Rehabilitation Postsurgical Stabilization for Shoulder Instability

Shyam Sundar, David V Rajan

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 40 – 48

Author: Shyam Sundar [1], David V Rajan [1].

[1] Ortho OneOrthopaedic Speciality Centre, Coimbatore, Tamil Nadu, India

Address of Correspondence

Dr. Shyam Sundar,
MS Orthopaedics, Ortho One Orthopaedic Speciality Centre, Coimbatore – 641 005, Tamil Nadu, India.
Email: drshyam.msortho@gmail.com

Abstract

The shoulder joint is a polyaxial joint with the advantage of increased mobility at the cost of stability. The incidence of subluxation/dislocation is on the increase considering the fact that children are more actively involved in sporting activities at a very young age. This has necessitated the orthopedic surgeons to identify those at risk of injuries as well as to treat those with injuries to restore normality without compromising the function. Over the recent past, surgical management for shoulder instability has evolved to a more precise level giving importance to the minutest details in respecting and repairing the injured structures. As a result of which the patient’s recovery and functional outcome has been better than how it was earlier. Nonetheless, the success of surgery depends not only on the surgeon or the patient factors but also in the implementation of a tailored rehabilitation protocol focusing on getting the patient back to normalcy at the earliest with minimal discomfort. The aim of this article is to kindle the various aspects of an ideal rehabilitation following surgical stabilization of shoulder instability and to guide in the optimizing treatment protocol.
Keywords: Shoulder instability, Rehabilitation, Proprioception, Kinetic chain.

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How to Cite this article:. Sundar S, Rajan DV. Rehabilitation Postsurgical Stabilization for Shoulder Instability Asian Journal of Arthroscopy Jan – April 2017;1(2):40-48.

 

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Biomechanics and Management of HAGL Lesions in Anterior Instability

Desmond J Bokor, Yuval Arama

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 36 -39

Author: Desmond J Bokor [1], Yuval Arama [1].

[1] Department of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia

Address of Correspondence

Dr. Desmond Bokor,
Suite 303, 2 Technology Place,Macquarie University. NSW. 2019, Sydney,Australia.
E-mail:desbok@iinet.net.au

Abstract

Humeral avulsion of the glenohumeral ligament is an uncommon but important cause for recurrent anterior instability of the shoulder. It is usually associated with high energy trauma in a slightly older male population with a hyperabduction/axial load mechanism. Associated damage can include avulsion of the glenoid labrum, rotator cuff tears, and bony damage. Diagnosis requires a high index of clinical suspicion, and MR arthrography performed 4-6 weeks post injury is the most reliable investigation. Care should be taken with MRI performed in the first week, as many of the lesions seen at this time will heal. Surgical repair is recommended for recurrent instability or if the patient requirements need them to have a stable shoulder. Repair can be performed using arthroscopic, minopen or full open techniques. Care should be taken when placing sutures through the capsule because of the proximity of the axillary nerve to the inferior capsular edge. Biomechanically, the capsule should be repaired to the medial humeral neck just below the chondral margin. Surgical outcomes are satisfactory in most series reported.
Keywords: Anterior instability, humeral avulsion of the glenohumeral ligament

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How to Cite this article:. Bokor DJ, Arama Y. Biomechanics and management of HAGL lesions in Anterior Instability. Asian Journal of Arthroscopy Jan – April 2017;1(2):36-39.

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Arthroscopic Stabilisation Techniques for Anterior Shoulder Instability

Shiraz Michael Bhatty, Jonathan Herald

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 29 -35

Author: Shiraz Michael Bhatty [1], Jonathan Herald [1].

[1] Fellow, Orthoclinic, Sydney

Address of Correspondence

Dr. Shiraz Michael Bhatty, Fellow, Orthoclinic, Sydney.
Email: shirazbhatty@gmail.com

Abstract

Traumatic anteroinferior dislocation of shoulder in young patients often results in recurrent instability and can be a challenging problem to solve surgically. Treatment of anterior shoulder instability continues to evolve. Arthroscopic shoulder stabilization has become a preferred method of treatment for shoulder instability because reported success rates are parallel to those of open stabilization techniques. This is due to continuing advancement in techniques, instrumentation, improved understanding of the associated pathoanatomy and proper patient selection. In addition to the typical capsulolabral disruptionsseen following a primary dislocation, patients with recurrent instability often have coexistent osseous injury to the humeral head and glenoid. Important considerations during arthroscopy include identifying all pathology, adequate mobilization of the capsulolabral sleeve, retensioning of glenohumeral sleeve and secure anatomic fixation. With advancements in technique and more accurate diagnoses, these outcomes will continue to rise, and patients will more reliably be able to return to prior functioning levels.
Keywords: disclocation of shoulder, pathoanatomy, capsulolabral sleeve.

