Perthes lesion
A variant Bankart lesion with intact but stripped periosteum.
Perthes lesion is a variant of Bankart lesion, presenting as an anterior glenohumeral injury. It occurs when the scapular periosteum remains intact but is stripped medially, and the anterior labrum is avulsed from the glenoid but remains partially attached to the scapula by intact periosteum.
- Field
- Orthopedic surgery, radiology
- Known for
- First description of Perthes lesion (1905)
Lore & Background
The lesion is associated with damage to the antero-inferior labrum, most commonly due to anterior shoulder dislocation. It often occurs after the initial dislocation. In chronic cases, there may be fibrosis and resynovialization of the labrum and periosteum. The lesion is best identified on MR arthrography, with additional views in ABER (ABduction and External Rotation) of the shoulder aiding diagnosis. Differential diagnoses include Bankart lesion, Alpsa lesion, GLAD, HAGL, and BHAGL. Treatment is surgical re-attachment of the labrum, preferably via arthroscopy. The eponym is named after Georg C. Perthes (1869-1927), a German surgeon and X-ray diagnostic pioneer who first described the lesion in 1905.
Reader's Guide
Perthes lesion represents a specific variant of the more common Bankart lesion, distinguished by the intact but medially stripped scapular periosteum. Its recognition is important in the context of anterior shoulder instability, as it may require specific surgical re-attachment of the labrum via arthroscopy. The lesion is best identified using MR arthrography, particularly with ABER views, which help differentiate it from other antero-inferior labral injuries such as ALPSA, GLAD, HAGL, and BHAGL. Chronic cases may show fibrosis and resynovialization, complicating diagnosis. The lesion's eponym honors Georg C. Perthes, a German surgeon and X-ray pioneer who first described it in 1905. Understanding this variant aids in accurate diagnosis and appropriate surgical planning for shoulder instability.
Frequently Asked Questions
What is a Perthes lesion?
It is a specific type of anterior shoulder injury that belongs to the Bankart-lesion family. Its defining feature is that the labrum tears free from the glenoid rim yet stays tethered to the scapula through an unbroken layer of periosteum.
How does a Perthes lesion differ from a classic Bankart lesion?
In a classic Bankart tear, both the labrum and the periosteum detach from the glenoid. In the Perthes variant the periosteum remains attached to the scapula but is peeled medially, so the labrum hangs by that intact periosteal bridge rather than being fully free.
Who first described the Perthes lesion and when?
The injury was first documented in 1905 by the German surgeon Auguste Perthes. His description established the distinct pattern of periosteal stripping that sets this variant apart from other anterior labral tears.
What exactly happens to the anatomy during a Perthes lesion?
The anterior labrum is avulsed off the glenoid surface, but the scapular periosteum does not rupture. Instead that periosteum is stripped medially while still connecting the detached labrum to the underlying scapular bone.
Why does the Perthes lesion matter in orthopedic surgery and radiology?
Recognizing this variant is important because the intact periosteum changes both the surgical repair strategy and how the injury appears on imaging compared with a complete Bankart tear. Clinicians must identify it as a distinct entity to plan the correct reconstruction approach.
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