Recurrent Shoulder Instability: Current Concepts for Evaluation and Management of Glenoid Bone Loss

Provencher, Matthew T.; Bhatia, Sanjeev; Ghodadra, Neil; Grumet, Robert C.; Bach, Bernard R.; Dewing, Christopher B.; LeClere, Lance E.; Romeo, Anthony A.

doi:10.2106/jbjs.j.00906

Cited by 371 publications

(299 citation statements)

References 36 publications

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“…Die Unterscheidung zwischen isoliertem Weichteilschaden (Labrum, Kapsel, glenohumerale Bänder) und knöchernem Schaden des Humeruskopfes, des Glenoids oder der Kombination beider Pathologien ist für die Therapieentscheidung wichtig, sowohl bei der akuten als auch bei der chronischen Instabilität [3]. Die Verletzung der dynamischen Stabilisatoren (Rotatorenmanschette) hat beim älteren Patienten einen besonderen Stellenwert.…”

Section: Instabilität Schultergelenkunclassified

Instabilität Schultergelenk

Ockert

2018

Unfallchirurg

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Section: Instabilität Schultergelenkunclassified

Instabilität Schultergelenk

Ockert

2018

Unfallchirurg

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“…1 Preoperative history taking and physical examination, as well as quantifying anterior glenoid bone deficiency, are critical for successful surgical treatment because the anterior glenoid has been identified as the primary location of bone loss. 2 The osseous structure, as well as integrity, has been identified as one of the most critical factors that influences surgical outcomes.…”

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“…3 History taking can elicit important clinical clues that point toward the diagnosis of glenoid bone loss, including a history of a high-energy mechanism of injury, specifically if the arm was abducted 70 or more and extended 30 or more during the initial dislocation event. 1 In addition, in patients who have multiple dislocations, instability in the midranges of motion, and instability at night, bone deficiency pathology should be considered. Physical examination can provide meaningful clues, which strongly suggest glenoid bone loss, particularly in patients with a positive apprehension test in the range of motion between 30 and 90 of shoulder abduction with a minimal amount of external rotation.…”

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confidence: 99%

“…Physical examination can provide meaningful clues, which strongly suggest glenoid bone loss, particularly in patients with a positive apprehension test in the range of motion between 30 and 90 of shoulder abduction with a minimal amount of external rotation. 1 The examination should also include an evaluation of anterior translation of the humeral head over the glenoid border because, when reproducible, this is suggestive of bone loss. 1 Preoperative imaging can help determine the extent and type of glenoid deficiency.…”

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confidence: 99%

“…1 The examination should also include an evaluation of anterior translation of the humeral head over the glenoid border because, when reproducible, this is suggestive of bone loss. 1 Preoperative imaging can help determine the extent and type of glenoid deficiency.…”

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Assessment and Evaluation of Glenoid Bone Loss

Hamamoto¹,

Leroux²,

Chahla

et al. 2016

Arthroscopy Techniques

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The preoperative assessment of anterior glenoid bone loss is a critical step in surgical planning for patients with recurrent anterior glenohumeral instability. The structural integrity of the glenoid has been identified as one of the most important factors influencing the success of operative repair. The currently accepted gold standard for glenoid structural assessment among most orthopaedic surgeons is the use of 3-dimensional reconstructed computed tomography images with the humeral head digitally subtracted, yielding an en face sagittal oblique view of the glenoid. This view allows for evaluation of glenoid morphology and quantitative assessment of glenoid bone loss. In this article, we describe the practical application of ImageJ software (National Institutes of Health, Bethesda, MD) to quantify the amount of glenoid bone loss reported as a percentage of either total surface area or diameter. The following equations are used in this technical note for the diameter-based method and surface area method, respectively: Percent bone loss ¼ (Defect width/ Diameter of inferior glenoid circle) Â 100% and Percent bone loss ¼ (Defect surface area/Surface area of inferior glenoid circle) Â 100%.

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A pictorial presentation and the clinical use of the modified trauma axial (MTA) shoulder x‐ray view

Tam

Awwad

2023

J of Medical Radiation Sci

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Anteroposterior (AP) and lateral shoulder projections are routinely performed as part of a post‐reduction shoulder x‐ray series in the emergency department (ED). Research has shown that these projections alone are insufficient to demonstrate post‐dislocation injuries, particularly Hill‐Sachs and Bankart lesions. These concomitant pathologies are best demonstrated on axial shoulder projections but are difficult to obtain in trauma patients with limited range of motion. The diagnostic quality and the pathology demonstrated by different projections is crucial so that doctors and other ED staff can triage patients appropriately, radiologists can report on the presence or absence of post‐dislocation shoulder injuries, and the orthopaedic team can plan for follow‐up or treatment. Different modified axial views were reported to improve the post‐dislocation pathology sensitivity in the shoulder series. However, all of these shoulder axial views require patient movement. The modified trauma axial (MTA) is an alternative projection that is suitable for trauma patients that does not depend on patient movement. This paper presents several cases where the MTA shoulder projection had clinical importance when used as part of the post‐reduction shoulder series in the ED or radiology department.

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Recurrent Shoulder Instability: Current Concepts for Evaluation and Management of Glenoid Bone Loss

Cited by 371 publications

References 36 publications

Instabilität Schultergelenk

Instabilität Schultergelenk

Assessment and Evaluation of Glenoid Bone Loss

A pictorial presentation and the clinical use of the modified trauma axial (MTA) shoulder x‐ray view

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