Controversies In The Surgical Management Of Shoulder Instability: Associated Soft Tissue Procedures

Background:The glenohumeral joint is a ball-and-socket joint that is inherently unstable and thus, susceptible to dislocation. The traditional and most common anatomic finding is the Bankart lesion (anterior-inferior capsule labral complex avulsion), but there is a wide variety of anatomic alterations that can cause shoulder instability or may be present as a concomitant injury or in combination, including bone loss (glenoid or humeral head), complex capsule-labral tears, rotator cuff tears, Kim´s lesions (injuries to the posterior-inferior labrum) and rotator interval pathology.Methods:A review of articles related to shoulder anatomy and soft tissue procedures that are performed during shoulder instability arthroscopic management was conducted by querying the Pubmed database and conclusions and controversies regarding this injury were exposed.Results:Due to the complex anatomy of the shoulder and the large range of movement of this joint, a wide variety of anatomic injuries and conditions can lead to shoulder instability, specially present in young population. Recognizing and treating all of them including Bankart repair, capsule-labral plicatures, SLAP repair, circumferential approach to pan-labral lesions, rotator interval closure, rotator cuff injuries and HAGL lesion repair is crucial to achieve the goal of a stable, full range of movement and not painful joint.Conclusion:Physicians must be familiarized with all the lesions involved in shoulder instability, and should be able to recognize and subsequently treat them to achieve the goal of a stable non-painful shoulder. Unrecognized or not treated lesions may result in recurrence of instability episodes and pain while overuse of some of the techniques previously described can lead to stiffness, thus the importance of an accurate diagnosis and treatment when facing a shoulder instability.

Download Full-text

SLAP Tears

Video Journal of Sports Medicine ◽

10.1177/26350254211000754 ◽

2021 ◽

Vol 1 (3) ◽

pp. 263502542110007

Author(s):

Steven B. Cohen ◽

John R. Matthews

Keyword(s):

Rotator Cuff ◽

Shoulder Arthroscopy ◽

Biceps Tendon ◽

Full Range ◽

Contralateral Side ◽

Highly Active ◽

Slap Repair ◽

Biceps Tenotomy ◽

Labral Tears ◽

Anterior Posterior

Background: Superior labral tears are frequently encountered during shoulder arthroscopy. Outcomes following superior labral anterior-posterior (SLAP) repairs in young athletes have been well documented. Superior labral repairs in older patient population continue to remain controversial due to concerns of postoperative complications including persistent preoperative symptoms, pain, stiffness, and higher rates of revision surgery. Indications: We present a case of a highly active 38-year-old woman who failed 1½ years of nonoperative management of a type IIB SLAP tear with extension to the posterior labrum. Her symptoms continued to limit her hobbies and work. Technique: A knotless single-anchor SLAP repair was performed along with debridement of the posterior frayed labrum. No biceps tenotomy or tenodesis was performed after full evaluation of the tendon failed to demonstrate evidence of synovitis, tendinopathy, or tear. The patient also did not have any concomitant shoulder pathology, including a rotator cuff tear or chondral lesion. Results: At 6 months, the patient had regained full range of motion similar to the contralateral side. She had returned to her normal activities and sports, including tennis. Discussion/Conclusion: Successful outcomes following SLAP repairs in patients over 35 years can be achieved, but treatment should be individualized with particular attention to concomitant pathology involving the rotator cuff, chondral surface, or biceps tendon which may require tenodesis or tenotomy.

Download Full-text

Shoulder examination: a systematic approach

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0211 ◽

2021 ◽

pp. 1-15

Author(s):

Akib M Khan ◽

Angelos Assiotis ◽

Mazin S Ibrahim ◽

Andrew R Sankey

Keyword(s):

Rotator Cuff ◽

Systematic Approach ◽

Healthcare Professionals ◽

Full Range ◽

Range Of Movement ◽

Systematic Examination ◽

Complex Joint ◽

Different Levels ◽

Shoulder Examination

The shoulder is a complex joint with static and dynamic stabilising structures working synchronously. These allow a full range of movement while preserving stability of the joint. Patients may present with pain, stiffness, weakness, deformity or instability. The authors suggest a systematic examination sequence to ensure that important pathology is not overlooked. Adopting this approach allows common pathologies, including tears of the rotator cuff, impingement and tendinopathy, to be easily identified. This shoulder examination sequence may be used by all healthcare professionals and can also act as a revision aid for those undergoing exams in this field, at different levels of training.

