Case: Shoulder: Posterior Labrum
Case: Shoulder: Posterior Labrum
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Shoulder - Posterior Labrum.
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<p begin="00:00:05.100" end="00:00:06.790" style="s2">- [Voiceover] The<br />following are case studies</p>
<p begin="00:00:06.790" end="00:00:09.121" style="s2">presenting pictures of the posterior</p>
<p begin="00:00:09.121" end="00:00:12.497" style="s2">glenoid labrum and its abnormalities.</p>
<p begin="00:00:12.497" end="00:00:13.998" style="s2">In our anatomical review we have the</p>
<p begin="00:00:13.998" end="00:00:16.087" style="s2">posterior surface of the humeral head</p>
<p begin="00:00:16.087" end="00:00:19.265" style="s2">with articular hyaline cartilage in blue,</p>
<p begin="00:00:19.265" end="00:00:22.863" style="s2">the proximal origin of the infraspinatus</p>
<p begin="00:00:22.863" end="00:00:25.248" style="s2">tendon here in yellow, with the more</p>
<p begin="00:00:25.248" end="00:00:28.199" style="s2">laterally light blue<br />landmark of the greater</p>
<p begin="00:00:28.199" end="00:00:30.251" style="s2">tuberosity which will act as its</p>
<p begin="00:00:30.251" end="00:00:33.418" style="s2">insertion of the infraspinatus tendon.</p>
<p begin="00:00:34.419" end="00:00:37.328" style="s2">Highlighted here in green is the</p>
<p begin="00:00:37.328" end="00:00:39.911" style="s2">spine of the scapula with a red</p>
<p begin="00:00:40.949" end="00:00:43.821" style="s2">posterior acromion process, which</p>
<p begin="00:00:43.821" end="00:00:46.850" style="s2">serves as a great palpation point to begin</p>
<p begin="00:00:46.850" end="00:00:50.136" style="s2">the examination of the<br />infraspinatus tendon.</p>
<p begin="00:00:50.136" end="00:00:54.041" style="s2">Highlighted here in<br />purple is the posterior</p>
<p begin="00:00:54.041" end="00:00:57.753" style="s2">bony glenoid of the scapula, and the</p>
<p begin="00:00:57.753" end="00:01:00.703" style="s2">structure here in white represents</p>
<p begin="00:01:00.703" end="00:01:03.870" style="s2">the posterior glenoid labrum, which is</p>
<p begin="00:01:05.250" end="00:01:07.513" style="s2">only clearly identified by ultrasound</p>
<p begin="00:01:07.513" end="00:01:10.002" style="s2">and its approximate 9 o'clock position.</p>
<p begin="00:01:10.002" end="00:01:12.872" style="s2">Overlying these structures is the large</p>
<p begin="00:01:12.872" end="00:01:15.465" style="s2">infraspinatus muscle and tendon</p>
<p begin="00:01:15.465" end="00:01:18.838" style="s2">followed by the teres minor resting</p>
<p begin="00:01:18.838" end="00:01:23.010" style="s2">just inferior to the infraspinatus tendon.</p>
<p begin="00:01:23.010" end="00:01:25.559" style="s2">Corresponding ultrasound image here</p>
<p begin="00:01:25.559" end="00:01:27.573" style="s2">of the posterior glenoid labrum.</p>
<p begin="00:01:27.573" end="00:01:30.166" style="s2">We have highlighted here the bony</p>
<p begin="00:01:30.166" end="00:01:33.793" style="s2">glenoid of the scapula, followed by</p>
<p begin="00:01:33.793" end="00:01:36.816" style="s2">a highlighted image of the bony</p>
<p begin="00:01:36.816" end="00:01:40.359" style="s2">posterior humerus with a dark rim</p>
<p begin="00:01:40.359" end="00:01:41.962" style="s2">over the bone representing the</p>
<p begin="00:01:41.962" end="00:01:44.712" style="s2">posterior articular hyaline cartilage.</p>
