Shoulder Instability with Bony Lesions

2016 ◽  
pp. 139-146
Author(s):  
Enrico Gervasi ◽  
Alessandro Spicuzza
Keyword(s):  
Shoulder Instability ◽  
Bony Lesions

scholarly journals Does the innate relative size of the humeral head and glenoid affect the risk of anterior shoulder instability?

2018 ◽  
Vol 11 (6) ◽  
pp. 424-429
Author(s):  
NW Willigenburg ◽  
RA Bouma ◽  
VAB Scholtes ◽  
VPM van der Hulst ◽  
DFP van Deurzen ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Humeral Head ◽  
Relative Size ◽  
Ct Scans ◽  
Anterior Shoulder Instability ◽  
Multivariate Logistic Regression ◽  
Recurrent Instability ◽  
Bony Lesions ◽  
Joint Contact ◽  
And Gender

Background Bony lesions after shoulder dislocation reduce the joint contact area and increase the risk of recurrent instability. It is unknown whether the innate relative sizes of the humeral head and glenoid may predispose patients to shoulder instability. This study evaluated whether anterior shoulder instability is associated with a larger innate humeral head/glenoid ratio (IHGR). Methods We evaluated CT scans of 40 shoulders with anterior shoulder instability and 48 controls. We measured axial humeral head diameter and glenoid diameter following native contours, discarding any bony lesions, and calculated IHGR by dividing both diameters. Multivariate logistic regression determined whether the IHGR, corrected for age and gender as potential confounders, was associated with anterior shoulder instability. Results Mean IHGR was 1.48 ± 0.23 in the group with anterior shoulder instability and 1.42 ± 0.20 in the group without anterior shoulder instability. Measurements for axial humeral head and axial glenoid diameters demonstrated excellent intra-rater reliability (ICC range: 0.94–0.95). IHGR was not significantly associated with anterior shoulder instability (OR = 1.105, 95%CI = 0.118–10.339, p = 0.930). Discussion The innate ratio of humeral head and glenoid diameters was not significantly associated with anterior shoulder instability in this retrospective sample of 88 shoulder CT scans.

scholarly journals Multidetector CT arthrography in shoulder instability and its comparison with MR arthrography and arthroscopy

2017 ◽  
Vol 3 (6) ◽  
pp. 1189
Author(s):  
Vinod Kumar ◽  
Jeetendra S. Lodhi ◽  
Dhananjay Sabat ◽  
Rakesh Sehrawat ◽  
Deepak Gupta
Keyword(s):  
Shoulder Instability ◽  
Predictive Value ◽  
Multidetector Ct ◽  
Mr Arthrography ◽  
Ct Arthrography ◽  
Diagnostic Arthroscopy ◽  
Bony Lesions ◽  
History Of ◽  
Recurrent Shoulder Dislocation ◽  
Sensitivity Specificity

<p class="abstract"><strong>Background:</strong> Purpose of this study was to compare diagnostic effectiveness of MDCT arthrography (MDCTA) in shoulder instability and pain in throwing and its comparison to MR arthrography (MRA) and arthroscopy taking arthroscopy as gold standard.</p><p class="abstract"><strong>Methods:</strong> 20 patients with history of recurrent shoulder dislocation in activity were included in this study. After detailed clinical examination, each patient underwent MDCT-MR arthrography in one sitting followed by diagnostic arthroscopy within 6 weeks. Results were compared with the help of statistician.<strong></strong></p><p class="abstract"><strong>Results:</strong> At arthroscopy, 10 Bankart’s lesions, 7 Hill Sachs lesion, 6 SLAP lesion, 1 ALPSA, 1 capsular laxity, 1 partial subscapularis tear and 1 supraspinatus fraying were visualized in 20 shoulders. For Bankart’s lesion MDCT has sensitivity 80%, specificity 100%, positive predictive value (PPV) 100% and negative predictive value (NPV) 83.3%. MRA has sensitivity of 90%, specificity 100%, PPV 100% and NPV 90.9%. For SLAP lesions sensitivity, specificity, PPV and NPV for MDCTA and MRA are 88.3%, 100%, 100%, 93.3%. For Hill-Sachs lesion; sensitivity, specificity, PPV and NPV for MDCTA are all 100% and for MRA they are 85.7%, 100%, 100%, 92.8% respectively. For ALPSA; sensitivity is 100%, specificity is 95%, PPV is 50% and NPV is 100% both for MDCTA and MRA. К value for MRA is 0.60 and for CTA is 0.55 suggesting moderate agreement.</p><p><strong>Conclusions:</strong> Considering availability, cost, time consumption, superior detection of bony lesions and comparable detection of soft tissue lesions; MDCTA can be used as single investigation of choice in shoulder instability pain.</p>

