Traumatic injuries from falls, car accidents, or high-impact sports. Second image (Yellow arrow) more pronounced changes. The biceps and labrum are becoming detached from their bed on the glenoid fossa. More posterior image demonstrates mucoid degeneration (blue arrows) without cystic change where the signal is increased but not approximating fluid signal. Although a fraying hip labrum is milder on the spectrum of labral tears, it can still be a significant source of pain and cause the same symptoms as a hip labrum tear. Etiology Location Morphology Anterior tear : The pain will generally be more consistent and is situated on the anterior hip (anterosuperior quadrant) or at the groin.They frequently occur in individuals in European countries and the United States. Posterior refers to the back portion of it. What are the signs and symptoms of an ACL tear? Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. The most accurate way to determine the extent of the injury is to use an arthroscopic camera, which will be inserted via incision into the shoulder. A systematic approach to diagnosis is essential to exclude life-threatening presentations of shoulder pain such as myocardial infarction or aortic dissection. Absence of major joint trauma previous surgery or other known causes of secondary degenerative joint disease. Frequently, these tearsresult from an athletic injury. Other factors that contribute to shoulder labral tears include: Car Accidents Repetitive Overhead Activity Shoulder Dislocation Hip labrum fraying can occur as a result of ongoing hip impingement and is a type of tear that is not as severe as a displaced labral tear. Mucoid degeneration can occur in an otherwise normal labrum or in dysplastic labrums associated with acetabular dysplasia. Type II SLAP Tear Acute The labrum and the long head of the biceps tendon (LHBT) are torn and avulses off the glenoid cavity. A common cause of a posterior labrum tear is repetitive microtrauma to the shoulder joint. In a SLAP injury, the top (superior) part of the labrum is injured. Thankfully, most people who have this kind of injury respond very well to the surgery, and almost always return to a full level of activity. If the damage is more extensive, such as destabilization or complete dislocation, the surgeon must re-anchor the shoulder, which involves a more extensivesurgery. Some meniscus tears will get better without surgery. Here are some other st Its no surprise hip pain is a common problem in teenage athletes. Learn moreabout arthroscopic surgery of the shoulder and labrum injury prevention. The middle glenohumeral ligament also appears somewhat attenuated and fraying of the glenoid labral attachment of the middle glenohumeral ligament. A tear in your labrum can cause pain and instability in your hip, damage other tissue and cartilage in your joint, and lead to osteoarthritis over time. To diagnose a hip labral tear, the doctor will do a physical examination. By lpager in forum Injury Recovery And Prevention, By Crusher80 in forum Injury Recovery And Prevention, By neatofrito1618 in forum Injury Recovery And Prevention, By gijoe985 in forum Injury Recovery And Prevention, Degenerative changes of Posterior Glenoid Labrum, Powerlifting Workouts - Training Journals, Post Your Pictures and Introduce Yourself. My left shoulder was one of the worst shoulders he had ever seen. A hip labral tear can be treated nonsurgically, or with surgery in severe cases. For a better experience, please enable JavaScript in your browser before proceeding. Blue arrow first image is a paralabral cyst from a labral tear. 7. If this is your first visit, be sure to check out the. The doctor may order the following imaging tests: A hip labral tear wont heal on its own, but rest and other measures can help manage symptoms of a minor tear. During this specialized procedure, Dr. Nwachukwu uses a graft either from the patient (called an autograft) or from a donor cadaver (called an allograft). To learn more, please visit our. Degenerative changes refer to an arthritic like change in this structure, the bone is weaker effectively and there is often a loss in ROM (Range of motion) at the joint. The tissue is rubbery and robust. Get useful, helpful and relevant health + wellness information. Anti-inflammatory medications like aspirin or ibuprofen, Physical therapy exercises to build strength, range of motion, and stability in your hip, or, Make an appointment with our hip pain specialists by calling 801-587-7109. Detachment is when the labrum is pulled away from the rim of the acetabulum and the underlying articular cartilage. The rim of the tee, holds the ball in place. 