How to diagnose humeral glenoid dystrophy?

Diagnosis of Humeral Glenoid Dystrophy

The diagnosis of humeral glenoid dystrophy requires a combination of clinical assessment and advanced imaging, with MR arthrography being the gold standard for evaluation due to its superior ability to assess both osseous and soft tissue abnormalities.

Clinical Assessment

• Patients with humeral glenoid dystrophy may present with symptoms of shoulder instability, including pain associated with loss of shoulder function due to excessive translation of the humeral head on the glenoid fossa 1
• Physical examination should focus on:
  • Assessment of range of motion, particularly looking for limitation of abduction with external or internal rotation 2
  • Evaluation for signs of instability using specific tests for anterior, posterior, and multidirectional instability 3
  • Assessment of rotator cuff strength, as weakness in posterior shoulder musculature combined with overdeveloped anterior musculature can contribute to the pathology 2

Imaging Studies

Initial Imaging

• Standard radiographs should be the first imaging study, including:
  • Anteroposterior (AP) views in internal and external rotation 4
  • Axillary or scapula-Y view to properly assess glenohumeral alignment 4
  • Special views such as the Westpoint view for bony Bankart lesions and Stryker notch view for Hill-Sachs deformities 4

Advanced Imaging

• MR arthrography is the gold standard for evaluating glenoid dysplasia with a rating of 9/9 in appropriateness criteria 4, 2

  • Superior for detecting labral tears with sensitivity ranging from 86% to 100% 2
  • Excellent for assessing labroligamentous injuries, glenohumeral ligament injuries, and glenoid bone loss 4
  • Able to delineate humeral head and glenoid cartilage abnormalities 2

• Non-contrast MRI (rated 7/9) is a reasonable alternative when MR arthrography is not available 4

  • May be preferred in acute settings when post-traumatic joint effusion provides sufficient visualization of soft tissue structures 2
  • Performs comparably to CT in evaluating glenoid and humeral head bone loss 2

• CT without contrast:

  • Useful for identifying and characterizing scapular fracture patterns 2
  • Can better assess intra-articular extension, angulation, and lateral border offset compared to conventional radiographs 2
  • Three-dimensional reformatted CT images provide better visualization of displacement and angulation 2

• CT arthrography (rated 5/9) can be considered if MRI is contraindicated 4

  • Comparable with MR arthrography in diagnosing Bankart and Hill-Sachs lesions 2
  • However, inferior to MRI in diagnosing other soft-tissue pathology 2

Key Diagnostic Findings

• Characteristic findings of glenoid dysplasia on imaging include:

  • Abnormally thickened or hypertrophic posterior labrum 5
  • Increased capsular volume 5
  • Glenoid retroversion (>10° may be significant) 5
  • Posteroinferior glenoid deficiency 5
  • Possible posterior subluxation of the humeral head 6
  • Widening of the anterior glenohumeral joint space 6

• In severe cases, additional findings may include:

  • Notch-like defects along with signs of degenerative disease within the lower portion of the glenoid rims 6
  • Osteophytes arising from the hypoplastic glenoid 6
  • Degenerative cysts or cortical defects in the humeral head 6

Common Pitfalls to Avoid

• Ultrasound has no defined role in the assessment of glenoid dysplasia and should not be used as a primary diagnostic tool 4
• Relying solely on conventional radiographs may miss subtle forms of glenoid dysplasia that could predispose patients to symptomatic posterior shoulder instability 5
• Failure to obtain cross-sectional imaging (MRI or CT) in patients with persistent symptoms may lead to missed diagnoses 6
• Not recognizing that glenoid retroversion of >10° may be a risk factor for failure following soft-tissue-only procedures for symptomatic glenoid dysplasia 5

Management Considerations

• Initial management should focus on physical therapy with rotator cuff strengthening and proprioceptive control 5
• Surgical options may be considered for persistent instability and include:
  • Labral repair and capsulorrhaphy procedures for symptomatic posterior shoulder instability 5
  • Osseous procedures such as glenoid reorientation (osteotomy) or glenoid augmentation (bone graft) for cases with significant glenoid retroversion 5