The main goal of surgical treatment of a glenoid rim fracture is to restore the anatomy of the normal joint surface (Fig 5), to achieve a strong fixation and bone healing to prevent recurrent shoulder instability. Currently, there is no gold standard for the treatment of large glenoid rim fractures Glenoid Rim Anatomy Risk for Glenoid Vault Perforation During Labral Repair Yadin D. Levy,* MD, Michael Williamson,† MD, Cesar Flores-Hernandez,‡ BS, Darryl D. D'Lima,‡§ MD, PhD, and Heinz R. Hoenecke Jr,‡ MD Investigation performed at Shiley Center for Orthopaedic Research and Educatio
The glenoid labrum is a fibrous ring of tissue which attaches to the rim of the glenoid which is the shallow depression of the scapula or shoulder blade where the ball of the humerus sits. The glenoid labrum increases the depth of the shoulder cavity making the shoulder joint more stable Glenoid rim fractures occur when the humeral head impacts the glenoid during the act of dislocation creating a shear force on the underlying bone. Glenoid rim fractures may occur anteriorly or posteriorly secondary to anterior and posterior instability events, respectively Tears of the glenoid rim often occur with other shoulder injuries, such as a dislocated shoulder (full or partial dislocation). Treatment. Until the final diagnosis is made, your physician may prescribe anti-inflammatory medication and rest to relieve symptoms. Rehabilitation exercises to strengthen the rotator cuff muscles may also be recommended . Surgical treatment is often considered for these injuries, especially when the fracture is out of position or if there is a large fragment of the glenoid bone Type Ia fractures are best visualized anteriorly through a deltopectoral approach, which gives adequate access to the anterior glenoid rim. In type Ib fractures, a limited posterior approach to the glenohumeral joint allows for reduction and fixation of the posterior glenoid fossa with small fragment screws
Glenoid rim morphology in recurrent anterior glenohumeral instability We introduced a method to evaluate the morphology of the glenoid rim and to quantify the osseous defect in a simple and practical manner with three-dimensionally reconstructed computed tomography with elimination of the humeral head The glenoid labrum (glenoid ligament) is a fibrocartilaginous rim attached around the margin of the glenoid cavity in the shoulder blade. The shoulderjoint is considered a ball and socket joint Glenohumeral osteoarthritis (OA) is defined as progressive loss of articular cartilage, resulting in bony erosion, pain, and decreased function. This article provides a gross overview of this disease, along with peer-reviewed research by experts in the field. The pathology, diagnosis, and classification of this condition have been well described Part of the shoulder joint, the glenoid bone attaches to the scapula and has a articular cartilage coating. Due to the shallow nature of the bone, the glenoid also has a cartilaginous rim to help seal the humeral head into the cavity to create a secure and mobile joint. While many injuries of the shoulder occur, fractures to the glenoid remain quite uncommon Glenoid hypoplasia, posterior glenoid rim deficiency, and glenoid dysplasia represent a range of developmental anomalies associated with multidirectional and posterior instability. Patients present during the second and third decades of life with bilateral shoulder pain, limited abduction, and sense of instability [ 2 ]
Nonoperative treatment of anterior glenoid rim fractures following primary traumatic anterior shoulder dislocation results in excellent clinical outcomes with a very low rate of residual instability and, thus, treatment failure. Asymptomatic radiographic osteoarthritis occurred in roughly 1 of 4 patients Abstract Background:Knowledge regarding the morphology of the glenoid rim is important when patients with recurrent anterior glenohumeral instability are assessed. Ordinary imaging techniques are not always sensitive enough to demonstrate the morphology of the glenoid rim accurately
The glenoid rim cannot be clinically evaluated at the exclusion of soft tissue structures that play a large role in glenohumeral stability. The anterior glenoid rim serves as the anchor point for the labrum, middle glenohumeral ligament, and inferior glenohumeral ligament. Although the width of bone anterior to the glenoid rim peak would not. The gold standard for the treatment of large displaced glenoid rim fractures has been open reduction and internal fixation using cannulated screws. With the advancement in arthroscopic techniques there has been a growing trend towards arthroscopic treatment of glenoid rim fractures. This report outlines the case of 39-year-old health men who sustained a complex multifragmented displaced.
