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I'd like to share with you the spectrum of posterior

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labrum glenoid and labrocapsular lesions posteriorly.

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Let's start with the, the baby one.

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A very small, partial tear,

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in the back rim, not affecting the hyaline cartilage,

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not going all the way through, but producing a

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little bit of a peel back between the labrum and

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the adjacent bone and hyaline cartilage structures.

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And this is known as a Kim's lesion.

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Some people have referred to it

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as a reverse mini Perthes lesion.

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Let's go on to the next one.

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And by the way, this one is usually

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not seen with an overt dislocation.

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And it's seen with repetitive Microinstability

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from weightlifting, either military

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or more commonly bench pressing.

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The next one is a Perthes lesion.

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Now I'm showing this one anteriorly, because I don't

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have the posterior diagram, but it's exactly the same.

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In this case, The lesion does not go all

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the way through and through, by the way.

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Doesn't go through the labrum, nor

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does it go through the periosteum.

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The periosteum remains attached.

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And in fact, it's usually hugging

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even a little closer than this.

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And you can get a little pouch in it.

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You can have this in the back, you can have it in the front.

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Now, let's take that one step further.

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the underlying glenoid, and this tissue is now more

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prominently lifted up for a long, long distance.

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There's a wide area of separation here

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and here, and these patients are usually

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associated with an acute traumatic event.

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And this is known as a The pulpsal lesion, the

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posterior labral periosteal sleeve avulsion.

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Now, unlike the Perthes lesion, we have a

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slight peel, a very subtle peel right here.

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Let me take this away for a moment.

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And let me, let me bring back the

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reverse Perthes lesion for a minute.

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So, we'll use purple again.

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In the reverse Perthes lesion, actually,

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the labrum is a little bit closer,

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and the peel is very small.

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It's usually almost to the apex of the glenoid.

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Whereas in the pulps lesion, the peel goes for a pretty

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good long distance, and the separation here is wider.

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Now, the pulps lesion is in some ways analogous

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emotionally, because of its name, to the Alps lesion.

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But, they're quite different.

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Because in an ALPSA lesion, and I'll show you one in the

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front, because it stands for anterior labral periosteal

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sleeve avulsion, unlike the PULPSA, where the labrum

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pretty much marches in place, maybe diastatically

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separates, but it doesn't roll underneath the periosteum.

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Whereas, in the Alps lesion, the anterior labrum

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starts to roll like a can of sardines being opened.

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It rolls this way underneath the periosteum.

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So they're not quite the same.

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Then we've got the scenario of a capsuloperiosteal

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separation with the labrum remaining attached.

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Also known as posterior labrum intact

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periosteal capsular sleeve avulsion.

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Known as the Pellipsa Lesion, PLIPSA.

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If you have a Pellipsa Lesion, then there's a pretty

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good chance you're going to have an Ellipsa Lesion.

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Same thing, labrum intact, and the capsule

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and periosteum are displaced or detached.

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Pretty darn simple.

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Pellipsa, Ellipsa.

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In the back of the shoulder, you could get a bony Bankart.

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This is one in the front, but they're exactly the same.

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You could fracture through the bone and you could

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bleed into the periosteum, or you could rupture right

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through the periosteum, which is usually the case.

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And then here's the classic Bankart,

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where you have a separation of the labrum.

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You don't have the typical labral tear through

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and through, that's one form of Bankart.

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You could have what's called a periosteal

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Bankart, these are all avulsion lesions.

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So it goes through the periosteum, and then you've

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already seen the bony Bankart, where you go through bone.

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So you got A, you got B, you got C.

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That concludes our discussion of the important

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variations for labral pathology, focusing on

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the back, but using the front as a comparison.