Glenolabral articular disruption

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Glenolabral articular disruption
Other namesGLAD
Specialty Physical medicine and rehabilitation

Glenolabral articular disruption (GLAD) lesion is a type of shoulder injury. It is difficult to diagnose clinically, and requires surgical repair to correct the damage to the shoulder. [1]

Contents

Signs and symptoms

Persistent or worsening shoulder pain is the most common symptom of glenolabral articular disruption lesions. The pain is often described as anterior or global. [1] Joint instability has also been reported in some cases. [2] [3]

Causes

Glenolabral articular disruption lesions often develop as a result of shoulder trauma. External rotation and forced shoulder adduction from an abduction position characterize the classic pattern from the original series. This often occurs due to falling onto an outstretched arm. [1] The injury has also been reported in association with forceful adduction as a result of throwing. [4]

Mechanism

The glenoid cartilage underneath the labrum in the glenohumeral (GH) joint is disrupted by glenolabral articular disruption. [5] The articulation of the humeral head inside the glenoid fossa of the scapula forms the GH joint itself, which is a synovial ball and socket joint. The labrum, a fibrocartilaginous rim, encircles the fossa at its edge and is lined with articular cartilage. [6] The labrum gives the fossa more depth and serves as an anchor for the GH ligaments and the long head of the biceps tendon. [7]

Glenolabral articular disruption lesions usually occur from forceful adduction of the humeral head onto the glenoid fossa. Shear force might also be present. This results in varying degrees of underlying cartilage damage as well as a superficial tear along the anterior-inferior aspect of the labrum. This could be a loose chondral body, a more significant flap tear, or even a focal cartilage defect. [7]

Diagnosis

On non-contrast MRI or CT arthrography imaging, lesions might be harder to find, but the more recent 3T MRI scanners might increase the pick-up rate in the absence of contrast. [4] The accepted gold standard for identifying or detecting the glenolabral articular disruption lesion is MR arthroscopy (MRA). [1]

Treatment

The preferred course of treatment for the glenolabral articular disruption lesion is arthroscopic debridement of the labrum and glenoid articular defect in patients without any discernible anterior instability. [4]

See also

Related Research Articles

<span class="mw-page-title-main">Arthroscopy</span> Medical procedure

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<span class="mw-page-title-main">Shoulder</span> Part of the body

The human shoulder is made up of three bones: the clavicle (collarbone), the scapula, and the humerus as well as associated muscles, ligaments and tendons.

<span class="mw-page-title-main">Rotator cuff tear</span> Shoulder injury

Rotator cuff tendinopathy is a process of senescence. The pathophysiology is mucoid degeneration. Most people develop rotator cuff tendinopathy within their lifetime.

<span class="mw-page-title-main">Arthrogram</span>

An arthrogram is a series of images of a joint after injection of a contrast medium, usually done by fluoroscopy or MRI. The injection is normally done under a local anesthetic such as Novocain or lidocaine. The radiologist or radiographer performs the study using fluoroscopy or x-ray to guide the placement of the needle into the joint and then injects around 10 ml of contrast based on age. There is some burning pain from the anesthetic and a painful bubbling feeling in the joint after the contrast is injected. This only lasts 20 – 30 hours until the Contrast is absorbed. During this time, while it is allowed, it is painful to use the limb for around 10 hours. After that the radiologist can more clearly see what is going on under your skin and can get results out within 24 to 48 hours.

<span class="mw-page-title-main">Shoulder joint</span> Synovial ball and socket joint in the shoulder

The shoulder joint is structurally classified as a synovial ball-and-socket joint and functionally as a diarthrosis and multiaxial joint. It involves an articulation between the glenoid fossa of the scapula and the head of the humerus. Due to the very loose joint capsule that gives a limited interface of the humerus and scapula, it is the most mobile joint of the human body.

<span class="mw-page-title-main">Shoulder girdle</span> Set of bones which connects the arm to the axial skeleton on each side

The shoulder girdle or pectoral girdle is the set of bones in the appendicular skeleton which connects to the arm on each side. In humans it consists of the clavicle and scapula; in those species with three bones in the shoulder, it consists of the clavicle, scapula, and coracoid. Some mammalian species have only the scapula.

<span class="mw-page-title-main">SLAP tear</span> Medical condition

A SLAP tear or SLAP lesion is an injury to the superior glenoid labrum that initiates in the back of the labrum and stretches toward the front into the attachment point of the long head of the biceps tendon. SLAP is an acronym for "Superior Labrum Anterior and Posterior". SLAP lesions are commonly seen in overhead throwing athletes but middle-aged labor workers can also be affected, and they can be caused by chronic overuse or an acute stretch injury of the shoulder.

<span class="mw-page-title-main">Glenoid fossa</span> Part of the shoulder

The glenoid fossa of the scapula or the glenoid cavity is a bone part of the shoulder. The word glenoid is pronounced or and is from Greek: gléne, "socket", reflecting the shoulder joint's ball-and-socket form. It is a shallow, pyriform articular surface, which is located on the lateral angle of the scapula. It is directed laterally and forward and articulates with the head of the humerus; it is broader below than above and its vertical diameter is the longest.

<span class="mw-page-title-main">Glenoid labrum</span> Structure on the shoulder blade

The glenoid labrum is a fibrocartilaginous structure attached around the rim of the glenoid cavity on the shoulder blade. The shoulder joint is considered a ball-and-socket joint. However, in bony terms the 'socket' is quite shallow and small, covering at most only a third of the 'ball'. The socket is deepened by the glenoid labrum, stabilizing the shoulder joint.

