Perthes Lesion (A Variant of the Bankart Lesion)
MR Imaging and MR Arthrographic Findings with Surgical Correlation
Thorsten K. Wischer1,2,
Miriam A. Bredella1,
Harry K. Genant1,
David W. Stoller3,
Frederic W. Bost4 and
Phillip F. J. Tirman1,3
1
Department of Radiology, University of California San Francisco, 505 Parnassus
Ave., San Francisco, CA 94143-0628.
2
Present address: Department of Diagnostic Radiology, Kantonsspital, University
of Basle, Petersgraben 4, CH-4031 Basle, Switzerland.
3
National Orthopaedic Imaging Associates, 1260 S. Eliseo Dr., Greenbrae, CA
94904.
4
California Pacific Orthopedic and Sports Medicine, 3838 California St., Ste.
715, San Francisco, CA 94118.
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Fig. 1A. —Illustrations show glenoid and labrum. G = glenoid, L =
labrum. Drawing illustrates normal appearance of anterior labrum at insertion
to bony glenoid.
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Fig. 1B. —Illustrations show glenoid and labrum. G = glenoid, L =
labrum. Drawing of Perthes lesion as seen in abduction—external rotation
position shows that anterior band of inferior glenohumeral ligament becomes
taut and induces stress at glenoid insertion, allowing visualization of loose
and only partially healed labrum (arrow). Note stripped scapular
periosteum (arrowheads).
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Fig. 2C. —34-year-old man with left anterior shoulder instability after
injury caused by fall from mountain bike. Arthroscopic photograph shows
nondisplaced anterior labral tear revealed as cleft (arrows) at
labral insertion to glenoid, consistent with Perthes lesion. Probing of region
confirmed that labrum was still minimally attached to glenoid; however, it had
lost its stabilizing function. G = glenoid, L = labrum, H = humerus.
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Fig. 3C. —32-year-old basketball player with recurrent traumatic
anterior shoulder dislocations. Arthroscopic photograph obtained after probing
anterior labrum confirms presence of Perthes lesion with only loosely attached
anterior labrum (arrow). Fraying of labrum is visible at tip of
probe. Granulation tissue deposition at labral insertion was seen. G =
glenoid, L = labrum, P = probe.
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Fig. 4C. —30-year-old woman with anterior shoulder instability after
fall from horse. Arthroscopic photograph shows Perthes lesion with
nondisplaced detached anterior labrum (arrow) from bony glenoid. At
initial inspection, labrum appeared to be normal. Probing of anterior labrum
at arthroscopy confirmed presence of Perthes lesion. Reattachment of anterior
labrum to glenoid was performed. G = glenoid, L = labrum, P = probe.
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Fig. 4A. —30-year-old woman with anterior shoulder instability after
fall from horse. Axial T2-weighted fast spin-echo MR image with fat saturation
(TR/TE, 3200/40) shows slightly thickened but intact anterior labrum
(arrowheads).
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Fig. 4B. —30-year-old woman with anterior shoulder instability after
fall from horse. T2-weighted fast spin-echo MR image with fat saturation
(3200/40) obtained in abduction—external rotation position shows partial
detachment of anterior labrum from glenoid with increased signal intensity at
labral insertion (arrow) to glenoid.
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Fig. 2A. —34-year-old man with left anterior shoulder instability after
injury caused by fall from mountain bike. Axial T1-weighted spin-echo MR
arthrogram with fat saturation (TR/TE, 766/12) shows thin line of increased
signal intensity (arrow) under attachment of anterior labrum to bony
glenoid consistent with nondisplaced labral tear.
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Fig. 2B. —34-year-old man with left anterior shoulder instability after
injury caused by fall from mountain bike. T1-weighted spin-echo MR arthrogram
with fat saturation (533/15) obtained with patient in abduction—external
rotation position shows partial detachment of anterior labrum from glenoid.
Note subtle signal increase (arrow) at labral insertion to
glenoid.
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Fig. 3A. —32-year-old basketball player with recurrent traumatic
anterior shoulder dislocations. Axial T1-weighted MR arthrogram (TR/TE,
766/12) with fat saturation shows thickened anterior labrum (arrow)
with high signal at labral insertion.
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Fig. 3B. —32-year-old basketball player with recurrent traumatic
anterior shoulder dislocations. Oblique axial T1-weighted MR arthrogram
(533/15) obtained with patient in abduction—external rotation position
shows detachment (arrow) of anterior labrum from glenoid, with only a
few fibers still attached to glenoid. Fibrous tissue deposition at region of
anterior labrum can be observed (arrowhead).
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Fig. 5A. —32-year-old man with anterior shoulder instability after fall
on outstretched hand. Axial T1-weighted MR arthrogram (TR/TE, 766/12) with fat
saturation shows thickened anterior labrum (arrowheads). No tear was
noted on axial images.
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Fig. 5B. —32-year-old man with anterior shoulder instability after fall
on outstretched hand. Oblique axial T1-weighted MR arthrogram (533/15)
obtained in abduction—external rotation position shows detachment of
anterior labrum from glenoid (arrow), consistent with Perthes lesion.
Arthroscopy performed 1 month after MR imaging confirmed presence of Perthes
lesion; labral reattachment was performed.
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Copyright © 2002 by the American Roentgen Ray Society.
