Perthes lesion

Last revised by Arlene Campos on 11 Jan 2024

Perthes lesion of the shoulder is one of the types of anterior glenohumeral injury in which the anterior inferior labrum is torn and lifted from the edge of the glenoid 1 but still attached to the intact lifted periosteum from the anterior aspect of the glenoid. Although the labrum may be normally positioned, functionally it no longer provides any stability to the humeral head, mainly as a result of impairment of the normal stabilizing influence of the inferior glenohumeral ligament.

Perthes lesions should not be confused with Perthes disease of the hip.

As the labrum is often normally positioned it may be difficult to appreciate, especially if scarring obliterates the space deep to the labrum. The presence of joint effusion on MR arthrogram help in the detection of this lesion by demonstrating fluid extending beneath the labrum and filling the space between the elevated periosteum anteriorly and the scapula posteriorly.

Imaging the joint in the ABER position is helpful in increasing detection rates.

Although scarring may develop making detection both on imaging and arthroscopy difficult to interpret, the shoulder remains unstable, unless re-attachment of the labrum is performed.

It is named after Georg Clemens Perthes (1869-1927), German surgeon, who first described the lesion in 1905 5. Perthes was also interestingly one of the first people to use radiotherapy to treat breast carcinoma 5.

A number of lesions are closely related have similar appearances: see anterior glenohumeral injury for discussion of the differences.

An ALPSA lesion ("medialised Bankart") involves medial displacement of the torn labrum which is still attached to the medial scapular periosteum.

A sublabral recess can be a differential in some situations.

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Cases and figures

  • Figure 1: common labral injuries
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  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5: MR arthrography
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