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Osteochondral Injury, Shoulder
Michael J. Tuite, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • (Osteo)chondral defect, osteochondral (OC) lesion, osteochondritis dissecans
            • Definitions

              • Traumatic injury involving articular surface of humeral head or glenoid fossa
                • Isolated lesions are rare
                • More commonly associated with other injuries
                  • Bankart fracture, large Hill-Sachs fracture
                    • Anterior dislocation, often capsule injury
                  • Reverse Bankart fracture, reverse Hill-Sachs fracture
                    • Posterior dislocation
                  • Glenolabral articular disruption lesion
                    • Chondral injury and superficial tear anteroinferior labrum
                  • Glenoid articular disruption or divot
                    • Osteochondral defect and labral tear
                    • Can be anterior or posterior
                  • Rotator cuff impingement and tears
                    • Seen in 1/3 at surgery
                  • Internal impingement humeral head lesions
                    • Overhead throwing athletes
                    • Posterior greater tuberosity

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Omoumi P et al: Diagnostic performance of CT-arthrography and 1.5T MR-arthrography for the assessment of glenohumeral joint cartilage: a comparative study with arthroscopic correlation. Eur Radiol. 25(4):961-9, 2015
                                        2. Guermazi A et al: MR arthrography of the shoulder: optimizing pulse sequence protocols for the evaluation of cartilage and labrum. Eur J Radiol. 83(8):1421-8, 2014
                                        3. VanBeek C et al: Diagnostic accuracy of noncontrast MRI for detection of glenohumeral cartilage lesions: a prospective comparison to arthroscopy. J Shoulder Elbow Surg. 23(7):1010-6, 2014
                                        4. Gross CE et al: Operative treatment of chondral defects in the glenohumeral joint. Arthroscopy. 28(12):1889-901, 2012
                                        5. Kircher J et al: Osteochondral autologous transplantation for the treatment of full-thickness cartilage defects of the shoulder: results at nine years. J Bone Joint Surg Br. 91(4):499-503, 2009
                                        6. Wiener E et al: Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) of cadaveric shoulders: comparison of contrast dynamics in hyaline and fibrous cartilage after intraarticular gadolinium injection. Acta Radiol. 50(1):86-92, 2009
                                        7. Lecouvet FE et al: Multidetector spiral CT arthrography of the shoulder. Clinical applications and limits, with MR arthrography and arthroscopic correlations. Eur J Radiol. 68(1):120-36, 2008
                                        8. Choi YS et al: A shearing osteochondral fracture of the humeral head following an anterior shoulder dislocation in a child. HSS J. 1(1):100-2, 2005
                                        9. Ly JQ et al: Bare area of the glenoid: magnetic resonance appearance with arthroscopic correlation. J Comput Assist Tomogr. 28(2):229-32, 2004
                                        10. Sanders TG et al: The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation. AJR Am J Roentgenol. 172(1):171-5, 1999
                                        11. Yu JS: The glenolabral articular disruption lesion: similarities to the glenoid osteochondral defect. AJR Am J Roentgenol. 173(3):850-1, 1999
                                        12. Yu JS et al: Osteochondral defect of the glenoid fossa: cross-sectional imaging features. Radiology. 206(1):35-40, 1998
                                        13. Hamada S et al: Osteochondritis dissecans of the humeral head. Arthroscopy. 8(1):132-7, 1992
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • (Osteo)chondral defect, osteochondral (OC) lesion, osteochondritis dissecans
                                                  • Definitions

                                                    • Traumatic injury involving articular surface of humeral head or glenoid fossa
                                                      • Isolated lesions are rare
                                                      • More commonly associated with other injuries
                                                        • Bankart fracture, large Hill-Sachs fracture
                                                          • Anterior dislocation, often capsule injury
                                                        • Reverse Bankart fracture, reverse Hill-Sachs fracture
                                                          • Posterior dislocation
                                                        • Glenolabral articular disruption lesion
                                                          • Chondral injury and superficial tear anteroinferior labrum
                                                        • Glenoid articular disruption or divot
                                                          • Osteochondral defect and labral tear
                                                          • Can be anterior or posterior
                                                        • Rotator cuff impingement and tears
                                                          • Seen in 1/3 at surgery
                                                        • Internal impingement humeral head lesions
                                                          • Overhead throwing athletes
                                                          • Posterior greater tuberosity

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Omoumi P et al: Diagnostic performance of CT-arthrography and 1.5T MR-arthrography for the assessment of glenohumeral joint cartilage: a comparative study with arthroscopic correlation. Eur Radiol. 25(4):961-9, 2015
                                                                              2. Guermazi A et al: MR arthrography of the shoulder: optimizing pulse sequence protocols for the evaluation of cartilage and labrum. Eur J Radiol. 83(8):1421-8, 2014
                                                                              3. VanBeek C et al: Diagnostic accuracy of noncontrast MRI for detection of glenohumeral cartilage lesions: a prospective comparison to arthroscopy. J Shoulder Elbow Surg. 23(7):1010-6, 2014
                                                                              4. Gross CE et al: Operative treatment of chondral defects in the glenohumeral joint. Arthroscopy. 28(12):1889-901, 2012
                                                                              5. Kircher J et al: Osteochondral autologous transplantation for the treatment of full-thickness cartilage defects of the shoulder: results at nine years. J Bone Joint Surg Br. 91(4):499-503, 2009
                                                                              6. Wiener E et al: Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) of cadaveric shoulders: comparison of contrast dynamics in hyaline and fibrous cartilage after intraarticular gadolinium injection. Acta Radiol. 50(1):86-92, 2009
                                                                              7. Lecouvet FE et al: Multidetector spiral CT arthrography of the shoulder. Clinical applications and limits, with MR arthrography and arthroscopic correlations. Eur J Radiol. 68(1):120-36, 2008
                                                                              8. Choi YS et al: A shearing osteochondral fracture of the humeral head following an anterior shoulder dislocation in a child. HSS J. 1(1):100-2, 2005
                                                                              9. Ly JQ et al: Bare area of the glenoid: magnetic resonance appearance with arthroscopic correlation. J Comput Assist Tomogr. 28(2):229-32, 2004
                                                                              10. Sanders TG et al: The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation. AJR Am J Roentgenol. 172(1):171-5, 1999
                                                                              11. Yu JS: The glenolabral articular disruption lesion: similarities to the glenoid osteochondral defect. AJR Am J Roentgenol. 173(3):850-1, 1999
                                                                              12. Yu JS et al: Osteochondral defect of the glenoid fossa: cross-sectional imaging features. Radiology. 206(1):35-40, 1998
                                                                              13. Hamada S et al: Osteochondritis dissecans of the humeral head. Arthroscopy. 8(1):132-7, 1992