ALPSA lesion

A type of shoulder injury

ALPSA lesion (Anterior Labroligamentous Periosteal Sleeve Avulsion) is a specific type of shoulder injury that involves the detachment of the anterior glenoid labrum along with the periosteum. This condition is often associated with shoulder dislocation and can lead to shoulder instability.

Pathophysiology

The ALPSA lesion occurs when the anterior labrum is avulsed from the glenoid rim, but unlike a Bankart lesion, the periosteum remains intact and the labrum is displaced medially. This results in a sleeve-like appearance of the labrum and periosteum, which can be visualized on MRI scans. The medial displacement of the labrum can lead to a reduction in the stability of the shoulder joint, predisposing the patient to recurrent dislocations.

Clinical Presentation

Patients with an ALPSA lesion typically present with symptoms of shoulder instability, such as a feeling of the shoulder "slipping out" or "giving way," especially during activities that involve overhead motion. There may also be associated pain and weakness in the shoulder.

Diagnosis

The diagnosis of an ALPSA lesion is primarily made through imaging studies. Magnetic Resonance Imaging (MRI) is the preferred modality as it provides detailed images of the soft tissues, allowing for the identification of the characteristic medial displacement of the labrum. An MRI scan can also help differentiate an ALPSA lesion from other types of labral injuries, such as a Bankart lesion.

Treatment

The treatment of an ALPSA lesion depends on the severity of the symptoms and the degree of shoulder instability. Conservative management, including physical therapy, may be attempted initially to strengthen the shoulder muscles and improve joint stability. However, in cases where conservative treatment fails, surgical intervention may be necessary.

Surgical Intervention

Surgical treatment typically involves arthroscopic repair of the labrum. The goal of surgery is to reattach the labrum to the glenoid rim and restore the normal anatomy of the shoulder joint. This is achieved by using suture anchors to secure the labrum in its anatomical position. Postoperative rehabilitation is crucial to ensure a successful outcome and involves a structured physical therapy program to restore range of motion and strength.

Prognosis

The prognosis for patients with an ALPSA lesion is generally good, especially with appropriate surgical intervention and rehabilitation. Most patients are able to return to their previous level of activity, including sports, following successful treatment.

Related pages

• Shoulder dislocation
• Bankart lesion
• Glenoid labrum
• Shoulder instability

Gallery

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  MRI image showing an ALPSA lesion