First, the difference between a perthe lesion shown here

2:01

and a soft tissue bankart lesion shown here with disruption

2:06

of the anterior scapular periosteum.

2:08

And then I want to indicate this is the same

2:10

patient, two different levels.

2:13

So I can tell you the morphology changes level

2:17

by level imaging plane by imaging plane, such

2:21

that sometimes it becomes difficult separating

2:24

out these lesions.

2:26

The final lesion

2:27

that I don't know if there's anything published on it,

2:29

but we've certainly seen it in a few patients,

2:33

is an ellipse lesion anterior ligamentous periosteal

2:37

sleeve avulsion.

2:38

Typically, in the three cases that I've seen,

2:41

it's been bilateral

2:42

and the patients have a feeling of slipping

2:45

of their Glen Al joints.

2:46

They all were young women who were athletes.

2:50

The abnormality appears to be a detachment of

2:53

that anter band from the labrum.

2:56

So the labrum is not torn,

2:59

It is not detached.

3:00

It is in fact stripping of the attachment

3:03

of the anterior band.

3:05

And this is what it looks like

3:07

shown best in the a bear position.

3:09

The arrow showing you the anterior band,

3:11

which is now attaching to bone, not to the labrum.

3:15

You can see the space between them

3:17

and the labrum is in normal position.

3:20

Now, you could argue, is this traumatic,

3:22

is this developmental?

3:24

I don't know. Now, there are a couple

3:27

of other miscellaneous lesions

3:29

that have recently been described at the glenoid site

3:32

of failure, and I've listed them here.

3:35

They all have these abbreviations in my mind.

3:38

Your orthopedic surgeon doesn't know any of them.

3:42

Glenoid articular, uh, or labral. Articular teardrop, glat.

3:46

There's a glass. There are two glass. There's a glaad.

3:49

The G glad I'm gonna talk about in the next lecture.

3:52

But what's occurring here is a flap of tissue

3:56

composed some cases only of cartilage

3:58

and other cases only of labrum

4:01

or of both cartilage and labrum.

4:03

And typically it's displaced downward into the aary pouch.

4:08

These patients may have macro instability

4:11

or micro instability.

4:12

Here's another example.

4:14

This one perhaps better called a glatt lesion.

4:18

Here you can see that there's a flap

4:20

of conroy tissue derived from the, an inferior aspect

4:24

of the glenoid, and it's rotated inferiorly.

4:28

And by the way, we call it a flap

4:31

because it's still attached at one end.

4:35

It is not a fragment.

4:36

Here's what might be called a glass lesion.

4:40

oid labral, articular flap.

4:42

This, these can be co composed of cartilage

4:46

or cartilage in labrum together.

4:48

And this is what they look like.