An Overview of Shoulder Instability and its Management

Farrar, Nicholas; Malal, Joby Jacob George; Fischer, Jochen; Waseem, Mohammad

doi:10.2174/1874325001307010338

Cited by 35 publications

(34 citation statements)

References 47 publications

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“…Waldt et al found that 86% of patients with acute anterior instability had arthroscopically proven Bankart lesions (46). Evidence supports arthroscopic surgical intervention for Bankart lesions in patients with traumatic, unidirectional instability and Bankart lesion often requiring surgery, as there is a substantial reduction in rate of recurrence with stabiliza-tion (47). CT assessment of bone stock should be considered when the Bankart fragment involves more than 25% of the glenoid face, given the likelihood of open repair and surgical bone grafting in this cohort (48).…”

Section: Classic Bankart Lesionsmentioning

confidence: 99%

Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder

Roy¹,

Cheyne²,

Andrews³

et al. 2016

Radiology

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Shoulder disease is common in the athletic population and may arise as a consequence of a single traumatic episode or multiple repeated events. Associated labroligamentous injuries can result in substantial disability. Specific athletic and occupational activities result in predictable injury patterns. Imaging in general and magnetic resonance (MR) imaging, in particular, are vital in establishing the correct diagnosis and excluding common mimicking conditions, to ensure timely and appropriate management. In this review, the utility of MR imaging and MR arthrography will be explored in evaluation of shoulder disease, taking into account normal variants of the labroligamentous complex. Subsequently, broad categories of labral lesions and instability, external and internal impingement, as well as nerve entrapment syndromes, will be discussed, while emphasizing their imaging findings in the clinical context and illustrating key features. More recent concepts of internal impingement and secondary subacromial impingement will also be clarified.

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Section: Classic Bankart Lesionsmentioning

confidence: 99%

Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder

Roy¹,

Cheyne²,

Andrews³

et al. 2016

Radiology

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“…7,24 Unlike glenohumeral dislocation, which requires a manual reduction, the diagnosis of traumatic anterior glenohumeral subluxation is often more elusive and cannot be objectively documented and quantified with similar accuracy. 27 …”

Section: Diagnosismentioning

confidence: 99%

“…7 These classification systems take into account the etiology, direction, and type of instability. 37 The type of instability ranges from subluxation to dislocation.…”

Section: Classificationmentioning

confidence: 99%

Current Concepts in the Diagnosis and Management of Traumatic, Anterior Glenohumeral Subluxations

Gil

DeFroda

Owens

2017

Orthopaedic Journal of Sports Medicine

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Traumatic anterior glenohumeral subluxations comprise the majority of glenohumeral instability events and are endemic in young athletes. Unlike the definitive complete dislocation event, subluxation events may often be more subtle in presentation and, therefore, may be overlooked by clinicians. Glenohumeral subluxation events are associated with a high rate of labral tears as well as humeral head defects. While less is known of the natural history of these injuries, young athletes are at risk for recurrent instability events if not properly diagnosed and treated. While reports of surgical treatment outcomes isolated to subluxation events are limited, arthroscopic and open Bankart repair have been shown to result in excellent outcomes. The purpose of this paper is to review the etiology and pathoanatomy of traumatic anterior glenohumeral subluxations as well as to review the appropriate evaluation and management of patients with this injury. Keywords: subluxation; glenohumeral subluxation; shoulder instability; instabilityThe glenohumeral joint has the greatest range of motion of any joint in the body, leaving it susceptible to instability, particularly during extremes in ranges of motion, such as those encountered among contact athletes.24 Glenohumeral instability comprises a spectrum of injuries that range from atraumatic subluxations to traumatic dislocations. Although glenohumeral subluxation accounts for the majority of shoulder instability events, studies that have investigated shoulder instability have focused primarily on glenohumeral dislocations. 21,26 Glenohumeral subluxation events are more difficult to investigate because of the challenge of precisely defining and diagnosing these events. 27In 1980, Protzman 29 clearly delineated glenohumeral subluxation as a unique type of shoulder instability that is present in shoulders that have not previously sustained a glenohumeral dislocation event. In 1983, Warren 37 reported on a series of patients with chronic recurrent glenohumeral subluxations who underwent a stabilization procedure. Radiographic evaluation of these patients revealed that 37% of patients had a Hill-Sachs lesion and 50% had a Bankart lesion. In 1983, Mizuno and Hirohata 21 also reported on a series of 55 patients with chronic recurrent anterior glenohumeral subluxations. They reported that radiographs demonstrated a Bankart lesion in 45 of these patients. In 1992, Burkhead and Rockwood 4 reported on a series of patients with traumatic glenohumeral subluxation, and 55% of these patients had radiographic evidence of an osseous Bankart lesion. In 2007, Owens et al 26 demonstrated that 85% of traumatic glenohumeral instability events are glenohumeral subluxations rather than dislocations. These were diagnosed by a history of a traumatic shoulder event combined with physical examination findings of a positive anterior apprehension sign and a symptomatic load shift. Despite long-term knowledge of glenohumeral subluxations and the subsequent studies that demonstrated a high rate of associated gl...

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“…In the abducted position (90°), the anteroinferior glenohumeral ligament (AIGHL) provides the main source of resistance to anterior dislocation, while the middle and superior glenohumeral ligaments provide resistance in the mid-abducted (45°) and adducted positions, respectively. The most common mechanism for anteroinferior dislocation is a traumatic event that places the shoulder in extremes of abduction and external rotation [5]. These exaggerated maneuvers result in injuries to the corresponding soft tissues (anteroinferior capsule-labral complex or Bankart lesion) or bony structures (anteroinferior glenoid or posterosuperior humeral head).…”

Section: Introductionmentioning

confidence: 99%

Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability

Lizzio

An Overview of Shoulder Instability and its Management

Cited by 35 publications

References 47 publications

Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder

Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder

Current Concepts in the Diagnosis and Management of Traumatic, Anterior Glenohumeral Subluxations

Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability

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