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                  Il futuro appartiene a coloro che sanno credere nella grandezza dei loro sogni.                                   

Le instabilità di spalla (lussazione o sublussazione) sono patologie molto complesse che hanno avuto una definizione molto più accurata dopo l’avvento dell’artroscopia.  Si possono distinguere in:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Qui di seguito vengono descritte quella che sono le sigle delle lesioni  di spalla.

 

· Bankart lesion

Lesione del gruppo A > classica lesione del labbro glenoideo con distacco antero-inferiore capsulolabrale.

· Bony Bankart lesion

Lesione del gruppo A > è una complicazione della lesione di Bankart in quanto qui è presente anche una avulsione frattura della glenoide (con gradi più o meno severi)

· Perthes lesion

a lesion with incomplete avulsion of the labrum and capsular stripping from the scapular neck. Because of the intact periosteum these lesions may be occult at both imaging and surgery. Adding an ABER sequence to the imaging protocol significantly increases the sensitivity of MR arthrography in detecting these lesions by placing the IGHL complex under tension.

· ALPSA LESION (anterior labral periosteal sleeve avulsion)

Il labbro glenoideo si stacca e scivola posteriormente, perdendo la sua funzione di stabilità.

· SLAP Lesion (Superior Labral, Anterior and Posterior tear)

often seen in athletes involved in sports requiring repetitive overhead use of the arm and varying in severity but involving the superior portion of the glenoid labrum and, sometimes, the biceps anchor.

· HAGL LESION (Humeral Avulsion Glenhumeral Ligament)

avulsione capsulare che include il legamento Gleno Omerale

Incidence of 7% and 9% , the HAGL lesion is an important cause of anterior instability of the glenohumeral joint. The majority (68%) of patients with an HAGL lesion have associated injuries. 

· BHAGL (bony HAGL)

has been described where there is bony avulsion from the neck of the humerus.

· GLOM lesion (glenoid labrum ovoid mass)

a small low signal intensity mass occasionally seen anterosuperiorly in the setting of labral injury on the axial images. It is felt to represent a torn and retracted labrum or MGHL.

· GLAD lesion (glenolabral articular disruption)

a superficial tear of the antero-inferior labrum with an adjacent articular cartilage injury. The extent of the injury may vary from a cartilaginous flap tear to a depressed osteochondral injury of the articular cartilage and underlying bone.

· GARD lesion (the Glenoid Rim Articular Divot lesion)

is not associated with instability.

 

· Hill-Sachs Lesion

Fracture of the posterolateral surface of the humeral head indicative of previous anterior glenohumeral joint dislocation.

· Mc Laughlin sign or reverse Hill Sach's lesion

is a compression fracture of the anterior aspect of the humeral head associated with posterior dislocation. The trough sign.

· Bennett lesion

Enthesophyte that arises from the posteroinferior portion of the glenoid rim, often seen in baseball pitchers and probably arising at the site of insertion of the posterior band of the inferior glenohumeral ligament complex. It is thought to be due to posterior capsular avulsion secondary to traction from the posterior band of the IGHL. Posterior capsule and labral injuries have been reported in 36% and 86% of shoulders with posterior instability respectively. There is also a high incidence of anterior labral abnormalities in shoulders with posterior instability.

 

· SLIP (supraspinatus labral instability pattern)

· Trough Lesion

Fracture of the medial surface of the humeral head indicative of previous posterior glenohumeral joint dislocation.

· Sublabral Foramen

Normal variation in which a foramen is identified between the anterosuperior portion of the glenoid labrum and the articular cartilage of the glenoid cavity.

Buford Complex

Normal variation in which a cord-like middle glenohumeral ligament is associated with absence of the anterosuperior portion of the glenoid labrum.

Osteochondritis Dissecans

A lesion of the glenoid cavity related to an impaction force.

Perilabral Ganglion Cyst

Ganglion cyst arising adjacent to the glenoid labrum and often associated with a labral tear

 

 

 

 

 

 

 

 

INSTABILITY

ACQUIRED

(AMBRI)

MULTIDIRECTIONAL INSTABILITY (NEER)

LAXITY (Lassità di spalla)

LESIONI ALPSA - LESIONI SLAP