Case of the Day(sm)

1 of 6

Athlete with shoulder pain.

Contributed from the case records of the
Indiana University Department of Radiology

History: Athlete with shoulder pain.

Click these images to enlarge them.

Which choice best localizes the salient finding(s)?

Bicipital tendon.Anterior glenoid.Posterior glenoid.A and B.B and C.

1 of 6

Case of the Day(SM) Copyright

Case of the Day(sm)

2 of 6

Athlete with shoulder pain.

Same images are again shown below. Given that there are labral tears (anterior and posterior), which choice best describes the composition of a visible accompanying abnormality?

Bone.Intra-articular fluid.Extra-articular fluid.Cartilage.Fat.

2 of 6

Case of the Day(SM) Copyright

Case of the Day(sm)

3 of 6

Athlete with shoulder pain.

Can you name the actual diagnosis?

Bennett lesion.Bankart lesion.HAGL lesion.Calcific tendonitis.GLOM lesion.

3 of 6

Case of the Day(SM) Copyright

Case of the Day(sm)

4 of 6

Athlete with shoulder pain.

Findings: Sagittal PD FSE and multiple axial T2* GRE images through the right shoulder demonstrate a hypointense, heterotopic ossification posterior to the posterior glenoid. Also present are tears of the anterior and posterior labrum.

Bennet lesion is shown by yellow arrows below.

Differential diagnosis:

Bennett lesion
Posterior labral tear
Posterosuperior glenoid impingement
Posterior capsular tear
Scapular fracture
Calcific tendonitis

Diagnosis: Bennett lesion

4 of 6

Case of the Day(SM) Copyright

Case of the Day(sm)

5 of 6

Athlete with shoulder pain.

Key points - Bennett lesion:

Definition:
- Extraarticular, posterior dystrophic/heterotopic ossification at the posterior or posteroinferior glenoid rim
- Size of ossification can range from several mms to >1 cm
- Ossification is crescentic +/- fragmentation
- Adjacent to torn or degenerated posterior labrum
Etiology:
- Posterior capsular avulsion secondary to traction from the posterior band of the Inferior glenohumeral ligament
- Deceleration phase of pitching
Presentation:
- Posterior shoulder pain especially with throwing activities
- Tenderness at posterior inferior glenoid region
- Occurs in young athletes, commonly in baseball players (e.g., professional pitchers)
Imaging:

Radiography and CT findings

Mineralization adjacent posterior glenoid
Subchondral sclerosis and cysts

MR findings

T1WI:

Globular to crescent like ossification within posterior soft tissues
Decreased subchondral signal representing sclerosis

T2WI:

Hypo intense area of ossification at insertion of posterior joint capsule
May have adjacent chondromalacia (increased signal intensity within the hyaline articular cartilage, +/- surface irregularity)

PD FSE

Increased signal in surrounding soft tissues representing edema and hemorrhage
Labrum torn or markedly heterogenous

T2*GRE: Calcium "bloom"

Arthrogram (CT or MR)

Associated posterior labral tear with contrast extending into the tear

Treatment:
- Conservation: PT and NSAIDS, pain may subside with cessation of throwing activity
- Surgical: Arthroscopic debridement of soft tissue ossification