scholarly journals Clinical and radiological examination of bony-mediated shoulder instability

2020 ◽  
Vol 5 (11) ◽  
pp. 815-827
Author(s):  
Jakub Stefaniak ◽  
Przemyslaw Lubiatowski ◽  
Anna Maria Kubicka ◽  
Anna Wawrzyniak ◽  
Joanna Wałecka ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Bone Defects ◽  
Anterior Shoulder Instability ◽  
Measurement Tool ◽  
3D Ct ◽  
Younger Age ◽  
Bony Lesions ◽  
Magnetic Resonance Imaging Mri ◽  
Recurrent Anterior Shoulder Instability ◽  
Bone Assessment

The coexistence of glenoid and humeral head bone defects may increase the risk of recurrence of instability after soft tissue repair. Revealed factors in medical history such as male gender, younger age of dislocation, an increasing number of dislocations, contact sports, and manual work or epilepsy may increase the recurrence rate of instability. In physical examination, positive bony apprehension test, catching and crepitations in shoulder movement may suggest osseous deficiency. Anteroposterior and axial views allow for the detection of particular bony lesions in patients with recurrent anterior shoulder instability. Computed Tomography (CT) with multiplanar reconstruction (MPR) and various types of 3D rendering in 2D (quasi-3D-CT) and 3D (true-3D-CT) space allows not only detection of glenoid and humeral bone defects but most of all their quantification and relations (engaging/not-engaging and on-track/off-track) in the context of bipolar lesion. Magnetic resonance imaging (MRI) is increasingly developing and can provide an equally accurate measurement tool for bone assessment, avoiding radiation exposure for the patient. Cite this article: EFORT Open Rev 2020;5:815-827. DOI: 10.1302/2058-5241.5.200049

Anterior and posterior glenoid bone augmentation options for shoulder instability: state of the art

2021 ◽  
pp. jisakos-2019-000413
Author(s):  
Emilio Calvo ◽  
Eiji Itoi ◽  
Philippe Landreau ◽  
Guillermo Arce ◽  
Nobuyuki Yamamoto ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Surgical Techniques ◽  
Bone Defects ◽  
Anterior Shoulder Instability ◽  
Bone Block ◽  
Posterior Instability ◽  
Early Return ◽  
Bony Lesions ◽  
Glenoid Surface ◽  
Posterior Bone Block

Bony lesions are highly prevalent in anterior shoulder instability and can be a significant cause of failure of stabilisation procedures if they are not adequately addressed. The glenoid track concept describes the dynamic interaction between the humeral head and glenoid defects in anterior shoulder instability. It has been beneficial for understanding the role played by bone defects in this entity. As a consequence, the popularity of glenoid augmentation procedures aimed to treat anterior glenoid bone defects; reconstructing the anatomy of the glenohumeral joint has risen sharply in the last decade. Although bone defects are less common in posterior instability, posterior bone block procedures can be indicated to treat not only posterior bony lesions, attritional posterior glenoid erosion or dysplasia but also normal or retroverted glenoids to provide an extended glenoid surface to increase the glenohumeral stability. The purpose of this review was to analyse the rationale, current indications and results of surgical techniques aimed to augment the glenoid surface in patients diagnosed of either anterior or posterior instability by assessing a thorough review of modern literature. Classical techniques such as Latarjet or free bone block procedures have proven to be effective in augmenting the glenoid surface and consequently achieving adequate shoulder stability with good clinical outcomes and early return to athletic activity. Innovations in surgical techniques have permitted to perform these procedures arthroscopically. Arthroscopy provides the theoretical advantages of lower morbidity and faster recovery, as well as the identification and treatment of concomitant pathologies.

