Neviaser described the GLAD lesion (glenolabral articular disruption), a superficial anteroinferior labral tear with glenoid cartilage injury, as a cause of anterior shoulder pain without instability.
Five patients with anterior shoulder pain after an adduction injury, all treated with arthroscopic debridement.
Key Findings
All five had a superficial anteroinferior labral tear with damage to the adjacent glenoid cartilage, and none was unstable on examination or at surgery.
Only the superficial labral fibers were torn. The deep fibers of the inferior glenohumeral ligament stayed firmly attached.
Every patient described an adduction force across the chest from abduction and external rotation. Three fell onto the abducted elbow.
Arthrograms were normal, yet lidocaine injected with the contrast relieved every patient's symptoms. Neither CT nor MRI showed the cartilage damage.
After debridement and chondroplasty, all five were relieved by 3 months, kept full motion and returned to full activity.
Board pearl
GLAD lesion: superficial anteroinferior labral tear plus glenoid cartilage injury from forced adduction out of abduction and external rotation, painful but stable, treated by debridement rather than stabilization.
Authors' conclusion
Arthroscopic debridement of the labral tear with glenoid articular chondroplasty or abrasion arthroplasty is the treatment of choice.
Neviaser described the GLAD lesion (glenolabral articular disruption), a superficial anteroinferior labral tear with glenoid cartilage injury, as a cause of anterior shoulder pain without instability.
Five patients with anterior shoulder pain after an adduction injury, all treated with arthroscopic debridement.
Key Findings
All five had a superficial anteroinferior labral tear with damage to the adjacent glenoid cartilage, and none was unstable on examination or at surgery.
Only the superficial labral fibers were torn. The deep fibers of the inferior glenohumeral ligament stayed firmly attached.
Every patient described an adduction force across the chest from abduction and external rotation. Three fell onto the abducted elbow.
Arthrograms were normal, yet lidocaine injected with the contrast relieved every patient's symptoms. Neither CT nor MRI showed the cartilage damage.
After debridement and chondroplasty, all five were relieved by 3 months, kept full motion and returned to full activity.
Board pearl
GLAD lesion: superficial anteroinferior labral tear plus glenoid cartilage injury from forced adduction out of abduction and external rotation, painful but stable, treated by debridement rather than stabilization.
Authors' conclusion
Arthroscopic debridement of the labral tear with glenoid articular chondroplasty or abrasion arthroplasty is the treatment of choice.