Glenoid dysplasia, also referred to as glenoid hypoplasia and posterior glenoid rim deficiency, is now increasingly recognized as an anatomic variant that predisposes patients to posterior glenohumeral instability The aim of this study was to evaluate patient related outcome and shoulder stability following open reduction and internal fixation (ORIF) in patients with glenoid rim fractures. After a median follow-up of four years, 14 patients completed the Rowe Shoulder Stability Score and Quick DASH questionnaire
The treatment of glenoid rim fractures depends on a number of factors, including the articular step-off and the instability that is present following this injury. Articular step-off of 5 mm or more, particularly when associated with recurrent instability, is an indication for surgical treatment The Glenoid Labrum (Glenoid Ligament) is a fibrocartilaginous rim attached around the margin of the Glenoid cavity in the Shoulder Blade. The Shoulder Joint is considered as a 'ball and socket' joint. However, in bony terms the 'socket' (the glenoid fossa of the Scapula) is quite shallow and small, covering only a third of the 'ball' (the head of the Humerus) Glenoid Rasp; The flat, angled Glenoid Rasp is designed specifically for debriding the glenoid rim during Bankart repair procedures. The Glenoid Rasp has a 15° tip angle, which provides the appropriate arthroscopic angle to safely and easily debride the glenoid rim
A glenoid component is selected that covers the maximal amount of the prepared glenoid face with minimal overhang. The quality of the glenoid bone preparation is checked by inserting the glenoid trial and ensuring that it does not rock even when the surgeon's finger applies an eccentric load to the rim The Bankart Rasp facilitates arthroscopic debridement of the glenoid rim in tighter joint spaces when inserted through an arthroscopic portal. The Bankart Rasp has a small 90° tip angle with a 4.65 mm x 7 mm surface and is well suited for preparing the glenoid rim in the anterior-superior quadrant
The inferior glenoid secondary ossification centers form the lower two-thirds of the glenoid articular surface . As these ossification centers grow and fuse, they form a horseshoe-shaped epiphysis that coalesces with the glenoid rim and subcoracoid ossification center and grows centrally within the glenoid Version angle (red) = 90 o - angle between scapular and glenoid lines. scapular line (yellow) joins the midpoint of the glenoid line to the medial tip of scapular blade. glenoid line (blue) at the mid-glenoid level, joins the anterior and posterior margins of the glenoid rim Glenoid Bone Defect with Coracoid Fractures 24 a dislocation event. One reported case series by Plachel et al described a phenomenon known as 25 the Triple Dislocation Fracture, in which they described fractures of the glenoid rim, greater 26 tuberosity and coracoid process associated with dislocations of the shoulder.15 Often thes Anterior glenoid rim fractures are strongly associated with primary traumatic shoulder dislocation [4, 5] and based on Ideberg et al. , classified as Type Ia if the fracture fragment is < 5 mm, and as Type Ib if the fracture fragment is > 5 mm. There is still a controversy about the management of large anterior glenoid rim fractures The adequate treatment of antero-inferior glenoid rim fractures is a controversial issue. Marginal knowledge exists about the results of non-operative treatment. Therefore, the aim of this study.
