Glenoid hypoplasia, also known as glenoid dysplasia, is an uncommon congenital condition resulting from underdevelopment of inferior glenoid ossification center.
Although previously considered rare, there is increasing recognition of a spectrum of glenoid hypoplasia with the increasing use of CT and MRI for shoulder assessment. More recent reports estimate a prevalence ~20% (range 14 to 35%) 2,6, and possibly varying by race 7.
Glenoid hypoplasia is likely under-diagnosed since it is frequently asymptomatic or minimally symptomatic, particularly early in life and in cases of mild deformity.
Glenoid hypoplasia is commonly asymptomatic or only mildly symptomatic, particularly in younger patients 1,6.
Symptomatic presentations are most common in middle-aged or elderly, and include 1-4:
- limited range of motion
- shoulder pain
- shoulder dislocation (posterior glenohumeral instability) - rare
There are two glenoid ossification centers, superior and inferior 5. The typical pattern in glenoid hypoplasia involves failure of the inferior glenoid epiphysis to ossify properly. Depending on the degree of development, there is variably deficient of the inferior glenoid, compensatory hypertrophy of the articular cartilage/labrum, and variable retroversion of the glenoid relative to the scapular body/neck.
The abnormal morphology may predispose to early degenerative changes such as glenohumeral osteoarthritis and posterior labral tears, resulting from altered glenohumeral mechanics 1,3,6.
Degree of morphologic abnormality is typically classified using the Walch classification of glenoid morphology.
- widened appearance of inferior glenohumeral joint interval 4
- secondary to deficient inferior osseous glenoid, often with associated hypertrophy of the glenoid articular cartilage
- irregular glenoid articular surface
- undulating "dentate" or biconcave appearance 4
- early-onset secondary osteoarthritis 3,4
- depends on degree of underlying morphologic abnormality
- +/- posterior labral tears
- +/- additional osseous morphologic abnormalities, usually limited to adjacent shoulder bones 2
- hypoplasia of proximal humerus
- bossing or "hooking" of distal clavicle
- hypertrophy of coracoid process
- 1. Baca MJ, King RW, Bancroft LW. Glenoid hypoplasia. (2016) Radiology case reports. 11 (4): 386-390. doi:10.1016/j.radcr.2016.08.005 - Pubmed
- 2. Suryawanshi A, Mittal A, Dongre S, Kashyap N. Unilateral glenoid hypoplasia: a case report and review of the literature. (2011) Case reports in orthopedics. 2011: 412721. doi:10.1155/2011/412721 - Pubmed
- 3. Allen B, Schoch B, Sperling JW, Cofield RH. Shoulder arthroplasty for osteoarthritis secondary to glenoid dysplasia: an update. (2014) Journal of shoulder and elbow surgery. 23 (2): 214-20. doi:10.1016/j.jse.2013.05.012 - Pubmed
- 4. Resnick D, Walter RD, Crudale AS. Bilateral dysplasia of the scapular neck. (1982) AJR. American journal of roentgenology. 139 (2): 387-9. doi:10.2214/ajr.139.2.387 - Pubmed
- 5. Ryan, P et al. Glenoid hypoplasia: A case series of ten shoulders. SA orthop. j. [online]. 2014, vol.13, n.4 [cited 2018-08-10], pp.43-49. Available from: Scielo
- 6. 10. Keith W. Harper, Clyde A. Helms, Clare M. Haystead, Lawrence D. Higgins. Glenoid Dysplasia: Incidence and Association with Posterior Labral Tears as Evaluated on MRI. (2012) American Journal of Roentgenology. 184 (3): 984-8. doi:10.2214/ajr.184.3.01840984 - Pubmed
- 7. Edelson JG. Localized glenoid hypoplasia. An anatomic variation of possible clinical significance. (1995) Clinical orthopaedics and related research. Pubmed
- 8. Redouane Kadi, Annemieke Milants, Maryam Shahabpour. Shoulder Anatomy and Normal Variants. (2018) Journal of the Belgian Society of Radiology. 101 (S2): 3. doi:10.5334/jbr-btr.1467 - Pubmed
- 9. Kavanagh EC, Zoga AC, Abboud JA, Koulouris G, Morrison WB. Glenoid Dysplasia: Radiographic, Direct MR Arthrographic and Arthroscopic Appearances. (2006) Radiology case reports. 1 (2): 50-3. doi:10.2484/rcr.v1i2.20 - Pubmed