<p begin="00:01:44.712" end="00:01:46.439" style="s2">Highlighted here would<br />be the infraspinatus</p>
<p begin="00:01:46.439" end="00:01:49.888" style="s2">muscle belly, which is seen obliquely</p>
<p begin="00:01:49.888" end="00:01:52.861" style="s2">in this slice, so that<br />we can have a clear image</p>
<p begin="00:01:52.861" end="00:01:56.370" style="s2">of the posterior glenoid labrum here,</p>
<p begin="00:01:56.370" end="00:01:59.826" style="s2">highlighted as a hyperechoic triangle.</p>
<p begin="00:01:59.826" end="00:02:02.553" style="s2">Internal and external rotations</p>
<p begin="00:02:02.553" end="00:02:04.805" style="s2">are great dynamic maneuvers for the</p>
<p begin="00:02:04.805" end="00:02:07.730" style="s2">posterior glenoid labrum,<br />as a greater tegrocity</p>
<p begin="00:02:07.730" end="00:02:12.285" style="s2">is brought posteriorly<br />towards the bony glenoid,</p>
<p begin="00:02:12.285" end="00:02:16.120" style="s2">the posterior glenoid<br />labrum is brought under</p>
<p begin="00:02:16.120" end="00:02:19.956" style="s2">tremendous stress, forcing a blunting</p>
<p begin="00:02:19.956" end="00:02:22.139" style="s2">of the posterior glenoid labrum.</p>
<p begin="00:02:22.139" end="00:02:24.222" style="s2">Seen here is a disruption</p>
<p begin="00:02:25.764" end="00:02:29.440" style="s2">of the normally homogeneous pattern</p>
<p begin="00:02:29.440" end="00:02:31.650" style="s2">of the posterior glenoid labrum.</p>
<p begin="00:02:31.650" end="00:02:33.461" style="s2">On external rotation this becomes</p>
<p begin="00:02:33.461" end="00:02:36.037" style="s2">even more noticeable as the tissue</p>
<p begin="00:02:36.037" end="00:02:40.037" style="s2">interfaces are brought<br />together and then relaxed</p>
<p begin="00:02:41.165" end="00:02:44.668" style="s2">under this dynamic stress maneuver.</p>
<p begin="00:02:44.668" end="00:02:47.634" style="s2">On internal rotation we may also see</p>
<p begin="00:02:47.634" end="00:02:50.603" style="s2">loose bodies deeper than the joint.</p>
<p begin="00:02:50.603" end="00:02:52.616" style="s2">This image of an external rotation</p>
<p begin="00:02:52.616" end="00:02:55.120" style="s2">reveals a false joint effusion.</p>
<p begin="00:02:55.120" end="00:02:57.989" style="s2">What looks like a large<br />hypoechoic structure</p>
<p begin="00:02:57.989" end="00:03:00.406" style="s2">protruding from the<br />posterior joint surface</p>
<p begin="00:03:00.406" end="00:03:04.158" style="s2">is actually just contracted muscle belly,</p>
<p begin="00:03:04.158" end="00:03:06.759" style="s2">which contains a large amount of water,</p>
<p begin="00:03:06.759" end="00:03:09.946" style="s2">as well as a high incidence of anisotropic</p>
<p begin="00:03:09.946" end="00:03:13.604" style="s2">artifact due to the angle<br />of tendon insertion.</p>
<p begin="00:03:13.604" end="00:03:15.596" style="s2">Special care should be used when</p>
<p begin="00:03:15.596" end="00:03:17.774" style="s2">identifying a posterior joint effusion</p>
<p begin="00:03:17.774" end="00:03:21.028" style="s2">to overlay the infraspinatus tendon</p>
<p begin="00:03:21.028" end="00:03:24.559" style="s2">over the joint, creating an interface</p>
<p begin="00:03:24.559" end="00:03:28.401" style="s2">for fluid to rest that is not hypoechoic.</p>
<p begin="00:03:28.401" end="00:03:31.001" style="s2">By bringing this hyperechoic<br />interface over the</p>
