The document describes various structures of the shoulder joint that provide stability, including the labrum, biceps tendon, and glenohumeral ligaments. It discusses common labral injuries like SLAP tears and Bankart lesions caused by anterior dislocation of the humeral head. It also describes variants like Buford complex and sublabral recesses that should not be confused with pathology.
Anatomy and imaging of wrist joint (MRI AND XRAY)Kajal Jha
Anatomy and imaging of wrist joint (xray and MRI).
this ppt was made as the class presentation by Kajal Jha as the part of the course of BSC MIT at BPKIHS,Dharan . It covers the part of syllabus of third year of BSC MIT of this institution.
MRI imaging of knee joint -- from radiological anatomy to pathology. inspired from my dear professor Mamdouh Mahfouz, professor of radio diagnosis - Cairo university.
Anatomy and imaging of wrist joint (MRI AND XRAY)Kajal Jha
Anatomy and imaging of wrist joint (xray and MRI).
this ppt was made as the class presentation by Kajal Jha as the part of the course of BSC MIT at BPKIHS,Dharan . It covers the part of syllabus of third year of BSC MIT of this institution.
MRI imaging of knee joint -- from radiological anatomy to pathology. inspired from my dear professor Mamdouh Mahfouz, professor of radio diagnosis - Cairo university.
Shoulder Mri Scan in Delhi by Dr Shekhar ShrivastavDelhiArthroscopy
Shoulder MRI Scan in Delhi,Shoulder MRI Scan,Shoulder MRI Delhi by Dr Shekhar Shrivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
Details at http://www.delhiarthroscopy.com/
Walif Chbeir provides an in-depth look at labral variants and the analysis of CT and MRI scans on patients.
In this article, we discuss, describe and illustrate the normal anatomic variants of the glenoid labrum, the Biceps labral complex and of the gleno-humeral Ligaments as well as their differenciation of some labral tears with wich they could be easily confused. From this perspective, Resonance Magnetic Imaging Pitfalls are also described.
Appendicular trauma refers to injuries or damage sustained to the appendicular skeleton, which includes the bones of the upper and lower extremities (arms and legs) as well as the pelvis. These injuries can result from various causes such as accidents, falls, sports-related incidents, or direct blows.
Do it-yourself-paeds-ortho (Paediatric Orthopaedics for beginners)Jonathan Cheah
This is a powerpoint developed by the consultants from the mater children's hospital brisbane emergency department (which has now amalgamated with the royal children's hospital to create the brand new Lady Cilento Children's Hospital LCCH)
This is ideal for medical students/ residents to use to learn paediatrics orthopaedics.
Easy and fun to go through.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
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2. The glenohumeral joint has the
following supporting structures:
Superiorly
coracoacromial arch and
coracoacromial ligament
long head of the biceps tendon
tendon of the supraspinatus muscle
Anteriorly
anterior labrum
glenohumeral ligaments - SGHL, MGHL, IGHL (anterior band)
subscapularis tendon
Posteriorly
posterior labrum
posterior band of the IGHL
infraspinatus and teres minor tendon
3. Glenoid Labrum
The glenoid labrum is a fibrocartilaginous structure that
attaches to the glenoid rim and is about 4 mm wide.
The labrum may show considerable variation in shape and in
mechanism of attachment to the glenoid. It is usually rounded
or triangular on cross-sectional images.
4. Biceps Tendon
The tendon of the long head of the biceps muscle attaches to the
anterosuperior aspect of the glenoid rim.
The attachment of the biceps tendon may demonstrate four components,
including fibers that attach to the anterosuperior labrum, the
posterosuperior labrum, the supraglenoid tubercle, and the base of the
coracoid process.
From its site of attachment, the biceps tendon courses laterally and exits
the glenohumeral joint through the intertubercular groove, where it is
secured by the transverse ligament.
5. coronal section obtained at the level of the labral-bicipital complex illustrates the
biceps tendon (B), superior labrum (L), and glenoid cartilage (C), all of which are
intimately related in this region.
biceps tendon attachment at the level of the superior labrum and glenoid illustrates
attachments to the superior glenoid rim (1), the posterior (2) and anterior (3) labrum, and
the base of the coracoid process (4).
6. Glenohumeral Ligaments
Superior Glenohumeral Ligament.—
The glenohumeral ligaments play a role as shoulder stabilizers and consist of
thickened bands of the joint capsule.
