Labral injuries and traumatic instability
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Labral injuries and traumatic instability
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Labral injuries and traumatic instability
- 3. Anatomy • Circumferential structure • Histology: Fibro- cartilaginous: like the meniscus Shoulderdoc.co.uk
- 4. Antero-superior part • Loosely attached Cooper et al, JBJS 9(A) 1992
- 5. Superior Part Fibres of Labrum, blend into the biceps tendon and these attach into the supra-glenoid tubercle Cooper et al, JBJS 9(A) 1992
- 6. Biceps attachment Normal recess under the superior labrum Cooper et al, JBJS 9(A) 1992
- 7. Inferior part Firmly attached Cooper et al, JBJS 9(A) 1992
- 8. Vascularity • Periphery of labrum well vascularised • Antero-superior less vascularised than inferior • Originate from capsular/ periosteal vessels- none from bone Cooper et al, JBJS 9(A) 1992
- 9. Attachments • Anchor for Gleno-humeral ligaments Image courtesy: www.pitt.edu
- 10. Nerve endings • Proprioceptive and free nerve fibres in the GH ligaments and labrum • Mechanical disruption may lead to decreased propriocetion Vangness et al; Neural anatomy; Arthroscopy 1995
- 11. Function • Stability • Deepening the socket • Attachment of ligaments • Proprioception
- 12. Presentation • THE HISTORY • Mechanism of injury • Antero-inferior • Posterior • Superior • No discrete injury
- 13. Symptoms • Recurrent Dislocation • Apprehension • Loss of confidence • Pain
- 14. Examination • Antero-inferior labrum • Posterior labrum • Superior labrum • Laxity tests
- 15. Investigations • MR Arthrogram • CT Arthrogram
- 16. Injury Patterns Description Based on clock-face
- 17. Labral tear The Classic Bankart’s lesion
- 18. Injuries • Beware of variants • ALPSA • Perthes lesion • GLAD • GLOM • HAGL
- 19. Injuries • Beware of variants • ALPSA • Perthes lesion • GLAD • GLOM • HAGL
- 20. Injuries • Beware of variants • ALPSA • Perthes lesion • GLAD • GLOM • HAGL
- 21. Injuries • Beware of variants • ALPSA • Perthes lesion • GLAD • GLOM • HAGL Rowan et al, Clin Radiology, 2004
- 22. Injuries • Beware of variants • ALPSA • Perthes lesion • GLAD • GLOM • HAGL
- 23. SLAP tears Bedi, Clin Sports Med 2008
- 24. Management- Decision making Based on personality of the injury • Patient factors • Pathology • Clinician factors Patie nt Patho logy Clinic ian
- 25. Patient factors • Age • Level of play / season • Profession • Compliance • Expectations
- 26. Pathology • Level and duration of symptoms • Previous treatment • Associated injuries • Compensatory issues • Degree of Laxity
- 27. Clinician Factors • Physiotherapy team • Radiology service • Surgical team • Experience
- 28. Example 1 • 23 yr contact sports, likes scuba diving, one episode dislocation. MRA 2 to 6 o clock anterior labral lesion.
- 29. Example 2 • 32 year old, office worker, recreational tennis player, First episode of dislocation. MRA 2 to 6 o’ clock lesion
- 30. Example 3 • 30 year professional rugby player failed Labral repair done 5 years ago. Symptoms of instability. No bone loss on CT arthrogram. 2 to 6 o’clock lesion.
- 32. Repair • Key steps • Identify and define pathology • Release • Prepare bed • Repair • Test strength / stability
- 35. Summary; Message Thorough Assessment: Clinical, radiological and arthroscopic Individualised treatment