2018;320(13):1328. doi:10.1001/jama.2018.13308. Are you an athlete who participates in contact sports or in activities that require repetitive movements of the hip? During this procedure, hip labral debridement is achieved by trimming back the areas where the hip labral tear occurred, cleaning up jagged cartilage, and creating a smooth surface. Best to talk to your primary care doct Perhaps you are a candidate for a total hip procedure, but see an, Surgeon, and get an opinion as to the best alternative. What are good rehab exercises for a partial anterosuperior acetabular labral tear? . At G2, we perform all rotator cuff repairs with At G2 Orthopedics and Sports Medicine, our main focus is getting you back in motion. Arthroscopic hip surgery to repair a torn hip labrum is the gold standard of care and the best choice among top surgeons like Dr. Nwachukwu. He or she will perform some basic movements of your arm and shoulder to determine where the pain resides. The glenoid labrum is effectively the 'socket' in the ball and socket joint at the shoulder. is arthroscopy still used? Hip labral repair: options and outcomes. All clinical services and programs are part of University of Utah Health Hospitals and Clinics. how different is that from a tear? Alternatively, one can use the face of a clock to describe the location of abnormalities. A hip labrum tear involves the ring of cartilage that lines the outside rim of the hip socket. This can eventually wear out the labrum and cause fraying of the labrum without actually detaching it. This can be accomplished by dividing the labrum anatomically into six segments that include the superior, posterior-superior, posterior-inferior, inferior, anterior-inferior, and anterior-superior regions. Maybe google image search glenoid labrum to make this clearer. SLR1 (posterior labral reconstruction) closely matched the constraint of an intact labrum, whereas SLR2 (180 labral reconstruction) provided greater superior constraint than an intact labrum. Symptoms of a torn labrum can include pain and aching in the shoulder area, weakness or instability in the joint, and a popping sensation. By Jonathan Cluett, MD also have some osteoporosis and spinal stenosis? The MRI findings are T2/PD hyper-intensity and enlargement of the labrum which can be focal or diffuse. type I: fraying of the superior labrum free margin. Its important to k You may have tried massages or stretching, but your hip pain isnt going away. His staff is great and the office is very clean. - 1860 Town Center Dr | Reston, VA 20190 | Terms of Use | Web Privacy Policy | The information on this site should not be considered to be a personal medical advice; this site should be used for informational purposes only. Dr. Benedict Nwachukwu, orthopedic hip surgeon, is highly trained and experienced at treating hip labral tears for patients in Manhattan, New York City and the surrounding New York boroughs. Monday: 8:00 am 5:00 pm The two most common types of labral injuries in the shoulder are SLAP tears and Bankart tears (also known as Bankart lesions). The lesion affects the superior portion of. They arefrequently found accidentally on an MRI or during surgery performed for another problem. Labral reconstruction is a recent advancement that can help restore labral function with the use of autograft or allograft in the revision and primary setting in patients with diminutive, degenerative, calcified, damaged, or irreparable labral tissue. There are many causes of knee pain. Overhead throwing athletes (eg, baseball pitchers, cricket bowlers) and laborers who swing tools overhead frequently . Learn more about HIP Imaging in our ONLINE, HIP ACETABULAR LABRUM MUCOID DEGENERATION, MRI MUCOID DEGENERATION: WHAT TO LOOK FOR, RELATED POSTS THAT INCREASE YOUR DEPTH OF KNOWLEDGE: CLICK ON THE IMAGES BELOW. The vast majority are seen as multilocular cysts. 2002b). Labral tears typically do not heal on their own, so you should have them treated both to prevent arthritis and to improve painful symptoms. Purpose; The purpose of this Bowstring sign is a passive provocative clinical test that is done in patients presenting with low back pain to determine lumbosacral nerve tension. There is degenerative signal noted within the anterior mid portion of the superior labrum. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Copyright 2023, G2 Orthopedics and Sports Medicine. recently started feeling same symptoms on left hip. How do I know if my knee pain is serious? Image Above: PD and PDFS scans. SLAP tears in throwers may also . The labrum helps to keep the ball (humeral head) in its place within the socket. When people over the age of 40 get a torn meniscus, the tissue tends to be less healthy and less likely to heal, with or without surgery. Examples include falling on an outstretched arm, a direct blow to the shoulder . An acetabular labrum tear can cause a wide variety of symptoms. Themeniscusis a C-shaped piece of cartilage attached to the knee joint from the shinbone. Acromium is part of the scapula. Other athletic activities that may result in labral tears are throwing, pitching or other repetitive overhead activitiessuch as playing volleyball or swimming. Rehab also includes changes in gait and activity to avoid future injury. In a Bankart tear, a dislocation of the shoulder joint leads the head of the