ALPSA lesion

PD-weighted MRI with fat saturation of the shoulder showing an ALPSA lesion

An ALPSA (anterior labral periosteal sleeve avulsion) lesion is an injury at the front of the shoulder associated with shoulder dislocation.

Anatomy

The shoulder joint is made up of the glenoid and humeral head. The humeral head is ball shaped but the glenoid is more dish shaped than cup shaped. To aid stability of the joint, the glenoid has a soft tissue bumper around its edge (the labrum) which acts as a bumper preventing dislocation of the head from the glenoid.

Pathology

The anterior (front) labrum can peel off the glenoid resulting in a Bankart lesion. When the periosteum (fibrous tissue surrounding bone) peels off as well this is called an ALPSA lesion. When this happens the labrum (bumper) falls away and rolls up. It normally falls medially and downwards.

Surgery

If required, the labrum and periosteum can be reattached, recreating the bumper affect, aiding shoulder stability and hopefully preventing further dislocation. It can be done by Arthroscopic techniques or with open surgery. The injury cannot always be repaired.

Dislocations/subluxations, sprains and strains

Joints and
ligaments

Head and neck	Dislocation of jaw Whiplash

Shoulder and upper arm	GH (Dislocated shoulder) AC (Separated shoulder) ALPSA lesion SLAP tear Bankart lesion

Elbow and forearm	Nursemaid's elbow Gamekeeper's thumb

Hip and thigh	Dislocation of hip

Knee and leg	Tear of meniscus Anterior cruciate ligament injury Unhappy triad Patellar dislocation

Ankle and foot	Sprained ankle (High ankle sprain) Metatarsophalangeal joint sprain (Turf toe)

Muscles and
tendons

Shoulder and upper arm	Rotator cuff tear

Hip and thigh	Pulled hamstring

Knee and leg	Patellar tendon rupture Achilles tendon rupture Shin splints

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