Perthes lesion

Perthes lesion is a medical condition affecting the shoulder joint, specifically the labrum of the shoulder. It is named after Georg Perthes, a German surgeon who contributed significantly to the study of orthopedics. This condition is a variant of a labral tear and is closely associated with shoulder dislocations and instability.

Overview

The shoulder joint is a ball-and-socket joint that allows a wide range of movement. The labrum is a fibrocartilaginous rim attached to the margin of the glenoid cavity in the shoulder blade. It deepens the cavity, providing stability to the joint by increasing the surface area for the head of the humerus (upper arm bone) to fit into. A Perthes lesion involves a detachment of the labrum and the glenohumeral ligaments from the glenoid, but the periosteum (a membrane that covers the bone) remains intact. This condition can lead to pain, instability, and decreased range of motion in the shoulder.

Causes

Perthes lesion is often caused by trauma or an injury to the shoulder, such as a fall on an outstretched hand or a direct blow to the shoulder. It can also occur due to repetitive overhead activities, making it common among athletes, particularly those involved in throwing, swimming, or volleyball.

Symptoms

Common symptoms of a Perthes lesion include:

• Pain in the shoulder, especially with overhead activities
• A sensation of the shoulder "giving way"
• Decreased range of motion
• Instability in the shoulder
• A catching or locking sensation in the shoulder

Diagnosis

Diagnosis of a Perthes lesion typically involves a combination of patient history, physical examination, and imaging studies. During the physical examination, the doctor may perform specific tests to assess the stability of the shoulder and identify any labral tears. Imaging studies such as Magnetic Resonance Imaging (MRI) or Magnetic Resonance Arthrography (MRA) are often used to confirm the diagnosis and assess the extent of the injury.

Treatment

Treatment for a Perthes lesion may vary depending on the severity of the condition and the patient's activity level. Non-surgical treatment options include:

• Rest and avoidance of activities that exacerbate symptoms
• Physical therapy to strengthen the muscles around the shoulder and improve stability
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation

In cases where non-surgical treatment does not relieve symptoms, or in patients who require a full return to high-level activities, surgical intervention may be necessary. Surgery typically involves arthroscopy to reattach the labrum and ligaments to the glenoid. Post-surgery, patients usually undergo a rehabilitation program to restore function and prevent recurrence.

Prognosis

With appropriate treatment, most individuals with a Perthes lesion can return to their previous level of activity. The prognosis is generally good, especially for those who undergo surgical repair, with many patients experiencing a significant reduction in pain and improvement in shoulder stability and function.