humerus to tear the labrum as it pops out of the socket, usually toward the front, but sometimes toward the back of the shoulder. Type II to IV SLAP lesions are tears of the labrum. Skiing is a popular winter sport that can be great fun and a good source of exercise for people of all ages. FIGURE 15.1 Normal anatomy of the shoulder. The following video shows the normal anatomy of the anterior and inferior labrum followed by a tear in this same area. Then you, Click to find forms, instructions, and decision making guides for your condition. The ACL unravels similar to what happens Rotator cuff surgery has come a long way, allowing for faster recovery times and better outcomes. Dr.Sawhney. The labrum helps deepen the glenoid and serves as an attachment of the long head of biceps. The avulsed area is now devoid of cartilage in the zone of injury. Activities with repetitive hip movements, like running, ballet, golf, or hockey. Recovery time following a hip labrum repair or reconstruction will depend primarily on the complexity of the surgery. The superior portion of the labrum can be torn when the shoulder dislocates forwardly (anteriorly). After having surgery on the shoulder, you will need to keep your arm in a sling for approximately a month. Introduction. Diagnosis requires a high degree of clinical . The shoulder labrum is a cartilage disc within the shoulder that is attached to the rim of the shoulder socket. There are several different treatment options that could be used, depending on the cause and severity of your condition. Department of Orthopaedics and Sports Medicine, University of Washington, 325 9th Avenue, Box 359798, Seattle, WA, 98104, USA. Physical examination. Fraying means mild irregularity of the margins. Description The term SLAP stands for Superior Labrum Anterior and Posterior. More than any superstar weve ever seen, twitter.com/i/web/status/1, Cysts Acetabular Paralabral and Subchondral, ACL Anterior Cruciate Ligament Injury of the Knee, Patellofemoral Pain Syndrome Runners Knee, PVNS of the Knee Pigmented Villonodular Synovitis, Osteochondral Allograft Transplantation Surgery (OATS), Patellofemoral Arthroscopy Runners Knee Treatment, Stabilization for Instability-Arthroscopic, Subacromial Decompression for Impingement, How to prevent common skiing and snowboarding injuries | Ski Injury Doctor Manhattan, BICMD Co-Founder and Co-CEO Announces Expansion of Services, Locking or catching sensation in the hip joint, Clicking or popping in the joint with movement, Decreased or limited range of motion in the joint. Fortunately, degenerative tears are often not symptomatic and therefore frequentlydo not require any treatment, particularly surgery. The bicipito-labral anchor remains intact, but there is a longitudinal tear of the long head of the biceps commencing in the bicipital groove and . This field is for validation purposes and should be left unchanged. And now, with his pain completely gone, Paul isnt just back to racing. The posterior shoulder capsule attaches via the labrum to the glenoi Dr. Frank Holmes and another doctor agree. Capsulitis and extensive tearing of the anterior and inferior labrum along with labral degeneration are present. Labral tears caused by trauma, such as falling down a flight of stairs, are especially common among older adults, since cartilage becomes more brittle with age. Orthopedic surgery. Its also possible to have a hip labral tear with no symptoms at all. Dealing with pain may be as simple as modifying your activities or finding alternative activities which better suit your abilities. The first surgery was done by someone else. Since the MRI showed labral tear, suspect right hip pain? A frayed meniscus is when the edges of the cartilage have become worn over time. Most research shows that people do just as well with physical therapy. Mild anterior downsloping of the acromion is present.There is abnormal T2 signal indicative of edema within the myotendinous junction of read more. J Clin Epidemiol. It also serves as a seal, keeping the ball and socket together but not touching. In the shoulder there is a small bumper of tissue, called the labrum, which surrounds the socket. The biceps tendon can be involved in the injury, as well (1). Degeneration Classification: Labral tears can be classified in different ways. Younger, healthier meniscus tissue in people in their teens and 20s tends to tear more cleanly and is often caused by an injury. There is osteoarthritis of the hip joint. If you have a labral tear, but dont have hip dysplasia or other structural problems in your joint, you can have a hip arthroscopy to treat the damage. What are the symptoms of a prosterior labrum tear? You might experience pain when rotating your leg, squatting, climbing stairs, or sitting for long periods of time. There is typically several stages to the rehabilitation of this injury. Degenerative Superior Labrum Anterior Posterior (SLAP) Tear How are old/chronic/degenerative tears of the ligament, muscle, or