Disruption of the lateral capsule of the shoulder. A cause of recurrent dislocation

Abstract

Experimental work has shown that dislocation of the shoulder may involve disruption of the capsule from its lateral humeral attachment. We report two patients with recurrent dislocation due to this injury. Lateral repair gave good results. It is suggested that this injury be considered and looked for when glenoid labral injury is minimal or absent.

Anterior instability of the shoulder after trauma

“…The most common reason for surgical error is inadequate treatment of all the constituent components of the instability at the time of surgery. Abnormalities commonly encountered at re-exploration after failed arthroscopic or open repair include an unhealed Bankart lesion, 77,81 humeral avulsion of the glenohumeral ligaments, 82,83 extensive glenoid erosion or deficiency from a bony Bankart lesion, 38,84,85 excessive capsular laxity, 81,86 a defect of the rotator interval, 87 an engaging Hill-Sachs lesion 38,39 and reduced retroversion of the head of the humerus or excessive retroversion of the glenoid cavity. 88 Several additional factors have been associated with recurrent instability after arthroscopic stabilisation including a younger age at surgery, 59,89 non-compliance with post-operative immobilisation, 84,90 early return to contact sport, 86,91 absence or deficiency of the capsulolabral complex and poor inferior glenohumeral ligaments, 86,92 and multiple episodes of instability before stabilisation.…”

Irreparable Capsule Tears in Initial Surgery for Glenohumeral Instability: Report of Two Cases Treated with Iliotibial Band Autograft

“…1,4 Tearing of the IGHL constitutes one of the main causes of recurrent anterior dislocation, as is the case with the Bankart lesion, and it arises at any site along its course just as in initial traumatic dislocation. 3,[7][8][9][10][11] In the present series, the site of tearing was the insertion on the humeral neck (Case 1), or the junction of the ligament with the labrum (Case 2). It is impossible to prove completely the existence of capsular tear from the preoperative clinical findings and imaging including MRI.…”

“…Anterior instability due to capsular tearing can usually be repaired by suturing the torn ends together with a satisfactory result. 3,[7][8][9][10][11] We describe two cases experienced during open Bankart procedure, in whom primary capsular repair was infeasible due to capsular deficiency including the IGHL despite an initial surgery to address anterior instability. We also present the presumed cause of primary irreparability and the surgical reconstructive technique we employed.…”

Case Report: Humeral avulsion of the glenohumeral ligament of the shoulder

“…This is described as a HAGL lesion (Humeral Avulsion of the Glenohumeral Ligament). 1 Arthroscopy of the shoulder confirmed the diagnosis of a HAGL lesion (Fig. 3).…”