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Posterior Labral Tear

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Topic updated on 11/05/13 1:51am
Introduction
  • Commonly referred to as a reverse Bankart lesion
  • Epidemiology
    • demographics
      • may occur in all athletes due to trauma
      • most commonly occur in 
        • football linemen (blocking)
        • weightlifters (bench press) 
  • Pathophysiology
    • mechanism
      • usually from a posteriorly directed force with arm flexed, adducted, and internally rotated
  • Associated injuries
    • Kim lesion
      • is an incomplete and sometimes concealed avulsion of posterior labrum
Anatomy
  • Posterior labrum
    • function
      • helps create cavity-compression and creates 50% of the glenoid socket depth
      • provides posterior stability
    • anatomy
      • composed of fibrocartilagenous tissue
      • anchors posterior inferior glenohumeral ligament (PIGHL)
  • See complete Glenohumeral joint anatomy 
Presentation
  • Symptoms 
    • shoulder pain
    • sense of instability
    • mechanical symptoms (clicking, popping) with range of motion
  • Physical exam
    • posterior joint line tenderness
    • provocative tests
      • Posterior Load and Shift
      • Jerk test
        • subluxation with posteriorly applied force while arm is in flexion and internal rotation
      • Kim test
        • subluxation with posteriorly applied force as arm is dynamically adducted by examiner
Imaging
  • Radiographs
    • recommended views
      • complete shoulder series
    • findings
      • are often normal
  • MRI 
    • diagnostic study of choice
    • intra-articular contrast (MRI arthrogram) increases sensitivity for labral pathology
Treatment
  • Nonoperative
    • NSAIDs, PT
      • indications
        • first line of treatment
      • technique
        • rotator cuff strengthening and periscapular stabilization
  • Operative
    • posterior labral repair with capsulorrhaphy 
      • indications
        • extensive nonoperative management fails
      • technique
        • both open and arthroscopic techniques can be used
        • probing of posterior labrum is required to rule out a subtle Kim lesion 
Complications
  • Axillary nerve palsy
    • posterior branch of the axillary nerve is at risk during arthroscopic stabilization 
      • travels within 1 mm of the inferior shoulder capsule and glenoid rim
        • is at risk during suture passage at the posterior inferior glenoid
  • Overtightening of posterior capsule
    • can lead to anterior subluxation or coracoid impingement

 

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Qbank (2 Questions)

TAG
(OBQ11.152) A 20-year-old college football offensive lineman undergoes arthroscopic right shoulder surgery for the injury shown in Figure A. Post-operatively he complains of burning pain in the region marked in yellow on Figure B. Which of the following nerves was most likely injured during the procedure? Topic Review Topic
FIGURES: A   B        

1. Radial
2. Upper subscapular
3. Lower subscapular
4. Suprascapular
5. Axillary

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Cases

http://upload.orthobullets.com/cases/1339/ct1.jpg http://upload.orthobullets.com/cases/1339/ct2.jpg http://upload.orthobullets.com/cases/1339/ct3.jpg
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Esmail AN, Getz CL, Schwartz DM, Wierzbowski L, Ramsey ML, Williams GR
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Ball CM, Steger T, Galatz LM, Yamaguchi K
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