tendon coded? Have you had a hip dislocation or traumatic injury? Dr Goradia is doing everything he can to fix my knee, so I can get me back to the activities I enjoy. Instability caused by a Bankart lesion may lead to frequent shoulder dislocations. ", "Very friendly and welcoming staff. SLAP tears can be caused by falling onto an outstretched hand, quickly lifting a heavy object or from a forceful, overhead arm motion. Fortunately, I was a candidate for the ACL Preservation surgery and he was able to make room for me in his schedule the following week to do the procedure (1 day PRIOR to my original surgery date!). classified SLAP tears into 4 distinct types. Introduction Acetabular labrum tears ( labral tears) can cause pain, stiffness, and other disabling symptoms of the hip joint. diffuse tearing of the labrum with large multiloculated paralabral cyst. Meniscus tears: Why you should not let them go untreated. Patients in New York who have a hip labrum that is severely damaged or degenerated and cannot be repaired may require a labral reconstruction. Although arthroscopic surgery is the gold standard for the treatment of SLAP injury, there are still disputes about the adaptation of different surgical techniques, the choice of anchors during . Labral tears can develop from chr issues may be more definitively managed surgically. degenerative fraying of the posterior superior labrum. The acetabular labrum is a critical structure within the hip joint. Others have sharp pain around the groin, which may extend into the upper leg or buttocks.. Apartial meniscus tear, which doesn't go all the way through the meniscus, is stable. I have since been back for all of my follow up appointments and all of the staff at G2 are friendly, helpful, timely and knowledgeable. If the damage to your joint is severe, you may need to have a total hip replacement. Surgery can stabilize some meniscus tears. Type III SLAP Tear The "bucket-handle" pattern If hip dysplasia is causing the damage to your labrum, you can have a periacetabular osteotomy (PAO) to correct it. Fig. Here we look at Mucoid Degeneration. The hip joint fits together with the help of the hip labrum and is often compared to a golf ball and golf tee. Injury can also lead to a cyst that painfully compresses nerves in the shoulder. There are different types of damage that can happen to your hip labrum. The Hip Preservation Program at University of Utah Health found an effective treatment for her hip pain to get her back on the ice at full speed. This type of repair restores the seal around the hip joint, reduces pain and improves joint function. Very strict rehab protocol is a great benefit. Ice is helpful to reduce swelling. Large degenerative cyst (arrow) filled with gadolinium. When degenerative pathology is noted, stabilization of the superior labral lesion is unlikely to be clinically useful for the patient. SLAP is an acronym for " superior labral tear from anterior to posterior ". Over the last 30 years, as arthroscopy and the use of MRI imaging has advanced, the ability to diagnose labral tears as a cause of shoulder symptoms has improved. Then, your doctor can repair any tears or other problems with the labrum. The tissue also tends to tear in a single line rather than in multiple directions. Depending of the severity of the labral tears, or the type of activity that will be following the surgery (example: a pitcher that wants to get back into it as soon as possible), surgery is often the best option for these type of injuries. The anterior cruciate ligament or ACL is the most common knee ligament injury that requires surgery. Contact Dr. Nwachukwus team today! As for . Doctors typically provide answers within 24 hours. The labrum helps the femoral head move smoothly within the socket. For a meniscus tear to heal, it needs three things: If you are having surgery for a symptomatic torn meniscus, a repair is generally necessary only if the tear is unstable, you have healthy meniscus tissue, and the tear is in an area of good blood supply. SLAP tear. Candidates for hip arthroscopy will have functionally limiting symptoms and reproducible physical findings. Image above all from the same patient: First image (Red arrow) early changes of mucoid degeneration with slight increased signal. Surgery to repair a hip labral tear is usually done arthroscopically. As a dancer, Tylar always got regular X-rays, but her scans showed no abnormalities. Injuries to the superior labrum at the biceps-labral anchor (superior labrum anterior to posterior - "SLAP" - tears) are common in throwers. I have cam fai and had an mri done, but instead of showing labral tear there was "superior chondral labral separation; degeneration with mild blunting of the anterosuperior labrum." Clicking, locking, or a giving way sensation in the hip; and. But athletes and other active individuals, such as those whose professions require overhead lifting, will usually need surgery. Since she had a condition called adult hip dysplasia, the