Anterior glenoid rim fractures can lead to recurrent dislocations, mal-union, persistent pain, and early onset of osteoarthritis. If untreated, displaced glenoid fractures can lead to chronic pain and disability, including early onset of glenohumeral osteoarthritis as well as shoulder instability with chronic dislocations Coupled to these concepts of glenoid orientation are glenoid concavity and the possible effective arcs. The arc is defined by the maximal angle of motion possible before dislocation occurs. With asymmetrical glenoid rim wear, less effective arcs are possible
The glenoid labrum is a fibrocartilaginous rim attached around the margin of the glenoid cavity. of the scapula.. The shoulder joint is considered a 'ball and socket' joint. The glenoid labrum helps to deepen the socket. It is continuous with the tendon of the long head of the biceps brachii, which blends with it Background: A combined fracture of the glenoid rim, greater tuberosity, and coracoid process after anterior shoulder dislocation is a rare event. Only 1 patient has been reported in the literature
In fractures of the glenoid rim where the glenoid fragments are too small to fix with screws, the glenoid labrum still needs to be reduced and fixed to obtain a stable shoulder. This can be performed using suture anchors. 2. Patient preparation The glenoid rim replacement portion projects outwardly from the bearing-side end portion of the glenoid vault-occupying portion. The glenoid bearing support defines a bone graft receptacle. A prosthesis assembly for use with a scapula is disclosed. The prosthesis assembly includes a glenoid bearing support and a bearing Use glenoid guide to drill a hole in the center of the glenoid. The glenoid is then reamed until punctate bleeding cancellous bone is visualized. Two additional drill holes can be made around the. Background: Knowledge regarding the morphology of the glenoid rim is important when patients with recurrent anterior glenohumeral instability are assessed. Ordinary imaging techniques are not always sensitive enough to demonstrate the morphology of the glenoid rim accurately. We developed a method of three-dimensionally reconstructed computed tomography with elimination of the humeral head to.
Anterior glenoid rim. Anatomical hierarchy. General Anatomy > Bones; Skeletal system > Appendicular skeleton > Bones of upper limb > Pectoral girdle; Shoulder girdle > Scapula > Glenoid cavity > Anterior glenoid rim. Translations Garofalo et al. performed a case series of 26 patients with large glenoid fractures associated with complex proximal humerus fractures treated with RSA and glenoid rim bone grafting. They reported good to excellent outcomes in 24/26 patients at an average of 36 months follow-up and no major complications or revision surgery [ 34 ]
Fractures of the glenoid rim occur when the humeral head is driven against the glenoid margin. Surgical management is indicated if the fracture results in persistent subluxation of the humeral head, defined as failure of the humeral head to lie concentrically within the glenoid fossa, or if the reduction is unstable Arthroscopic reduction and fixation of large anteroinferior glenoid rim fractures. The following video demonstrates the arthroscopic reconstruction of a large anteroinferior glenoid rim fracture, using a modified Sugaya knotless anchor technique and bioabsorbable Chondral Dart implants ABSTRACT Objective: To analyze whether the Bernageau radiographic view is adequate for studying the anterior glenoid rim and to determine the distance between the posterior and anterior glenoid rims. Methods: Fifty patients (31 males) with a mean age of 34 years were evaluated by positioning their arm at 160º forward flexion and body at 70º to the x-ray chassis, while positioning the x-ray. Glenoid rim lesions: Bigliani classification Bigliani L U et al, Am J of Sports Med, 26:41-45, 1998. Type 1: united fragment attached to seperated labrum Type 2: malunited fragment detached from labrum Type 3A: anterior glenoid deficiency < 25% Type 3B: anterior glenoid deficiency > 25%. To from lhe anterior margin of the glenoid rim but attached to the neck of the scapula, there remains The patients present with swelling and dinner-fork counterpart is caused by a fa ll on the stretched hand with fully extended elbow so that the dislocated along with displaced fracture of Recurrent dislocation of the shoulder.- Repealed dislocation of the shoulder by trifle injury Complications
from lhe anterior margin of the glenoid rim but attached to the neck of the scapula, there remains bony tenderness suggests a crack fracture type of injury. An T - and Y - shaped fractures.- These fractures are more commonly seen in adults and are the displaced fragment suggest fracture of swelling becomes obvious at the inner end of the clavicle with localized tenderness at that by the weight. The labrum is a fibrocartilagenous ring surrounding the glenoid, or socket. The function of the labrum is similar to the rim of a golf tee. It serves to deepen the socket to help stabilize the ball within the socket. Damage to the labrum may result in instability (looseness) or pain. The shoulder joint proper is composed of the humeral head. Glenoid fossa of right side. (Glenoidal labrum labeled as glenoid lig.) 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 Recognized Consensus Standards. 1.1 These test methods measure how much a prosthetic anatomic glenoid component rocks or pivots following cyclic displacement of the humeral head to opposing glenoid rims (for example, superior-inferior or anterior-posterior). Motion is quantified by the tensile displacement opposite each loaded rim after dynamic.
