Glenolabral articular disruption explained

Synonyms:	GLAD

Glenolabral articular disruption (GLAD) lesion is a type of shoulder injury. It is difficult to diagnose clinically, and requires surgical repair to correct the damage to the shoulder.^[1]

Signs and symptoms

Persistent or worsening shoulder pain is the most common symptom of glenolabral articular disruption lesions. The pain is often described as anterior or global.^[1] Joint instability has also been reported in some cases.^{[2] [3]}

Causes

Glenolabral articular disruption lesions often develop as a result of shoulder trauma. External rotation and forced shoulder adduction from an abduction position characterize the classic pattern from the original series. This often occurs due to falling onto an outstretched arm.^[1] The injury has also been reported in association with forceful adduction as a result of throwing.^[4]

Mechanism

The glenoid cartilage underneath the labrum in the glenohumeral (GH) joint is disrupted by glenolabral articular disruption.^[5] The articulation of the humeral head inside the glenoid fossa of the scapula forms the GH joint itself, which is a synovial ball and socket joint. The labrum, a fibrocartilaginous rim, encircles the fossa at its edge and is lined with articular cartilage.^[6] The labrum gives the fossa more depth and serves as an anchor for the GH ligaments and the long head of the biceps tendon.^[7]

Glenolabral articular disruption lesions usually occur from forceful adduction of the humeral head onto the glenoid fossa. Shear force might also be present. This results in varying degrees of underlying cartilage damage as well as a superficial tear along the anterior-inferior aspect of the labrum. This could be a loose chondral body, a more significant flap tear, or even a focal cartilage defect.^[7]

Diagnosis

On non-contrast MRI or CT arthrography imaging, lesions might be harder to find, but the more recent 3T MRI scanners might increase the pick-up rate in the absence of contrast.^[4] The accepted gold standard for identifying or detecting the glenolabral articular disruption lesion is MR arthroscopy (MRA).^[1]

Treatment

The preferred course of treatment for the glenolabral articular disruption lesion is arthroscopic debridement of the labrum and glenoid articular defect in patients without any discernible anterior instability.^[4]

See also

• ALPSA lesion
• Bankart lesion

Further reading

• Wermers . Jens . Schliemann . Benedikt . Raschke . Michael J. . Dyrna . Felix . Heilmann . Lukas F. . Michel . Philipp A. . Katthagen . J. Christoph . The Glenolabral Articular Disruption Lesion Is a Biomechanical Risk Factor for Recurrent Shoulder Instability . Arthroscopy, Sports Medicine, and Rehabilitation . Elsevier BV . 3 . 6 . 2021 . 2666-061X . 10.1016/j.asmr.2021.08.007 . e1803–e1810 . free . 34977634 . none.
• Porcellini . Giuseppe . Cecere . Antonio Benedetto . Giorgini . Andrea . Micheloni . Gian Mario . Tarallo . Luigi . The GLAD Lesion: are the definition, diagnosis and treatment up to date? A Systematic Review. . Acta Biomedica Atenei Parmensis . 2020 . Mattioli 1885 srl . 91 . 14–S . 10.23750/abm.v91i14-S.10987 . e2020020 . free . 33559615 . none.

Notes and References

1. Sanders TG, Tirman PF, Linares R, Feller JF, Richardson R . The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation . American Journal of Roentgenology . 172 . 1 . 171–5 . January 1999 . 9888763 . 10.2214/ajr.172.1.9888763.
2. Singh . Ranjeet B . Hunter . John C . Smith . Kevin L . Mri of shoulder instability: state of the art . Current Problems in Diagnostic Radiology . Elsevier BV . 32 . 3 . 2003 . 0363-0188 . 10.1016/s0363-0188(03)00014-8 . 127–134. 12783081 .
3. Antonio . Gregory E. . Griffith . James F. . Yu . Alfred B. . Yung . Patrick S.H. . Chan . Kai Ming . Ahuja . Anil T. . First-time shoulder dislocation: High prevalence of labral injury and age-related differences revealed by MR arthrography . Journal of Magnetic Resonance Imaging . Wiley . 26 . 4 . September 25, 2007 . 1053-1807 . 10.1002/jmri.21092 . 983–991. 17896393 .
4. Neviaser . Thomas J. . The GLAD lesion: Another cause of anterior shoulder pain . Arthroscopy: The Journal of Arthroscopic & Related Surgery . Elsevier BV . 9 . 1 . 1993 . 0749-8063 . 10.1016/s0749-8063(05)80339-1 . 22–23. 8442825 .
5. Web site: Hay . Bruce . Fraser-Moodie . James A. . Glenolabral Articular Disruption (GLAD) . StatPearls Publishing . January 23, 2023 . 36943956 . January 2, 2024 . May 7, 2024 . https://web.archive.org/web/20240507235902/https://www.ncbi.nlm.nih.gov/books/NBK589638/ . live .
6. Web site: Chang . Lou-Ren . Anand . Prashanth . Varacallo . Matthew . Anatomy, Shoulder and Upper Limb, Glenohumeral Joint . StatPearls Publishing . August 8, 2023 . 30725703 . January 2, 2024 . January 6, 2024 . https://web.archive.org/web/20240106043735/https://www.ncbi.nlm.nih.gov/books/NBK537018/ . live .
7. Robinson . G. . Ho . Y. . Finlay . K. . Friedman . L. . Harish . S. . Normal anatomy and common labral lesions at MR arthrography of the shoulder . Clinical Radiology . Elsevier BV . 61 . 10 . 2006 . 0009-9260 . 10.1016/j.crad.2006.06.002 . 805–821.