D

Fig. 8. Normal superior labral recess. Fast spin echo proton density coronal oblique demonstrating prominent fluid within the superior labral recess (arrow) but not extending into the labrum. This finding can be a normal variant.

contrast tracking into the labrum [1,2,7]. Fluid or contrast within or dissecting into the labrum indicates a tear; however, this criterion is less accurate when compared with that for nonoperated labra [7]. Following labral surgery, the superior labral recess may become accentuated (Fig. 8). Susceptibility artifact at the repair site is common and can limit interpretation severely. Nonabsorbable or ferromagnetic devices can cause extensive artifact. These devices also may become detached and be responsible for postoperative pain (Fig. 9). Conversely, absorbable polylactic acid suture anchors can be difficult to see and present as subtle drill tracks, which can disappear with time [1,2]. Metallic anchors causing susceptibility artifact also can mimic retears [1,7]. MR arthrogra-phy is useful particularly when evaluating continued pain following instability repair [7]. Contrast can aid in the diagnosis of labral retears and distend the capsule for evaluation of the capsulolabral structures (Fig. 10). Imaging in the ABER position has been described to improve visualization of the repaired

Anterior Capsular Shift The Shoulder

Fig. 9. Loose hardware. (A,B,C) Three images from several patients demonstrating various surgical tacks that have become dislodged and may reflect the cause of the painful shoulder from recurrence of the labral abnormality or the loose body itself. The hardware track in the glenoid is identified (open arrow).

Fig. 9. Loose hardware. (A,B,C) Three images from several patients demonstrating various surgical tacks that have become dislodged and may reflect the cause of the painful shoulder from recurrence of the labral abnormality or the loose body itself. The hardware track in the glenoid is identified (open arrow).

Anthography Images Shoulder Slap Tear Pictures

Fig. 10. SLAP tear in a patient who had a prior rotator cuff repair. (A) T2 fat-suppressed coronal oblique demonstrating rotator cuff repair intact and leakage of contrast into the subacro-mial space (arrow). (B) T1 fat-suppressed coronal oblique demonstrating contrast extending into labrum (curved arrow) consistent with a tear.

structures [2]. Moreover, the capsule and glenohumeral ligaments can become thickened following repair, which is best seen with MR arthrography [2,6]. The normal AIGHL should abut the humeral head covering its entire margin and the transition from the AIGHL to the labrum should be seamless [2].

Following capsular shift surgery, the anterior capsule, especially at the ante-roinferior aspect, should be smaller than before surgery. Tirmin and coworkers [53] described measurement of the anterior and posterior capsular distances. The anterior capsular distance (A) is measured between the base of the labrum and the anterior capsule. The posterior capsule distance (P) is the distance between the posterior-most aspect of the humeral head and the posterior capsule, measured 1 cm lateral to the most medial aspect of the humeral head. A P/A ratio of greater than 1 is a predictor of good outcome [6,15]. Rand and colleagues [15] showed a change of the P/A ratio from 0.64 preoperatively to 2.36 postoperatively in their series. A nodular thickened capsule is a common appearance [15]. Furthermore, the anterior capsular insertion is typically type 1 or 2 following repair [2]. Joint distention with MR arthrography is necessary to visualize these capsular and joint findings [7].

Thickening and abnormal contour of the subscapularis muscle and tendon can occur. The subscapularis can be traverse during Bankart repair or directly manipulated as in the Putti-Platt procedure [1,3]. Alterations of the coracoid process and anterior margin of the glenoid are seen in bone block procedures. A bony mass with extensive scar tissue can be seen at the anterior inferior gle-noid from the Bristow-Helfet or Eden-Hybinette procedures [3,12]. In these procedures, the labral and capsular abnormalities are not repaired and are persistent on repeat imaging [3].

Was this article helpful?

0 0
How To Get Rid Of Yeast Infections Once And For All

How To Get Rid Of Yeast Infections Once And For All

No more itching, odor or pain or your money is refunded! Safe and DRUG FREE Natural Yeast Infection Solutions Are you looking for a safe, fast and permanent cure for your chronic yeast infection? Get Rid of that Yeast Infection Right Now and For Good!

Get My Free Ebook


Post a comment