The Unknown Cases Texas Radiological Society 92nd Annual Scientific Meeting San Antonio, TX April 13

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The Unknown CasesTexas Radiological Society
92nd Annual Scientific MeetingSan Antonio, TX
April 1-3, 2005

• Justin Q. Ly, MD
• Douglas P. Beall, MD
• Ernesto Torres, MD
• Daniel H. Duffy
• Department of Radiology and Nuclear Medicine
• Wilford Hall Medical Center/SAUSHEC Radiology
• Oklahoma University Health Sciences Center
• Brooke Army Medical Center

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CASE 4

• Male in 20s with history of recent FOOSH injury
  presents with nonspecific anterior shoulder pain.
  Physical exam shows NO evidence of glenohumeral
  instability.

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(No Transcript)
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Diagnosis?

• GLAD

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GLAD Lesion

• GlenoLabral Articular Disruption

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Partial-thickness anteroinferior labral tear with
adjacent glenoid articular cartilage defect (red
arrow)
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GLAD Lesion

• Nevasier (Ortho), 1993
• Sanders et al (Radiol), 1999
• Glenohumeral impaction inj caused by forced
  adduction of shoulder from abducted and external
  rotated position (FOOSH)
• Anterior shoulder pain
• NO INSTABILITY on PE

Nevasier TJ, Arthroscopy 1993922-23 Sanders et
al, AJR 1999172171-175
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GLAD Lesion

• Superficial anteroinferior labral tear associated
  with anterioinferior glenoid articular cartilage
  inj
• Anterior band IGHL INTACT!-stable lesion

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GLAD Lesion

• Artic cart defects fibrillation, defect/flap,
  chondromalacia, loose jt bodies
• Contrast fills chondral defect/flap
• Important to differentiate from Bankart
• -Bankart requires stabilization procedure/repair
  of labrolig complex
• -GLAD-debridement of cartilage/labrum

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Glenoid Clockface 3-6 Oclock

• The Big Four
• Bankart
• ALPSA
• Perthes
• GLAD

A
12
3
9
6
11
BANKART
ALPSA
GLAD
PERTHES