Glenolabral articular disruption
| Glenolabral articular disruption | |
|---|---|
| Other names | GLAD |
| Specialty | Physical medicine and rehabilitation |
Glenolabral articular disruption (GLAD) lesion is a type of shoulder injury. It is difficult to diagnose clinically, and requires surgical repair to correct the damage to the shoulder.[1]
Signs and symptoms[edit]
Persistent or worsening shoulder pain is the most common symptom of glenolabral articular disruption lesions. The pain is often described as anterior or global.[1] Joint instability has also been reported in some cases.[2][3]
Causes[edit]
Glenolabral articular disruption lesions often develop as a result of shoulder trauma. External rotation and forced shoulder adduction from an abduction position characterize the classic pattern from the original series. This often occurs due to falling onto an outstretched arm.[1] The injury has also been reported in association with forceful adduction as a result of throwing.[4]
Mechanism[edit]
The glenoid cartilage underneath the labrum in the glenohumeral (GH) joint is disrupted by glenolabral articular disruption.[5] The articulation of the humeral head inside the glenoid fossa of the scapula forms the GH joint itself, which is a synovial ball and socket joint. The labrum, a fibrocartilaginous rim, encircles the fossa at its edge and is lined with articular cartilage.[6] The labrum gives the fossa more depth and serves as an anchor for the GH ligaments and the long head of the biceps tendon.[7]
Glenolabral articular disruption lesions usually occur from forceful adduction of the humeral head onto the glenoid fossa. Shear force might also be present. This results in varying degrees of underlying cartilage damage as well as a superficial tear along the anterior-inferior aspect of the labrum. This could be a loose chondral body, a more significant flap tear, or even a focal cartilage defect.[7]
Diagnosis[edit]
On non-contrast MRI or CT arthrography imaging, lesions might be harder to find, but the more recent 3T MRI scanners might increase the pick-up rate in the absence of contrast.[4] The accepted gold standard for identifying or detecting the glenolabral articular disruption lesion is MR arthroscopy (MRA).[1]
Treatment[edit]
The preferred course of treatment for the glenolabral articular disruption lesion is arthroscopic debridement of the labrum and glenoid articular defect in patients without any discernible anterior instability.[4]
See also[edit]
References[edit]
- ^ a b c d Sanders TG, Tirman PF, Linares R, Feller JF, Richardson R (January 1999). "The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation". American Journal of Roentgenology. 172 (1): 171–5. doi:10.2214/ajr.172.1.9888763. PMID 9888763.
- ^ Singh, Ranjeet B; Hunter, John C; Smith, Kevin L (2003). "Mri of shoulder instability: state of the art". Current Problems in Diagnostic Radiology. 32 (3). Elsevier BV: 127–134. doi:10.1016/s0363-0188(03)00014-8. ISSN 0363-0188. PMID 12783081.
- ^ Antonio, Gregory E.; Griffith, James F.; Yu, Alfred B.; Yung, Patrick S.H.; Chan, Kai Ming; Ahuja, Anil T. (September 25, 2007). "First-time shoulder dislocation: High prevalence of labral injury and age-related differences revealed by MR arthrography". Journal of Magnetic Resonance Imaging. 26 (4). Wiley: 983–991. doi:10.1002/jmri.21092. ISSN 1053-1807. PMID 17896393.
- ^ a b c Neviaser, Thomas J. (1993). "The GLAD lesion: Another cause of anterior shoulder pain". Arthroscopy: The Journal of Arthroscopic & Related Surgery. 9 (1). Elsevier BV: 22–23. doi:10.1016/s0749-8063(05)80339-1. ISSN 0749-8063. PMID 8442825.
- ^ Hay, Bruce; Fraser-Moodie, James A. (January 23, 2023). "Glenolabral Articular Disruption (GLAD)". StatPearls Publishing. PMID 36943956. Retrieved January 2, 2024.
- ^ Chang, Lou-Ren; Anand, Prashanth; Varacallo, Matthew (August 8, 2023). "Anatomy, Shoulder and Upper Limb, Glenohumeral Joint". StatPearls Publishing. PMID 30725703. Retrieved January 2, 2024.
- ^ a b Robinson, G.; Ho, Y.; Finlay, K.; Friedman, L.; Harish, S. (2006). "Normal anatomy and common labral lesions at MR arthrography of the shoulder". Clinical Radiology. 61 (10). Elsevier BV: 805–821. doi:10.1016/j.crad.2006.06.002. ISSN 0009-9260.
Further reading[edit]
- Wermers, Jens; Schliemann, Benedikt; Raschke, Michael J.; Dyrna, Felix; Heilmann, Lukas F.; Michel, Philipp A.; Katthagen, J. Christoph (2021). "The Glenolabral Articular Disruption Lesion Is a Biomechanical Risk Factor for Recurrent Shoulder Instability". Arthroscopy, Sports Medicine, and Rehabilitation. 3 (6). Elsevier BV: e1803–e1810. doi:10.1016/j.asmr.2021.08.007. ISSN 2666-061X. PMID 34977634.
- Porcellini, Giuseppe; Cecere, Antonio Benedetto; Giorgini, Andrea; Micheloni, Gian Mario; Tarallo, Luigi (2020). "The GLAD Lesion: are the definition, diagnosis and treatment up to date? A Systematic Review". Acta Biomedica Atenei Parmensis. 91 (14–S). Mattioli 1885 srl: e2020020. doi:10.23750/abm.v91i14-S.10987. PMID 33559615.