Glenoid Labrum

Original Editor - Priyanka Chugh

Top Contributors - Priyanka Chugh, Kim Jackson, Lucinda hampton, Naomi O'Reilly, Wendy Snyders, 127.0.0.1 and Wanda van Niekerk

Introduction

Glenoid Labrum (marked lig.)

The glenoid labrum is a fibrocartilaginous complex that attaches as a rim to the articular cartilage of the glenoid fossa. Its role is to: deepen and increase the surface area of the glenoid (acting as a static stabiliser of the glenohumeral joint); resist anterior and posterior movement and; attempting to block dislocation and subluxation at the maximal ranges of motion.

The labrum is frequently involved in shoulder pathology, by acute trauma (eg shoulder dislocation) or, more commonly, repeated microtrauma eg shoulder subluxation.

Structure

Glenoid labrum basics:

• Made of fibrocartilage, 3 mm thick and 4 mm wide (highly variable).
• On cross-section, the labrum is most commonly triangular, can be round.
• Inferior to the equatorial pole of the glenoid, the labrum gradually becomes rounder and smaller in contrast to superiorly , here it is more triangular in shape and larger.

Attachments

• Superiorly: tendon of the long head of biceps brachii
• Anteriorly: superior glenohumeral ligament; middle glenohumeral ligament (variably)
• Inferiorly: inferior glenohumeral ligament consistenting of an anterior band, axillary pouch, and a posterior band

Clinical Presentation

Patients with tears of the glenoid labrum present with an extensive range of non-specific symptoms including:

• Discomfort/pain, unable to pinpoint.
• Joint weakness and instability
• Clicking

Anatomic Variants

• Inconsistent cross-sectional shape: blunted, cleaved, notched or flat.
• Medialised posterior labrum
• Anterior capsulolabral insertion variance

Biomechanics

The labrum major functions include:

1. To increase the contact area between humeral head and scapula.
2. Help in the provision of the “Viscoelastic Piston” effect.
3. Provides insertion for stabilizing structures, as a fibrous “crossroad”, with the labrum and ligaments working in synergy, each structure contributing to the varying with the position of the limb.

Accuracy of Assessment

The ability to predict the presence of a glenoid labral tear by physical examination was compared with that of magnetic resonance imaging (conventional and arthro gram) and confirmed with arthroscopy. Main points of study:

• 37 men and 17 women (average age, 34 years) in the study group, 64% were throwing athletes and 61% recalled specific traumatic events.
• Clinical assessment included history with specific attention to pain with overhead activities, clicking, and instances of shoulder instability.
• Physical examination included the apprehension, relocation, load and shift, inferior sulcus sign, and crank tests.
• Shoulder arthroscopy confirmed labral tears in 41 patients (76%).
• Magnetic resonance imaging produced a sensitivity of 59% and a specificity of 85%.
• Physical examination yielded a sensitivity of 90% and a specificity of 85%.

Conclusion: Physical examination is more accurate in predicting glenoid labral tears than magnetic resonance imaging. In this era of cost containment, completing the diagnostic workup in the clinic without expensive ancillary studies allows the patient's care to proceed in the most timely and economic fashion.

Location of Injuries

Bankart lesion, a glenoid labrum injury

Labral injuries are named according to localisation

• Superior labrum: SLAP lesion
• Anteroinferior labrum: Bankart lesion; Perthes lesion; Glenolabral articular disruption lesion (GLAD); Anterior labroligamentous periosteal sleeve avulsion lesion (ALPSA)
• Posteroinferior labrum: Reverse Bankart lesion; Posterior GLAD; Posterior labrocapsular periosteal sleeve avulsion lesion (POLPSA); Kim lesion (superficial tears between the posterior glenoid labrum and glenoid articular cartilage without labral detachment)
• Circumferential labral lesion

Treatment and prognosis

No general rules exist for management of labral lesions are resected and others fixed. Labral repair or resection can be performed, possibly with capsuloplasty to address joint instability. The cause (which is usually shoulder instability), however, needs to be assessed and treated. See Shoulder Instability