Perthes lesion

Perthes Lesion

A Perthes lesion is a specific type of injury to the shoulder joint, particularly affecting the glenoid labrum. It is a variant of the Bankart lesion, which involves detachment of the labrum from the glenoid rim. The Perthes lesion is characterized by a partial detachment of the labrum with an intact periosteum, which can lead to instability of the shoulder joint.

Diagram of the shoulder joint showing the glenoid cavity and labrum.

Anatomy of the Shoulder

The shoulder joint is a complex structure that allows for a wide range of motion. It is a ball-and-socket joint formed by the articulation of the humerus with the glenoid cavity of the scapula. The glenoid labrum is a fibrocartilaginous rim attached around the margin of the glenoid cavity, which deepens the cavity and provides stability to the joint.

Pathophysiology

In a Perthes lesion, the labrum is partially detached from the glenoid, but the periosteum remains intact. This can occur due to trauma or repetitive stress on the shoulder joint, often seen in athletes involved in overhead sports such as baseball or tennis. The intact periosteum allows the labrum to heal in a non-anatomical position, which can lead to persistent instability and pain.

Clinical Presentation

Patients with a Perthes lesion typically present with shoulder pain, especially during activities that involve overhead motion. They may also experience a sensation of instability or "catching" in the shoulder. Physical examination may reveal tenderness over the anterior shoulder and positive tests for shoulder instability.

Diagnosis

Diagnosis of a Perthes lesion is often made using magnetic resonance imaging (MRI), which can visualize the labral detachment and the condition of the periosteum. Arthroscopy is considered the gold standard for diagnosis, as it allows direct visualization of the lesion.

Treatment

Treatment options for a Perthes lesion include both conservative and surgical approaches. Conservative treatment involves physical therapy to strengthen the shoulder muscles and improve stability. Surgical intervention may be necessary if conservative measures fail, typically involving arthroscopic repair of the labrum.

Prognosis

The prognosis for a Perthes lesion depends on the severity of the injury and the treatment approach. With appropriate management, many patients can return to their previous level of activity without significant limitations.

Related Pages

• Bankart lesion
• Shoulder instability
• Glenoid labrum
• Arthroscopy