The superior glenohumeral ligament is the most consistently identified capsular
ligament. It can arise from the anterosuperior labrum, the attachment of the
tendon of the long head of the biceps
muscle, or the middle glenohumeral
ligament.
7. Middle Glenohumeral Ligament.—
The middle glenohumeral ligament varies most in size and site of attachment to
the glenoid.
It may attach to the superior portion of the anterior glenoid labrum but more
frequently attaches medially on the glenoid neck.
The middle glenohumeral ligament may be absent or may appear thick and
cordlike (as, for example, in Buford complex).
CT arthrogram (2-mm section thickness) shows the middle glenohumeral ligament
(arrowhead) attached to the anterior labrum (arrow).
8. Transverse fat-saturated MR arthrogram (560/14) demonstrates the middle
glenohumeral ligament attaching medially on the glenoid neck (arrow).
9. Absent middle glenohumeral ligament in a 40-year-old woman. CT arthrogram (2-
mm section thickness) demonstrates absence of the middle glenohumeral
ligament (*) and a wide anterior joint recess (arrowheads).
10. Inferior Glenohumeral Ligament.—
The inferior glenohumeral ligament is an important stabilizer of the anterior
shoulder joint and consists of the axillary pouch and anterior and posterior
bands.
The anterior band inserts along the inferior two-thirds of the anterior glenoid
labrum. When redundant, it may overlap the anterior edge of the glenoid
cartilage.
The anterior band is usually quite prominent, although in approximately 25%
of cases it is very thin.
The posterior band is usually thinner than the anterior band.
11. Sagittal fat-saturated T1-weighted MR
arthrogram (750/15) demonstrates the biceps
tendon (t), subscapularis tendon (S), and anterior
and posterior bands of the inferior glenohumeral
ligament (arrows).
CORONAL
12. Labral variants
There are many labral variants.
These normal variants are all located in the 11-3 o'clock position.
13. It is important to recognize these variants, because they can mimick a
SLAP tear.
These normal variants will usually not mimick a Bankart-lesion, since it is
located at the 3-6 o'clock position, where these normal variants do not
occur.
However labral tears may originate at the 3-6 o'clock position and
subsequently extend superiorly.
14. Sublabral recess
There are 3 types of attachment of the superior labrum at the 12 o'clock
position where the biceps tendon inserts.
In type I there is no recess between the glenoid cartilage and the labrum.
In type II there is a small recess.
In type III there is a large sublabral recess.
This sublabral recess can be difficult to distinguish from a SLAP-tear or a
sublabral foramen.
16. Type I labral ---On a coronal MR arthrogram , the
labrum (black arrow) is tightly attached to the
glenoid cartilage and biceps tendon (white arrow)
Type II labral attachment. Coronal fat-saturated T1-
weighted MR arthrogram shows a small recess
between the labrum and the glenoid cartilage (arrow).
Type III labral attachment ----coronal CT
arthrogram shows a large recess between
the labrum and the glenoid (arrow).
17. Sublabral Foramen
A sublabral foramen or sublabral hole is an unattached anterosuperior
labrum at the 1-3 o'clock position.
It is seen in 11% of individuals.
On a MR-arthtrogram a sublabral
foramen should not be confused
with a sublabral recess or SLAP-tear,
which are also located in this region.
A sublabral recess however is located
at the site of the attachment of the
biceps tendon at 12 o'clock and does
not extend to the 1-3 o?lock position.
A SLAP tear may extend to the 1-3 o'
clock position, but the attachment of
the biceps tendon to the superior
labrum should always be involved.
18. notice the unattached labrum at the 12-3 o'clock position at the site of the sublabral
foramen. Notice the smooth borders unlike the margins of a SLAP-tear.
19. Buford complex
A Buford complex is a congenital labral variant.
The anterosuperior labrum is absent in the 1-3 o'clock position and the
middle glenohumeral ligament is usually thickened.
It is present in approximately 1.5% of individuals.
20. On these axial images a Buford complex can be identified.
The anterior labrum is absent in the 1-3 o'clock position and there is a thickened
middle GHL.
The thickened middle GHL should not be confused with a displaced labrum.
It should always be possible to trace the middle GHL upwards to the glenoid rim and
downwards to the humerus.
23. Labral pathology
A Clockwise approach to the labrum is the easiest way to diagnose labral
tears and to differentiate them from normal labral variants.
There are two types of labral tears: SLAP tears and Bankart lesions.