<p begin="00:03:31.001" end="00:03:35.168" style="s2">joint space, it is easy to<br />identify joint effusions.</p>
<p begin="00:00:06.790" end="00:00:09.121" style="s2">presenting pictures of the posterior</p>
<p begin="00:00:09.121" end="00:00:12.497" style="s2">glenoid labrum and its abnormalities.</p>
<p begin="00:00:12.497" end="00:00:13.998" style="s2">In our anatomical review we have the</p>
<p begin="00:00:13.998" end="00:00:16.087" style="s2">posterior surface of the humeral head</p>
<p begin="00:00:16.087" end="00:00:19.265" style="s2">with articular hyaline cartilage in blue,</p>
<p begin="00:00:19.265" end="00:00:22.863" style="s2">the proximal origin of the infraspinatus</p>
<p begin="00:00:22.863" end="00:00:25.248" style="s2">tendon here in yellow, with the more</p>
<p begin="00:00:25.248" end="00:00:28.199" style="s2">laterally light blue<br />landmark of the greater</p>
<p begin="00:00:28.199" end="00:00:30.251" style="s2">tuberosity which will act as its</p>
<p begin="00:00:30.251" end="00:00:33.418" style="s2">insertion of the infraspinatus tendon.</p>
<p begin="00:00:34.419" end="00:00:37.328" style="s2">Highlighted here in green is the</p>
<p begin="00:00:37.328" end="00:00:39.911" style="s2">spine of the scapula with a red</p>
<p begin="00:00:40.949" end="00:00:43.821" style="s2">posterior acromion process, which</p>
<p begin="00:00:43.821" end="00:00:46.850" style="s2">serves as a great palpation point to begin</p>
<p begin="00:00:46.850" end="00:00:50.136" style="s2">the examination of the<br />infraspinatus tendon.</p>
<p begin="00:00:50.136" end="00:00:54.041" style="s2">Highlighted here in<br />purple is the posterior</p>
<p begin="00:00:54.041" end="00:00:57.753" style="s2">bony glenoid of the scapula, and the</p>
<p begin="00:00:57.753" end="00:01:00.703" style="s2">structure here in white represents</p>
<p begin="00:01:00.703" end="00:01:03.870" style="s2">the posterior glenoid labrum, which is</p>
<p begin="00:01:05.250" end="00:01:07.513" style="s2">only clearly identified by ultrasound</p>
<p begin="00:01:07.513" end="00:01:10.002" style="s2">and its approximate 9 o'clock position.</p>
<p begin="00:01:10.002" end="00:01:12.872" style="s2">Overlying these structures is the large</p>
<p begin="00:01:12.872" end="00:01:15.465" style="s2">infraspinatus muscle and tendon</p>
<p begin="00:01:15.465" end="00:01:18.838" style="s2">followed by the teres minor resting</p>
<p begin="00:01:18.838" end="00:01:23.010" style="s2">just inferior to the infraspinatus tendon.</p>
<p begin="00:01:23.010" end="00:01:25.559" style="s2">Corresponding ultrasound image here</p>
<p begin="00:01:25.559" end="00:01:27.573" style="s2">of the posterior glenoid labrum.</p>
<p begin="00:01:27.573" end="00:01:30.166" style="s2">We have highlighted here the bony</p>
<p begin="00:01:30.166" end="00:01:33.793" style="s2">glenoid of the scapula, followed by</p>
<p begin="00:01:33.793" end="00:01:36.816" style="s2">a highlighted image of the bony</p>
<p begin="00:01:36.816" end="00:01:40.359" style="s2">posterior humerus with a dark rim</p>
<p begin="00:01:40.359" end="00:01:41.962" style="s2">over the bone representing the</p>
<p begin="00:01:41.962" end="00:01:44.712" style="s2">posterior articular hyaline cartilage.</p>
<p begin="00:01:44.712" end="00:01:46.439" style="s2">Highlighted here would<br />be the infraspinatus</p>
<p begin="00:01:46.439" end="00:01:49.888" style="s2">muscle belly, which is seen obliquely</p>
