0:00

Now, there's a lot of reasons

0:02

for getting labral failure in the throwing shoulder.

0:06

I would just co comment on micro instability

0:09

and multi-directional instability, which lead

0:12

to capsular laxity

0:13

and I sh talked about this finding,

0:15

looking like a sub labral foramen typically occurring at two

0:19

or three o'clock associated with anterior micro instability

0:25

or multi-directional instability.

0:27

It's like a outsole occurring higher up with detachment

0:32

of a lesion of the labrum

0:34

and stripping of the scapular periosteum.

0:36

Here's another one with very, very similar findings,

0:41

and the reason it means you don't mistake this

0:44

for a sub labral frame, and it starts at around two

0:47

or three o'clock, not at 12 o'clock.

0:50

This brings us to another pattern of labral failure

0:54

that no is known as the GLAD lesion

0:59

OID Len Labral Articular Disruption.

1:03

Now, this was described years ago

1:06

as a lesion occurring anter

1:08

inferiorly involving articular cartilage and labrum,

1:12

and a lesion unassociated with instability.

1:16

Recent evidence suggests

1:18

that this can certainly be associated with macro instability

1:23

of the gonial joint.

1:24

And further you can get a similar lesion,

1:27

a GLAD lesion posteriorly.

1:30

But this is what the lesion initially indicated.

1:33

I'll just show you a lesion

1:35

of articular cartilage extending

1:38

transversely into the labrum.

1:40

Typically seen or most commonly seen an inferiorly.

1:45

So that's what it looks like pathologically.

1:48

This is what it might look like with an MR arthrogram,

1:51

the arrow showing you that there's a horizontal labral tear

1:56

and you can see the loss of articular cartilage nearby.

2:00

And here's another one in the AVE position,

2:04

showing you the problems in the articular cartilage

2:07

extending transversely into the

2:10

antral inferior labrum.

2:12

This would be a GLAD lesion.