scholarly journals Anterior shoulder instability: a review of pathoanatomy, diagnosis and treatment

2011 ◽  
Vol 4 (4) ◽  
pp. 200-207 ◽  
Author(s):  
Guillaume D. Dumont ◽  
Robert D. Russell ◽  
William J. Robertson
Keyword(s):  
Shoulder Instability ◽  
Diagnosis And Treatment ◽  
Anterior Shoulder Instability

scholarly journals Comparison between all-suture and biocomposite anchors in the arthroscopic treatment of traumatic anterior shoulder instability: A retrospective cohort study

2021 ◽  
Vol 24 ◽  
pp. 264-270
Author(s):  
Ioannis Pantekidis ◽  
Michael-Alexander Malahias ◽  
Stefania Kokkineli ◽  
Emmanouil Brilakis ◽  
Emmanouil Antonogiannakis
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Shoulder Instability ◽  
Retrospective Cohort ◽  
Arthroscopic Treatment ◽  
Anterior Shoulder Instability

scholarly journals Open Capsulorrhaphy for Recurrent Multidirectional Instability of the Shoulder

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110071
Author(s):  
Ioanna K. Bolia ◽  
Rebecca Griffith ◽  
Nickolas Fretes ◽  
Frank A. Petrigliano
Keyword(s):  
Shoulder Instability ◽  
Return To Sport ◽  
Young Female ◽  
Subscapularis Tendon ◽  
Shoulder Stabilization ◽  
Ehlers Danlos Syndrome ◽  
Physically Active ◽  
Recurrent Shoulder Instability ◽  
Multidirectional Instability

Background: The management of multidirectional instability (MDI) of the shoulder remains challenging, especially in athletes who participate in sports and may require multiple surgical procedures to achieve shoulder stabilization. Open or arthroscopic procedures can be performed to address shoulder MDI. Indications: Open capsulorrhaphy is preferred in patients with underlying tissue hyperlaxity and who had 1 or more, previously failed, arthroscopic shoulder stabilization procedures. Technique Description: With the patient in the beach-chair position (45°), tissue dissection is performed to the level of subscapularis tendon via the deltopectoral approach. The subscapularis tenotomy is performed in an L-shaped fashion, and the subscapularis tendon is tagged with multiple sutures and mobilized. Careful separation of the subscapularis tendon from the underlying capsular tissue is critical. Capsulotomy is performed, consisting of a vertical limb and an inferior limb that extends to the 5 o’clock position on the humeral neck (right shoulder). After evaluating the integrity of the labrum, the capsule is shifted superiorly and laterally, and repaired using 4 to 5 suture anchors. The redundant capsule is excised, and the subscapularis tendon is repaired in a side-to-side fashion, augmented by transosseous equivalent repair using the capsular sutures. Results: Adequate shoulder stabilization was achieved following open capsulorrhaphy in a young female athlete with tissue hyperlaxity and history of a previously failed arthroscopic soft tissue stabilization surgery of the shoulder. The athlete returned to sport at 6 months postoperatively and did not experience recurrent shoulder instability episodes at midterm follow-up. Discussion/Conclusion: Based on the existing literature, 82% to 97% of patients who underwent open capsulorrhaphy for MDI had no recurrent shoulder instability episodes at midterm follow-up. One study reported 64% return-to-sport rate following open capsulorrhaphy in 15 adolescent athletes with Ehlers-Danlos syndrome, but more research is necessary to better define the indications and outcomes of this procedure in physically active patients.

scholarly journals Effectiveness of Latarjet for Anterior Shoulder Instability in Patients with Seizure Disorder

2020 ◽  
Author(s):  
Stephen G. Thonm ◽  
Katherine Branche ◽  
Darby A. Houck ◽  
Tracey Didinger ◽  
Armando F. Vidal ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Seizure Disorder ◽  
Anterior Shoulder Instability
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