The rim deepens the socket by up to 50% so that the head of the upper arm bone fits better. In addition, it serves as an attachment site for several ligaments. Symptoms of Glenoid Labrum Tear. The symptoms of a tear in the shoulder socket rim are very similar to those of other shoulder injuries. Symptoms include: Pain, usually with overhead. Much like a manhole cover, the InSet™ Glenoid sits inside a rim of hard, sclerotic bone that encompasses and supports the entire device 360 degrees at the very edge of the implant. Articular Geometry. The articular surface of the InSet™ glenoid incorporates three different radii, or zones, which allow for complete interchangeability. the glenoid and labral margin to the humeral neck. There may be bony impaction or fragmentation of the pos-terior glenoid rim and the anterior humeral head, which are the character-istic reverse Bankhart and reverse Hill-Sachs lesions. There may be a tear of the posterior band of the inferior glenohu-meral ligament. There is also an associa
The cortical bone graft is available in two sizes and is designed to match the curvature and surface of the existing glenoid. The single-use, disposable instrument system includes a drill guide for screw channel and graft orientation, a reamer for preparing the surface of the glenoid rim, and a depth gauge for the screws the native anterior glenoid face that is untouched by the humeral head wear. Walch Type C glenoids are dysplastic and retroverted >25° when using the Friedman method to measure glenoid retroversion where the angle is measured between the center-line of the scapular axis and a line connecting the anterior and posterior glenoid rims (Fig. 1.2)  The sulcus follows the surface of the glenoid rim medially, and does not extend posterior to the biceps anchor (Figure 12) . It corresponds to a synovial reflection medial to the superior edge of the glenoid rim at the biceps anchor, showing a normal defect of the attachment of the superior labrum to the superior glenoid cartilage Arthroscopic or Open Glenoid ORIF REHABILITATION PROTOCOL RANGE OF MOTION IMMOBILIZER EXERCISES PHASE I 0-6 weeks Limit ER to passive 45° to protect subscap repair ***only if open procedure performed FE progress as tolerated 0-2 weeks: Worn at all times (day and night) Off for gentle exercise only 2-6 weeks: Worn daytime onl Impaction fracture of humeral head against glenoid rim ; Anterior dislocations, Occurs against posterolateral surface; Incidence rate 40-90%; As high as 100% in recurrent dislocations (Provencher 2012) Posterior dislocations. Occurs against anterolateral surface (reverse Hill Sachs lesion) Incidence 86%
Type 3: A bucket-handle tear of the labrum where part of the rim detaches forming a flap which can get caught in the joint, causing locking or catching sensations. The biceps tendon is unaffected. Type 4: A bucket handle tear of the superior glenoid labrum which extends into the biceps tendon Type 1 and type 2 SLAP tears are the most common. Slap tears can also be associated with a Bankart. A SLAP lesion (superior labrum, anterior [front] to posterior [back]) is a tear of the rim above the middle of the socket that may also involve the biceps tendon. A tear of the rim below the middle of the glenoid socket that also involves the inferior glenohumeral ligament is called a Bankart lesion. Tears of the glenoid rim often occur with. of the glenoid rim in 100 consecutive cases of recurrent anterior instability. Ten percent of the patients had nor-mal glenoid bone architecture, 50% had a true bony Bankart lesion, and 40% had some degree of bony erosion, which may represent a true erosive mechanism or a com-pression fracture (Figure 1). Of the avulsion fractures, most were.