Download Full-text

Arthroscopic Soft Tissue Stabilization With Selective Augmentations for Traumatic Anterior Shoulder Instability in Competitive Collision Athletes

The American Journal of Sports Medicine ◽

10.1177/03635465211003091 ◽

2021 ◽

pp. 036354652110030

Author(s):

Shota Hoshika ◽

Hiroyuki Sugaya ◽

Norimasa Takahashi ◽

Keisuke Matsuki ◽

Morihito Tokai ◽

...

Keyword(s):

Soft Tissue ◽

Shoulder Instability ◽

American Football ◽

Bankart Repair ◽

Anterior Shoulder Instability ◽

Return To Sports ◽

Rotator Interval ◽

Functional Scores ◽

The Mean ◽

Tissue Stabilization

Background: Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes. Purpose: To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability Study Design: Case series; Level of evidence, 4. Methods: We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated. Results: This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; P = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; P = .002). Conclusion: Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.

Download Full-text

An Indigenous Dynamic Multiaxial Adjustable Shoulder Splint for the Management of Shoulder Subluxation

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20210620 ◽

2021 ◽

Vol 11 (6) ◽

pp. 140-144

Author(s):

Surajit Kumar Sahu ◽

Minakshi Behera ◽

C. R. Mohanty

Keyword(s):

Shoulder Instability ◽

Full Range ◽

Frozen Shoulder ◽

Intervention Period ◽

Range Of Movement ◽

Standard Design ◽

Before And After ◽

Related Quality ◽

Reduction Of Pain

Background: The main problem with shoulder subluxation is the instability of the shoulder joint. The anatomy of this joint permits a large range of movement, but it sacrifices stability. Available splint options for shoulder subluxations are a lot but they are not providing the full range of motion of the joint. Considering this we have designed and developed a new Dynamic Multiaxial Adjustable Shoulder Splint. Objective: This study aimed to design an Indigenous Dynamic Multiaxial Adjustable Shoulder Splint for the Management of shoulder subluxation which will reduce the subluxation and pain. Study design: A case report Methods: A 52-years-old lady diagnosed with right shoulder subluxation was fitted with the newly designed Indigenous Dynamic Multiaxial Adjustable Shoulder Splint for the reduction of pain and subluxation. The Western Ontario Shoulder Instability Index (WOSI) was assessed to measure the shoulder-related quality of life in patients with symptomatic shoulder instability. Before and after the test was conducted with and without the newly designed splint with an intervention period of 4 months. Results: The WOSI score of 9.8% was achieved after the intervention period of 4 months and the reduction of subluxation was immediate and provided total relief from the pain. Conclusion: This Indigenous Dynamic Multiaxial Adjustable Shoulder Splint can be considered as a very excellent splint for the orthotic management of shoulder subluxation and it also can be used as a standard design that can be prescribed for patients with brachial plexus injury, frozen shoulder and rotator cuff injury, post-operative cases, etc. Key words: Shoulder Subluxation, Multiaxial, shoulder splint, WOSI score.

Download Full-text

New study finds rotator cuff injuries treatable, but evidence unclear whether surgery is preferable

PsycEXTRA Dataset ◽

10.1037/e667662010-037 ◽

2010 ◽

Cited By ~ 1

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Injuries

Download Full-text

Serious Rotator Cuff Injuries

Clinics in Sports Medicine ◽

10.1016/s0278-5919(20)31417-4 ◽

1983 ◽

Vol 2 (2) ◽

pp. 407-412 ◽

Cited By ~ 1

Author(s):

Frank W. Jobe

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Injuries

Download Full-text

Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211001809 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110018

Author(s):

Emilio Calvo ◽

Gonzalo Luengo ◽

Diana Morcillo ◽

Antonio M. Foruria ◽

María Valencia

Keyword(s):

