Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep 22;5(9):2325967117728019.
doi: 10.1177/2325967117728019. eCollection 2017 Sep.

Acute Versus Delayed Magnetic Resonance Imaging and Associated Abnormalities in Traumatic Anterior Shoulder Dislocations

Nathan D Orvets  1 , Robert L Parisien  1 , Emily J Curry  1 , Justin S Chung  1 , Josef K Eichinger  2 , Akira M Murakami  3 , Xinning Li  1
Affiliations

Acute Versus Delayed Magnetic Resonance Imaging and Associated Abnormalities in Traumatic Anterior Shoulder Dislocations

Nathan D Orvets et al. Orthop J Sports Med. .

Abstract

Background: The delayed management of patients with shoulder instability may increase the prevalence and severity of concomitant intra-articular shoulder injuries resulting from persistent subluxations and dislocations.

Hypothesis: Patients with a longer delay from the initial dislocation event to undergoing magnetic resonance imaging (MRI) or magnetic resonance arthrography will demonstrate more subluxations or dislocations and a greater amount of intra-articular shoulder damage.

Study design: Cohort study; Level of evidence, 3.

Methods: We performed a retrospective review of 89 patients from a single institution with clinically and radiographically confirmed primary traumatic anterior shoulder dislocations. Patients were divided into 2 groups: those undergoing MRI less than 6 months (n = 44; LT6) or greater than 6 months (n = 45; GT6) from the initial dislocation event. The MRI assessment included evaluation of soft tissue injuries, including the labrum, capsule, rotator cuff, and cartilage damage severity along with bone loss.

Results: The delayed MRI group (GT6) demonstrated a greater degree of intra-articular abnormalities compared to the early MRI group (LT6). A greater percentage of superior labral anterior-posterior (SLAP) tears (58% vs 34%, respectively) and cartilage damage (73% vs 27%, respectively) was present in the GT6 group compared to the LT6 group. Cartilage damage was 18% mild, 7% moderate, and 2% severe for the LT6 group as compared to 38% mild, 31% moderate, and 4% severe for the GT6 group. Additionally, more recurrent shoulder dislocations were seen in the GT6 group (n = 6) compared to the LT6 group (n = 2). In the LT6 group, there were more rotator cuff tears (50% vs 24%, respectively) and capsular tears (25% vs 9%, respectively) than the GT6 group. There was no difference in anterior glenoid bone loss, glenoid version, or humeral head subluxation between the 2 groups.

Conclusion: Patients who undergo MRI greater than 6 months from the time of primary or initial shoulder dislocation had significantly more recurrent shoulder instability events and demonstrated a greater incidence and severity of intra-articular abnormalities, including SLAP tears, posterior labral tears, and anterior glenoid cartilage damage.

Keywords: SLAP tears; glenoid bone loss; intra-articular shoulder injury; labral tears; primary shoulder dislocation; shoulder dislocation and associated abnormality; shoulder stabilization surgery.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: X.L. is a paid consultant for Mitek and Tornier and has equity in the Journal of Medical Insight.

Figures

Figure 1.
Figure 1.
Hill-Sachs lesion (arrow) on an axial proton density sequence.
Figure 2.
Figure 2.
Soft tissue Bankart lesion with a tear of the anterior inferior labrum and an adjacent, small, full-thickness mild (<25%) chondral defect over the anterior inferior glenoid (arrow) on an axial proton density sequence.
Figure 3.
Figure 3.
(A) Soft tissue Bankart lesion with a mildly displaced tear of the anterior inferior labrum as well as focal stripping of the periosteum (arrowhead) and a posterior labral tear (arrow) on an axial proton density sequence. (B) Normal bony morphology of the glenoid on a sagittal T1 sequence using the surface area method.
Figure 4.
Figure 4.
(A) Bony Bankart lesion with a large displaced fragment of the anterior inferior glenoid (arrowhead) on an axial proton density sequence. (B) Quantification of the size of the bony defect on a sagittal T1 sequence using the surface area method; the defect encompasses nearly 30% of the articular surface of the glenoid.
Figure 5.
Figure 5.
Bony Bankart lesion with a large displaced fragment of the anterior inferior glenoid (arrow) on an axial proton density sequence. Localized chondral delamination along the margins of the defect (arrowhead).
Figure 6.
Figure 6.
Tear of the superior labrum (arrowhead) on a coronal T1 fat-saturated sequence (magnetic resonance arthrography).
Figure 7.
Figure 7.
Macerated anterior inferior labrum with an adjacent full-thickness chondral defect over the anterior inferior glenoid (arrow) and a posterior labral tear (arrowhead) on an axial proton density sequence.
Figure 8.
Figure 8.
Degree of cartilage damage seen in the LT6 (magnetic resonance imaging [MRI] less than 6 months) versus GT6 (MRI greater than 6 months) group.
See this image and copyright information in PMC

References

    1. Andrews JR, Carson WG, Jr, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13(5):337–341. - PubMed
    1. Arciero RA, Wheeler JH, Ryan JB, McBride JT. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med. 1994;22(5):589–594. - PubMed
    1. Bottoni CR, Wilckens JH, DeBerardino TM, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med. 2002;30(4):576–580. - PubMed
    1. Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16(7):677–694. - PubMed
    1. Buscayret F, Edwards TB, Szabo I, Adeleine P, Coudane H, Walch G. Glenohumeral arthrosis in anterior instability before and after surgical treatment: incidence and contributing factors. Am J Sports Med. 2004;32(5):1165–1172. - PubMed

LinkOut - more resources