Tears of the glenoid rim are often connected with other shoulder injuries, such as a shoulder dislocation or subluxation (see above) and can be either above (superior) or below (inferior) the middle of the glenoid socket. The tear itself can be caused by a repetitive shoulder motion, and is common in athletes who throw or weightlifters A SLAP lesion (superior labrum, anterior [front] to posterior [back]) is a tear of the rim above the middle of the socket that may also involve the biceps tendon. Our Approach to Glenoid Labrum Tear. UCSF is committed to helping patients with glenoid labrum tears recover function and build strength Glenoid fractures are not common, but any bone can be fractured under the right circumstances. There are two main causes of glenoid fractures, shoulder dislocation and impact. In a shoulder dislocation, the ball or head of the humerus can fracture the rim of the glenoid as it is forced out of the socket into the glenoid rim. The inferior placement allows access to the inferior capsule and labrum as well as the posterior/inferior glenoid rim. Create an anterior/inferior portal with an outside/in technique just superior to the articular fibers of the subscapularis tendon and lateral enough to provide the proper angle for ancho
Glenoid cavity fractures: Goss classsification Goss TP, J Am Acad Orthop Surg, 3:22-33, 1995. A variation on Ideberg classification, with more subdivisions for improved discussion of operative management of these injuries. Type 1: Glenoid rim fractures A- anterior rim B- Posterior rim. Type 2: Glenoid fracture exits at lateral border of scapul Glenoid Dysplasia. While primary glenoid dysplasia is a rare developmental abnormality of the shoulder, the term glenoid dysplasia refers to malformations in the lower rim of the glenoid, the socket of the shoulder
Round posterior glenoid rim 2. Chondrolabral cleft at the posterior inferior glenoid. Rounded posterior rim of the glenoid and chondrolabral cleft on MRI. Exam under anesthesia demonstrated no dislocation with the load and shift test. 6 o ' clock glenoid . Chondrolabral cleft posterior Results: The mean width of bone beyond the peak of the anterior glenoid rim was 3.2 ± 0.7 mm, corresponding to 10.5% of the anteroposterior glenoid diameter. This anatomic region is of similar relative size in males and females (11% vs 10% of the glenoid diameter)
The most significant finding on examination is a limited range of active and passive external rotation of the effected arm as the head of the humerus is caught to the glenoid rim. Palpation of the humeral head in a posterior position is the only other clear diagnostic feature on examination Youtube 자료를 PDF노트로 만들었습니다. https://youtu.be/XEDl-iAdzuQ 여기에 제가 사용법을 동영상으로 올려두었습니다. https://gumroad. was a significantly large glenoid fracture anteriorly inferiorly. There was also labral tear anteriorly and some capsular injury. The glenoid fracture was displaced 3-4 mm. Anterior portal was created through an outside-in technique. A probe was then placed, and the fracture was depressed and easily movable. A shaver was placed in the joint. Fracture of posterior glenoid rim; Avulsion fracture of lesser tuberosity Isolated fractures of the lesser tuberosity should raise suspicion of an associated posterior dislocation; Posterior Dislocation of the Shoulder. Image on left demonstrates a trough fracture or reverse Hill-Sachs fractureof the antero-medial aspect of the humeral head.
graft or allograft material, perfectly flush on the anterior glenoid rim, followed by soft-tissue fixation on the anteroinferior glenoid rim. It is an all-arthroscopic technique with the advantage of not using fixation devices, such as screws, but instead using round ENDOBUTTON™ fixation devices to fix the bone graft Av- glenoid fossa, and the center glenoid mark the glenoid rim to the point where the K- erage superoinferior diameter was 34.65 was aligned with one of the perimeter wire emerged from the anterior scapular mm (range: 26.7-42.5 mm), and average holes of the ring Other types of fractures can occur with shoulder dislocations including displaced proximal humerus fractures and glenoid rim fractures. The common theme with all of these injuries is that shoulder instability may occur if the fracture heals in a poor position. Treatment Of all scapular fractures, around 10% are glenoid rim fractures [1-3]. Anterior glenoid rim fractures are strongly associated with primary traumatic shoulder dis-location [4, 5] and based on Ideberg et al. , classified as Type Ia if the fracture fragment is <5mm, and as Type Ib if the fracture fragment is >5mm. There is still a controversy.