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Perthes’ Lesion

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Perthes’ Lesion. History of weightlifting and persistent shoulder pain. Anterior Ligamentous Periosteal Sleeve Avulsion (ALIPSA). Adhesive Capsulitis. Pectoralis Tendon Avulsion. 28M Posterior shoulder pain - No trauma. PDFS. Parsonage Turner. Superior surface tear Sag T2.

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Presentation Transcript
slide1
Perthes’ Lesion

History of weightlifting and persistent shoulder pain

25m bench pressing
25M – Bench pressing

Axial T2 Shoulder

pectoralis major rupture
Pectoralis Major Rupture
  • Can be difficult to see
    • Especially chronically
25m pain
25M - Pain

Cor T1 FS IAGd

full thickness tear
Full Thickness Tear
  • Acute
    • Anterior edge of supraspinatus
  • Degenerative
    • Mid supraspiantus
slide37
Cor T2FS

Cor T1

slide68
56MSwimming and body surfing in Hawaii 2 weeks ago; struck shoulder. Fracture/dislocation.Greater tuberosity fracture. R/o rotator cuff tear.
slide72
Findings
  • Fracture of posterolateral humeral head with avulsion of teres minor insertion
  • Joint effusion with large posterior collection
  • Extensive muscle edema and hemorrhage
  • Avulsion of infraspinatus tendon at insertion
  • Probable rupture of intraarticular biceps
  • Avulsion of posterior capsule
  • Supraspinatus tendinopathy
ovesen j sojbjerg jo posterior shoulder dislocation acta orthop scand 1986 57 535 536
Ovesen J, Sojbjerg JO. Posterior shoulder dislocation.Acta Orthop Scand. 1986; 57: 535-536.

10 cadaver shoulders, provoked posterior subspinous gh joint dislocation

  • In 10/10: Teres minor rupture, posterior capsule rupture, and infraspinatus tear
  • In 8/10: Lower subscapularis tear
  • In 10/10: Intact supraspinatus and CH ligament
slide75
Ax T1FS

Ax T1

Ax T2

Ax T1FSGd

*

Possible angiolipoma

angiolipoma
Angiolipoma
  • Rare, benign
  • Mature lipocytes with angiomatous prolif.
  • Young adults upper extremity
  • Firmer than lipoma
  • Noninfiltrating subQ, encapsulated
  • Infiltrating deep
slide82
Labral tear with

paralabral cyst

slide83

53M

53M

Pain and possible biceps calcific tendonosis on X-ray

slide86
Cor T2FS

Cor T1

Calcific bursitis

slide87

60M

1Y shoulder pain and reduced ROM

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