<span class="mw-page-title-main">Acetabular labrum</span> Ring of cartilage that surrounds the acetabulum of the hip

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<span class="mw-page-title-main">Dislocated shoulder</span> Injury

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Shoulder surgery is a means of treating injured shoulders. Many surgeries have been developed to repair the muscles, connective tissue, or damaged joints that can arise from traumatic or overuse injuries to the shoulder.

<span class="mw-page-title-main">Bankart lesion</span> Medical condition

A Bankart lesion is a type of shoulder injury that occurs following a dislocated shoulder. It is an injury of the anterior (inferior) glenoid labrum of the shoulder. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. It is an indication for surgery and often accompanied by a Hill-Sachs lesion, damage to the posterior humeral head.

<span class="mw-page-title-main">Hill–Sachs lesion</span> Cortical depression in the posterolateral head of the humerus

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<span class="mw-page-title-main">Capsule of the glenohumeral joint</span> Articular capsule of the shoulder joint

The capsule of the glenohumeral (shoulder) joint is the articular capsule of the shoulder. It completely surrounds the joint. It is attached above to the circumference of the glenoid cavity beyond the glenoidal labrum, and below to the anatomical neck of the humerus, approaching nearer to the articular cartilage above than in the rest of its extent.

<span class="mw-page-title-main">ALPSA lesion</span> Type of shoulder injury

An ALPSAlesion is an injury at the front of the shoulder associated with shoulder dislocation.

<span class="mw-page-title-main">Hip arthroscopy</span>

Hip arthroscopy refers to the viewing of the interior of the acetabulofemoral (hip) joint through an arthroscope and the treatment of hip pathology through a minimally invasive approach. This technique is sometimes used to help in the treatment of various joint disorders and has gained popularity because of the small incisions used and shorter recovery times when compared with conventional surgical techniques. Hip arthroscopy was not feasible until recently, new technology in both the tools used and the ability to distract the hip joint has led to a recent surge in the ability to do hip arthroscopy and the popularity of it.

<span class="mw-page-title-main">Perthes lesion</span> Medical condition

Perthes lesion is a variant of Bankart lesion, presenting as an anterior glenohumeral injury that occurs when the scapular periosteum remains intact but is stripped medially and the anterior labrum is avulsed from the glenoid but remains partially attached to the scapula by intact periosteum.

Humeral avulsion of the glenohumeral ligament (HAGL) is defined as an avulsion of the inferior glenohumeral ligament from the anatomic neck of the humerus. In other words, it occurs when we have disruption of the ligaments that join the humerus to the glenoid. HAGL tends to occur in 7.5-9.3% of cases of anterior shoulder instability. Making it an uncommon cause of anterior shoulder instability. Avulsion of this ligamentous complex may occur in three sites: glenoid insertion (40%), the midsubstance (35%) and the humeral insertion (25%). Bony humeral avulsion of the glenohumeral ligament (BHAGL) refers when we have HAGL with bony fracture.

The Latarjet operation, also known as the Latarjet-Bristow procedure, is a surgical procedure used to treat recurrent shoulder dislocations, typically caused by bone loss or a fracture of the glenoid. The procedure was first described by French surgeon Dr. Michel Latarjet in 1954.

References

  1. 1 2 3 4 Sanders TG, Tirman PF, Linares R, Feller JF, Richardson R (January 1999). "The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation". American Journal of Roentgenology. 172 (1): 171–5. doi:10.2214/ajr.172.1.9888763. PMID   9888763.
  2. ↑ Singh, Ranjeet B; Hunter, John C; Smith, Kevin L (2003). "Mri of shoulder instability: state of the art". Current Problems in Diagnostic Radiology. 32 (3). Elsevier BV: 127–134. doi:10.1016/s0363-0188(03)00014-8. ISSN   0363-0188. PMID   12783081.
  3. ↑ Antonio, Gregory E.; Griffith, James F.; Yu, Alfred B.; Yung, Patrick S.H.; Chan, Kai Ming; Ahuja, Anil T. (September 25, 2007). "First-time shoulder dislocation: High prevalence of labral injury and age-related differences revealed by MR arthrography". Journal of Magnetic Resonance Imaging. 26 (4). Wiley: 983–991. doi:10.1002/jmri.21092. ISSN   1053-1807. PMID   17896393.
  4. 1 2 3 Neviaser, Thomas J. (1993). "The GLAD lesion: Another cause of anterior shoulder pain". Arthroscopy: The Journal of Arthroscopic & Related Surgery. 9 (1). Elsevier BV: 22–23. doi:10.1016/s0749-8063(05)80339-1. ISSN   0749-8063. PMID   8442825.
  5. ↑ Hay, Bruce; Fraser-Moodie, James A. (January 23, 2023). "Glenolabral Articular Disruption (GLAD)". StatPearls Publishing. PMID   36943956. Archived from the original on May 7, 2024. Retrieved January 2, 2024.
  6. ↑ Chang, Lou-Ren; Anand, Prashanth; Varacallo, Matthew (August 8, 2023). "Anatomy, Shoulder and Upper Limb, Glenohumeral Joint". StatPearls Publishing. PMID   30725703. Archived from the original on January 6, 2024. Retrieved January 2, 2024.
  7. 1 2 Robinson, G.; Ho, Y.; Finlay, K.; Friedman, L.; Harish, S. (2006). "Normal anatomy and common labral lesions at MR arthrography of the shoulder". Clinical Radiology. 61 (10). Elsevier BV: 805–821. doi:10.1016/j.crad.2006.06.002. ISSN   0009-9260.

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