CHRONIC SHOULDER DISLOCATION; PATHOANATOMY AND INVESTIGATION &

management

• PRESENTED BY : • DR. TDS DEEPAK• DEPARTMENT OF ORTHOPEDICS• IGGGH & PGI PONDICHERRY

• An ALPSA (anterior labral periosteal sleeve avulsion) lesion is an injury at the front of the shoulder associated with shoulder dislocation.

• The anterior (front) labrum can peel off the glenoid resulting in a Bankart lesion. When the periosteum (fibrous tissue surrounding bone) peels off as well this is called an ALPSA lesion. When this happens the labrum (bumper) falls away and rolls up. It normally falls medially and downwards.

• A GLAD (glenolabral articular disruption) lesion is caused by a forced adduction injury to the shoulder from an abducted and external rotated position; patients with GLAD lesions present with anterior shoulder pain as their chief complaint

• A SLAP tear or SLAP lesion is an injury to the glenoid labrum (fibrocartilaginous rim attached around the margin of the glenoid cavity). SLAP is an acronym for "superior labral tear from anterior to posterior".

• Although ten varieties of SLAP lesion have been described on MRI or MR arthrography[5]

seven clinical types are generally described.[6]

• Type I. Degenerative fraying of the superior portion of the labrum, with the labrum remaining firmly attached to the glenoid rim

• Type II. Separation of the superior portion of the glenoid labrum and tendon of the biceps brachii muscle from the glenoid rim

• Type III. Bucket-handle tears of the superior portion of the labrum without involvement of the biceps brachii (long head) attachment

• Type IV. Bucket-handle tears of the superior portion of the labrum extending into the biceps tendon

• Type V. Anteroinferior Bankart lesion that extends upward to include a separation of the biceps tendon

• Type VI. Unstable radial flap tears associated with separation of the biceps anchor

• Type VII. Anterior extension of the SLAP lesion beneath the middle glenohumeral ligament

• Light-bulb sign • - globular head 2° IR

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