SLAP is an acronym that stands for 'Superior Labral tear from Anterior to Posterior'.
SLAP tears start at the 12 o'clock position where the biceps anchor is located, which
tears the labrum off the glenoid.
SLAP tears typically extend from the 10 to the 2 o'clock position, but can extend
more posteriorly or anteriorly and even extend into the biceps tendon.
Bankart lesions are typically located in the 3-6 o'clock position because that's where
the humeral head dislocates.
24. Dislocation
Anterior dislocation
The shoulder is a very mobile and therefore unstable joint.
The humeral head is almost always displaced anteriorly, inferiorly and medially
below the coracoid process (95% of cases).
Motion to superior is limited by the acromion, coracoid process and rotator cuff
(figure).
Motion in a posterior direction is limited by the posterior rim of the glenoid which is
in an anteverted position.
25. The dislocation of the humeral head to antero-inferior causes damage to the antero-
inferior rim of the glenoid in the 3 - 6 o'clock position (marked in red).
Especially in younger patients this results in a Bankart fracture or a Bankart lesion
which is a tear of the anteroinferior labrum.
This results in instability and recurrent dislocations.
27. Hill-Sachs
On MR a Hill-Sachs defect is seen at or above the level of the coracoid
process.
Hill-Sachs is a posterolateral depression of the humeral head.
It is above or at the level of the coracoid in the first 18 mm of the proximal
humeral head.
It is seen in 75-100% of patients with anterior instability.
It is chondral or osteochondral.
28. Bankart and variants
Bankart-lesions and variants like Perthes and ALPSA are injuries to the anteroinferior
labrum.
These injuries are always located in the 3-6 o'clock position because they are caused by
an anterior-inferior dislocation.
29. Bankart lesion
Bankart lesions are labral tears without an osseus fragment.
MR arthrography or arthroscopy are optimal to diagnose Bankart or Bankart-like
lesions.
There is a detachment of the anteroinferior labrum (3-6 o'clock) with complete
tearing of the anterior scapular periosteum.
The arrow points to the disrupted periosteum.
30. On MR-athrography the labrum is missing on the anterior glenoid and the labral
fragment is displaced anteriorly (arrow).
31. Osseus Bankart
Bankart lesions with an osseus fragment are common findings in patients with an
anterior dislocation and are frequently seen on the x-rays or CT-scan.
32. On MR-arthrography it may be difficult to depict the osseus fragment.
On CT it is easy to appreciate the osseus fragment of the anterior glenoid (arrow).
33. Reverse Bankart
CT-images in another patient show a reversed osseus Bankart in a patient with
posterior dislocation.
Axial MR-arthrogram of a reverse Bankart.
34. Perthes lesion
A Perthes lesion is a labroligamentous avulsion like a Bankart, but with a medially
stripped intact periosteum.
On images of the shoulder with the arm in a neutral position, the torn labrum may
be held in its normal anatomic position by the intact scapular periosteum, which
thereby prevents contrast media from entering the tear.
This means that MR-arthrography
with the arm in the neutral position
may fail to detect the labral tear.
35. In the ABER-position it is obvious that there is a Perthes lesion (black arrow).
Due to the ABER-position the anterior band of the inferior GHL creates tension
on the anteroinferior labrum and contrast fills the tear.
In the ABER position however there is tension on the antero-inferior labrum by
the stretched anterior band of the inferior glenohumeral ligament and you have
more chance to detect the tear.
The arrow points to the intact periosteum.
36.
37. ALPSA
An ALPSA-lesion is an Anterior Labral Periosteal Sleeve Avulsion.
The anterior labrum is absent on the glenoid rim.
The arrow points to the medially displaced labroligamentous
complex.
38. Images of a patient with an ALPSA-lesion.
Notice the medially displaced labrum.
40. GLAD
A GLAD-lesion is a GlenoLabral Articular Disruption.
It represents a patial tear of the anteroinferior labrum with adjacent
cartilage damage.
The arrow points to the cartilage defect.
41. The images show a partial tear of the anteroinferior labrum
with adjacent cartilage damage at the 4-6 o 'clock position
(arrows).
GLAD-lesion
42. Defect is at the base of the labrum, predominantly in the glenoid articular
hyaline cartilage.
43. HAGL is a Humeral Avulsion of the inferior Glenohumeral Ligament.
There is discontinuity of the IGHL attachment on the humerus with
leakage of contrast.
HAGL