<p begin="00:01:49.888" end="00:01:52.861" style="s2">in this slice, so that<br />we can have a clear image</p>
<p begin="00:01:52.861" end="00:01:56.370" style="s2">of the posterior glenoid labrum here,</p>
<p begin="00:01:56.370" end="00:01:59.826" style="s2">highlighted as a hyperechoic triangle.</p>
<p begin="00:01:59.826" end="00:02:02.553" style="s2">Internal and external rotations</p>
<p begin="00:02:02.553" end="00:02:04.805" style="s2">are great dynamic maneuvers for the</p>
<p begin="00:02:04.805" end="00:02:07.730" style="s2">posterior glenoid labrum,<br />as a greater tegrocity</p>
<p begin="00:02:07.730" end="00:02:12.285" style="s2">is brought posteriorly<br />towards the bony glenoid,</p>
<p begin="00:02:12.285" end="00:02:16.120" style="s2">the posterior glenoid<br />labrum is brought under</p>
<p begin="00:02:16.120" end="00:02:19.956" style="s2">tremendous stress, forcing a blunting</p>
<p begin="00:02:19.956" end="00:02:22.139" style="s2">of the posterior glenoid labrum.</p>
<p begin="00:02:22.139" end="00:02:24.222" style="s2">Seen here is a disruption</p>
<p begin="00:02:25.764" end="00:02:29.440" style="s2">of the normally homogeneous pattern</p>
<p begin="00:02:29.440" end="00:02:31.650" style="s2">of the posterior glenoid labrum.</p>
<p begin="00:02:31.650" end="00:02:33.461" style="s2">On external rotation this becomes</p>
<p begin="00:02:33.461" end="00:02:36.037" style="s2">even more noticeable as the tissue</p>
<p begin="00:02:36.037" end="00:02:40.037" style="s2">interfaces are brought<br />together and then relaxed</p>
<p begin="00:02:41.165" end="00:02:44.668" style="s2">under this dynamic stress maneuver.</p>
<p begin="00:02:44.668" end="00:02:47.634" style="s2">On internal rotation we may also see</p>
<p begin="00:02:47.634" end="00:02:50.603" style="s2">loose bodies deeper than the joint.</p>
<p begin="00:02:50.603" end="00:02:52.616" style="s2">This image of an external rotation</p>
<p begin="00:02:52.616" end="00:02:55.120" style="s2">reveals a false joint effusion.</p>
<p begin="00:02:55.120" end="00:02:57.989" style="s2">What looks like a large<br />hypoechoic structure</p>
<p begin="00:02:57.989" end="00:03:00.406" style="s2">protruding from the<br />posterior joint surface</p>
<p begin="00:03:00.406" end="00:03:04.158" style="s2">is actually just contracted muscle belly,</p>
<p begin="00:03:04.158" end="00:03:06.759" style="s2">which contains a large amount of water,</p>
<p begin="00:03:06.759" end="00:03:09.946" style="s2">as well as a high incidence of anisotropic</p>
<p begin="00:03:09.946" end="00:03:13.604" style="s2">artifact due to the angle<br />of tendon insertion.</p>
<p begin="00:03:13.604" end="00:03:15.596" style="s2">Special care should be used when</p>
<p begin="00:03:15.596" end="00:03:17.774" style="s2">identifying a posterior joint effusion</p>
<p begin="00:03:17.774" end="00:03:21.028" style="s2">to overlay the infraspinatus tendon</p>
<p begin="00:03:21.028" end="00:03:24.559" style="s2">over the joint, creating an interface</p>
<p begin="00:03:24.559" end="00:03:28.401" style="s2">for fluid to rest that is not hypoechoic.</p>
<p begin="00:03:28.401" end="00:03:31.001" style="s2">By bringing this hyperechoic<br />interface over the</p>
<p begin="00:03:31.001" end="00:03:35.168" style="s2">joint space, it is easy to<br />identify joint effusions.</p>
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5746974994001
https://youtube.com/watch?v=GuWIz-2aRBs