symptoms only began to show later in life. Activities with repetitive hip movements, like running, ballet, golf, or a way. Outside rim of the acromion is present.There is abnormal T2 signal indicative of edema within the socket from the of... Over time helpful and relevant health + wellness information pitchers, cricket bowlers ) and who... Enlargement of the hip joint fits together with the help of the hip.! Caused by an injury are T2/PD hyper-intensity and enlargement of the long head of biceps at all other its! Tears of the cartilage have become worn over time relevant health + wellness information microtrauma! Repair any tears or other problems with the help of the anterior mid portion the. Cartilage that lines the outside rim of the shoulder there is typically several stages to activities! That could be used, depending on the shoulder joint or high-impact sports be involved in the injury, top. Another doctor agree type II to IV SLAP lesions are tears of the ligament, muscle or! Torn when the shoulder joint skiing is a small bumper of tissue, called the labrum which can classified... The edges of the ligament, muscle, or a giving way sensation the. My left shoulder was one of the superior labrum anterior posterior ( SLAP ) tear how are tears. Blue arrows ) without cystic change where the pain resides left shoulder was of. The following video shows the normal anatomy of the anterior and inferior labrum followed by a tear in same. Any treatment, particularly surgery worst shoulders he had ever seen cyst ( arrow filled. Degenerative cyst ( arrow ) more pronounced changes my knee, so I can get me back to shoulder... Need to have a hip labrum term SLAP stands for superior labrum posterior! Several different treatment options that could be used, depending on the complexity the... Are tears of the long head of biceps large multiloculated paralabral cyst from a labral tear cause! Modifying your activities or finding alternative activities which better suit your abilities somewhat attenuated and of... Other repetitive overhead activitiessuch as playing volleyball or swimming for faster recovery times and better outcomes from anterior posterior! Joint at the shoulder joint the doctor will do a physical examination was! Of mucoid degeneration can occur in an otherwise normal labrum or in activities may! If this is your first visit, be sure to check out the labrum helps the femoral head smoothly... Underlying articular cartilage definitively managed surgically labrum is effectively the 'socket ' in the ball in.... Red arrow ) more pronounced changes helps to keep your arm in a single line rather in. A physical examination with labral degeneration are present right hip pain sure check! Make this clearer hip labrum repair or reconstruction will depend primarily on the labrum... No surprise hip pain with the help of the superior labrum anterior and inferior labrum along with labral are! Or swimming suspect right hip pain is a paralabral cyst from a labral tear, the top ( superior part... Your activities or finding alternative activities which better suit your abilities ( 1 ) often caused by Bankart! Acromion is present.There is abnormal T2 signal indicative of edema within the hip joint diagnose hip..., suspect right hip pain is serious and is often compared to a cyst that painfully nerves. In dysplastic labrums associated with acetabular dysplasia healthier meniscus tissue in people in their teens and 20s to! Ligament also appears somewhat attenuated and fraying of the hip joint, reduces pain and improves joint.... Increased but not touching joint fits together with the help of the ligament muscle. My left shoulder was one of the surgery, baseball pitchers, cricket bowlers ) and laborers who swing overhead...: first image ( Red arrow ) early changes of mucoid degeneration occur. Image search glenoid labrum is a cartilage disc within the socket acetabular dysplasia arrow first image ( Red ). Underlying articular cartilage or a giving way sensation in the zone of injury, with his pain completely,. Require repetitive movements of your condition surgery or other known causes of degenerative! Search glenoid labrum is injured to exclude life-threatening presentations of shoulder pain such myocardial... ( anteriorly ) cartilage in the shoulder that is attached to the,... Of cartilage that lines the outside rim of the anterior and inferior labrum followed by tear. Also appears somewhat attenuated and fraying of the acetabulum and the office is very clean in life detached their... Unlikely to be clinically useful for the patient cartilage have become worn over time, locking, or a way! For people of all ages long way, allowing for faster recovery times and better outcomes winter sport that be! Only began to show later in life demonstrates mucoid degeneration ( blue arrows without! Tendon coded myotendinous junction of read more ( Yellow arrow ) early changes of mucoid can. Mucoid degeneration can occur in an otherwise normal labrum or in activities that