Soft Tissue ◽

Bone Loss ◽

Revision Surgery ◽

Shoulder Instability ◽

Activity Level ◽

Bankart Repair ◽

Anterior Shoulder Instability ◽

Arthroscopic Bankart Repair ◽

Functional Scores ◽

Arthroscopic Latarjet

Background: Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization. Purpose/Hypothesis: To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique. The hypothesis was that Latarjet would be superior to soft tissue procedures in terms of objective and subjective functional scores, recurrence rates, and range of movement. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 45 patients (mean age, 29.1 ± 8.9 years) with subcritical bone loss (<15% of articular surface) who had undergone revision anterior shoulder instability repair after failed Bankart repair. Of these, 17 patients had arthroscopic Bankart repair and 28 had arthroscopic Latarjet surgery. Patients were evaluated at a minimum of 2 years postoperatively with the Rowe score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Subluxation or dislocation episodes were considered failures. Results: No statistically significant differences were found between groups in age, sex, sporting activity, preoperative Rowe score, or the presence of hyperlaxity or bony lesions. At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, 13 a medially healed labrum, and 6 a bony Bankart. In 6 patients, no abnormalities were present that could explain postoperative recurrence. In the Bankart repair group, 7 patients underwent isolated Bankart procedures; in the remaining 10 cases, a capsular shift was added. No significant differences were found between the Bankart and Latarjet groups in outcome scores, recurrence rate (11.8% vs 17.9%, respectively), or postoperative athletic activity level. The mean loss of passive external rotation at 0° and 90° of abduction was similar between groups. Conclusion: Arthroscopic Latarjet did not lead to superior results compared with repeated Bankart repair in patients with subcritical glenoid bone loss and recurrent anterior shoulder instability after Bankart repair.

Download Full-text

Chronic Adaptations of the Posterior Rotator Cuff in Professional Pitchers

The American Journal of Sports Medicine ◽

10.1177/0363546520988688 ◽

2021 ◽

pp. 036354652098868

Author(s):

Stephen J. Thomas ◽

Justin Cobb ◽

Scott Sheridan ◽

Joseph Rauch ◽

Ryan W. Paul

Keyword(s):

Soft Tissue ◽

Rotator Cuff ◽

Internal Rotation ◽

External Rotation ◽

Negative Relationship ◽

Muscle Thickness ◽

Pennation Angle ◽

Muscle Architecture ◽

Infraspinatus Muscle ◽

Teres Minor

Background: Because of the large forces and high frequency of throwing, the upper extremity experiences repetitive stresses that lead to acute and chronic adaptations. While the importance of pennation angle and muscle thickness as predictors of muscle force production has been shown in other populations and other joints, there has been little research done that examines these variables in the shoulders of baseball players. Purpose: (1) To examine the chronic effect pitching has on the rotator cuff muscle architecture (pennation angle and muscle thickness) in healthy professional baseball pitchers, and (2) to examine the correlation between muscle architecture and clinical measures of strength and range of motion (ROM). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty-eight healthy professional pitchers were recruited during the 2019 spring training. Internal rotation (IR) and external rotation (ER) strength were measured with a handheld dynamometer and IR and ER ROM were measured with an inclinometer. A diagnostic ultrasound machine was utilized to capture images of humeral retroversion, as well as the pennation angle and muscle thickness of the infraspinatus and teres minor muscles. ImageJ software was used to quantify the pennation angle and muscle thickness. Results: There were no significant differences between the dominant and nondominant arms for ER or IR strength. Also, no pennation angle and muscle thickness differences were found between the dominant and nondominant arms. A weak positive relationship between infraspinatus muscle thickness (superficial and total) and ER strength ( P = .016, R = 0.287 and P = .009, R = 0.316) and a moderate negative relationship between soft tissue glenohumeral internal rotation deficit (GIRD) and the bilateral difference of the teres minor deep pennation angle ( R = −0.477, P = .008) were observed. No other significant relationships were noted. Conclusion: Our results are contrary to current literature as we expected to see a stronger dominant arm, with a larger pennation angle and greater muscle thickness. Interestingly, we found that ER strength was positively related to only the thickness of the infraspinatus muscle, and that soft tissue GIRD was positively related to only the side-to-side adaptation of the pennation angle within the deep portion of the teres minor. This suggests that when posterior shoulder tightness occurs, specifically the architecture of the teres minor muscle is involved. However, the organization to which these players belonged has a very extensive training protocol throughout the year that emphasizes bilateral training during a large majority of the exercises. Therefore, the results may not be generalizable to all professional players.

Download Full-text