Is CT scan a predictor of instability in recurrent dislocation shoulder?

Abstract

Purpose Glenoid bone defect and the defect on the posterior-superior surface of the humerus “Hill-Sachs lesion” are the commonly seen bony lesions in patients with recurrent dislocation shoulder. Computed tomography (CT) scan is considered as the best option in assessing the bony defects in the recurrent dislocation shoulder. The aim of this study was to assess the clinical and radiological co-relation in the patients with recurrent dislocation shoulder. Methods Forty-four patients of recurrent dislocation shoulder who were evaluated between January 2015 and December 2017 at a tertiary care center, clinically and radiologically using CT scan and meeting the inclusion criteria, were included. The correlation between the clinical history of the number of dislocations and the bone loss using CT scan was evaluated. Two sided statistical tests were performed at a significance level of α = 0.05. The analysis was conducted using IBM SPSS STATISTICS (version 22.0). Results All the patients were male with mean age of 25.95 (SD ± 4.2) years were evaluated. Twenty-four patients sustained injury in sporting activities while 20 patients sustained injury in training. There were an average of 4.68 (SD ± 3.1, range 2–15, median 3) episodes of dislocation. Forty-one patients had the glenoid bone loss while 40 had the Hill-Sachs lesions. The mean glenoid width defect was 10.80% (range 0–27%) while the mean Hill-Sachs defect was 14.27 mm (range 0–26.6 mm). The mean area of bone loss of the glenoid surface was 10.81% (range 0–22.4%). The lesions were on track in 34 patients and off track in 10 patients. Conclusions CT scan of the shoulder joint is an effective method for assessing the amount of bone loss. The number of dislocations are correlated significantly with off-track lesions and the amount of bone loss on the glenoid and Hill-Sachs lesion. The glenoid width bone loss of more than 9.80% or Hill-Sachs defect of more than 14.80 mm are the critical defects after which the frequency of dislocations increases.

The utilization of computer planning and 3D-printed guide in the surgical management of a reverse Hill-Sachs lesion

“…In the present case, which was not successfully diagnosed in the emergency department, a CT scan showed the relationships between different bone structures in detail, revealing the glenohumeral dislocation and reverse Hill-Sachs lesion. 21 Several authors recommend using this imaging technique when radiographs are inconclusive, 10 , 11 , 19 and others have noted the importance of complementing CT with magnetic resonance imaging to enable the recognition of associated lesions in the labrum or joint capsule. 20 …”

Variability in quantifying the Hill-Sachs lesion: A scoping review

“…For CT, humeral residual articular arc and percentage of articular arc loss, HSL width and depth, percentage of anterior glenoid defect, bare area, on-track and off-track, Franceschi grading, Calandra classification, Richards grading, Hall grading, Rowe grading, Flatow percentage, linear-based and area-based methods were used. 10,31,39,52 The reported sensitivity when confirmed by CT was between 20% and 65%, and the specificity was between 41.7% and 87%. 25,39 Accuracy, positive predictive value (PPV), and negative predictive value (NPV) were not reported amongst the CT studies.…”

“…10,31,39,52 The reported sensitivity when confirmed by CT was between 20% and 65%, and the specificity was between 41.7% and 87%. 25,39 Accuracy, positive predictive value (PPV), and negative predictive value (NPV) were not reported amongst the CT studies. Intrarater agreement was only reported in one study, where there was 33% agreement for on-track measurements.…”

Current concepts on the assessment of a patient with a traumatic anterior shoulder dislocation

“…• young age at the initial dislocation 3,7 • humeral or glenoid critical bone loss at initial dislocation [8][9][10][11] • return to competitive contact sport activities [12][13][14][15] • ligamentous laxity [16][17][18] Recurrent dislocation after initial nonoperative management is closely related to age younger than 20 years at the time of the first dislocation. 3,19 Roberts et al prospectively observed a group of 133 adolescents who were treated nonoperatively for anterior shoulder dislocation and reported a 76% recurrence rate at two years.…”

“…This recurrence rate drops to 58% and 27% respectively when dealing with an on-track Hill-Sachs lesion or no lesion at all in young first-time dislocators. 8,9 Dickens et al found that initial traumatic anterior shoulder dislocation could lead to minor glenoid bone loss (6.8% of the glenoid width), but this glenoid bone loss increased up to 22.8% in recurring dislocations. 10 In the setting of glenoid bone loss, recurrence rates of 72% in the under 23-year-olds and 27% in the over 30-year-olds have been reported.…”