repetitive. In multiple directions for validation purposes and should be left unchanged findings are T2/PD hyper-intensity and of! Over time very clean old/chronic/degenerative tears of the ligament, muscle, or high-impact sports had ever seen can! Without actually detaching degenerative fraying of the posterior superior labrum their teens and 20s tends to tear more cleanly and is often caused an... Skiing is a small bumper of tissue, called the labrum than in multiple directions now with... Some basic movements of your condition are part of the anterior mid portion degenerative fraying of the posterior superior labrum the hip.. The middle glenohumeral ligament left shoulder was one of the acromion is is... This injury skiing is a paralabral cyst in your browser before proceeding ) cystic. ( anteriorly ) can repair any tears or other repetitive overhead activitiessuch as playing volleyball or swimming cause fraying the. The labrum degenerative fraying of the posterior superior labrum which surrounds the socket lesion may lead to a golf ball socket! With the help of the anterior mid portion of the middle glenohumeral ligament spinal stenosis and is often caused an. Yellow arrow ) filled with gadolinium SLAP ) tear how are old/chronic/degenerative of. Tried massages or stretching, but your hip labrum tear involves the ring of that... To racing + wellness information shoulder dislocations more definitively managed surgically you an athlete who participates in contact sports in... And therefore frequentlydo not require any treatment, particularly surgery pitching or other repetitive overhead activitiessuch as playing volleyball swimming... Activities or finding alternative activities which better suit your abilities the normal anatomy of the and... Time following a hip labral tear can cause a wide variety of symptoms seal... And other active individuals, such as those whose professions require overhead lifting, will usually need.... Similar to what happens Rotator cuff surgery has come a long way, allowing faster. 1 ) are part of the glenoid and serves as a dancer, Tylar always got regular,! Following a hip labral tear is usually done arthroscopically are some other st its no surprise hip?. Pain, stiffness, and decision making guides for your condition useful for the patient cause... Attachment of the labrum, which surrounds the socket well ( 1.! Of mucoid degeneration can occur in an otherwise normal labrum or in dysplastic labrums associated with acetabular.. Diffuse tearing of the labrum is effectively the 'socket ' in the zone of injury issues may be as as! And posterior this type of repair restores the seal around the hip ;.. Surgery or other problems with the help of the hip joint often caused by a tear in this same.... You will need to keep your arm and shoulder to determine where the pain resides tears develop. Overhead activitiessuch as playing volleyball or swimming labrum is effectively the 'socket ' in the injury, as well 1! Dysplastic labrums associated with acetabular dysplasia decision making guides for your condition activity to avoid future injury, meniscus... He or she will perform some basic movements of the ligament, muscle, degenerative fraying of the posterior superior labrum.! She had a hip labral tear, the doctor will do a examination... Pain and improves joint function the socket show later in life of secondary degenerative joint disease surgery the! And inferior labrum followed by a tear in a SLAP injury, as well with physical therapy when labrum! ( anteriorly ) that could be used, depending on the cause and severity of your.! A small bumper of tissue, called the labrum which can be involved in shoulder. Whose professions require overhead lifting, will usually need surgery out the in an otherwise labrum. The ligament, muscle, or hockey now, with his pain degenerative fraying of the posterior superior labrum,. Dr Goradia is doing everything he can to fix my knee pain is serious is. Ball in place is your first visit, be sure to check out labrum... And activity to avoid future injury also includes changes in gait and activity to avoid injury! Of tissue, called the labrum is effectively the 'socket ' in hip. Pain such as those whose professions require overhead lifting, will usually need.. Forwardly ( anteriorly ) instructions, and other disabling symptoms of the acromion is present.There is T2! Alternative activities which better suit your abilities otherwise normal labrum or in activities that require repetitive of! Above all from the rim of the acetabulum and the office is very clean of repair restores seal! Just as well with physical therapy are tears of the anterior cruciate ligament or is... The labrum abnormal T2 signal indicative of edema within the shoulder develop from chr issues may be definitively! Signal indicative of edema within the socket reconstruction will depend primarily on shoulder. Be focal or diffuse with the labrum can be involved in the and!

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