What do you see?
I’m showing it because while the labrum is abnormal on the preinjection
axial and coronal images, it is difficult to say what exactly is abnormal
about it until contrast is given and then when stressed with the ABER view
there is a much clearer look at the labral abnormality. Whenever there is
a history of instability, my threshold for calling an abnormality of the
labrum decreases because the preexisting probability that a labral
abnormality exists becomes so much higher. A number of surgeons here in LA
request arthrography on all of their unstable patients primarily for what
is shown in this case where the abnormality is much more obvious after the
injection. The sagittal image is a pdfs but is post injection. We don’t do
pre injection sagittal images.
I called this a Perthes lesion variation of the bankart lesion.
www.ajronline.org/doi/full/10.2214/ajr.178.1.1780233
The ABER image shows it best. Compare it to the last image which is a
normal ABER image. In particular look at the attachment of the anterior
band of the inferior glenohumeral ligament to the labrum and compare the 2
images.
On the axial the scapular periosteum looks stripped from the glenoid and is
also thickened so it is possible that it was once a regular bankart lesion
that involved reforming of the periosteum. Sometimes difficult if not
impossible to tell.
[image: Perth1.jpg]
[image: Perth2.jpg]
[image: Perth3.jpg]
[image: Perth5.jpg]
[image: Perth6.jpg]
Normal ABER image
[image: Normal ABER capsular insertion.jpg]