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How to Cite this article:. Bhatty SM, Herald J. Arthroscopic Stabilisation Techniques for Anterior Shoulder Instability. Asian Journal of Arthroscopy Jan – April 2017;1(2):29-35.

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Current Trends in Management of Glenoid Bone Loss in Anterior Shoulder Instability

Vikram K Kandhari, Bibhas DasGupta, Deepak N Bhatia

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 20 – 28

Author: Vikram K Kandhari [1], Bibhas DasGupta [1], Deepak N Bhatia [1].

[1] Department of Orthopaedic Surgery, Seth GS Medical College, King Edward VII Memorial Hospital, Parel, Mumbai, Maharashtra,
[2] Sportsmed Mumbai, Parel, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Deepak N Bhatia,
Department of Orthopaedic Surgery,  Seth GS Medical College, and King Edward VII Memorial Hospital,
Parel, Mumbai – 400 012, Maharashtra, India.
E-mail: shoulderclinic@gmail.com

Abstract

Significant bone defects of glenohumeral joint play an important role in the management of shoulder instability. Bony instability is an important cause of failed soft-tissue repair and recurrent episodes of shoulder dislocations. Bony instability can also be associated with labral (superior and posterior) tears, humeral avulsion of glenohumeral ligament lesions, or rotator cuff tears. Computed tomography (CT) scan with three-dimensional reconstruction is essential for quantification of glenohumeral bone loss. Magnetic resonance imaging (MRI) is reliable for quantification of bone loss, and in addition, demonstrates the soft tissue pathology. Surface area based methods of quantifying glenoid bone loss are more accurate than width based methods. Certain factors important in managing patients with anterior glenohumeral instability include patients’ age, level of sports participation, involvement with contact sports, time of presentation (acute or chronic), and type of bony defect (bony Bankart or attritional bone loss). Soft-tissue reconstruction procedures (labroplasty and remplissage) are usually used in managing patients with nonsignificant bone loss. Patients having significant bone defects of glenoid (>25%) and humerus (off-track/engaging Hill-Sachs lesions) are candidates for open bone grafting of glenohumeral bone defects. Coracoid transfer(Latarjet procedure), either mini-open or arthroscopic gives good functional results and decreases chances of recurrence. Associated lesions should be addressed concomitantly to improve the functional outcome in patients with bony instability of the shoulder. This review presents an evidence-based comprehensive diagnostic and treatment options for patients with bony glenoid deficiency in anterior shoulder instability.
Keywords: Shoulder instability, Hill-Sachs lesion,Labroplasty, Latarjet procedure,Remplissage, Glenoid bone loss, Bony Bankart.

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How to Cite this article:. Kandhari VK, DasGupta B, Bhatia DN. Current Trends in Management of Glenoid Bone Loss in Anterior Shoulder Instability. Asian Journal of Arthroscopy Jan – April 2017;1(2):20-28.

 

 

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Investigations for the Unstable Shoulder

Oliver James Negus, Jonathan James Negus

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 7 – 14

Author: Oliver James Negus [1], Jonathan James Negus [2].

[1] Department of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, England,
[2] Department of Orthopaedics, University College Hospital, London, England.

Address of Correspondence

Dr. Jonathan Negus,
Department of Orthopaedics, University College Hospital, London, England.
E-mail: jonathan.negus@cantab.net

Abstract

The unstable shoulder has a wide spectrum of presentations from the obvious dislocations to the subtle chronic instabilities. It is the job of the clinician who is interpreting the imaging to correlate a clear history with the pathology that can be seen and to go searching for the pathology that may not be obvious but could drastically alter management. For most cases, imaging is used mainly to direct further management than to diagnose. Therefore, it is critical to have access to the appropriate imaging modality taken in the correct manner to maximize the possibility of picking up all lesions. This review looks at the possible lesions and imaging modalities needed to diagnose them and more importantly, direct their future management.
Keywords: Shoulder instability, Shoulder imaging, Unstable shoulder, Shoulder dislocation.

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57. McMullen J, Uhl TL. A kinetic chain approach for shoulder rehabilitation. J Athl Train 2000;35(3):329-337.
58. Kibler WB, Sciascia A, Thomas SJ. Glenohumeral internal rotation deficit: Pathogenesis and response to acute throwing. Sports Med Arthrosc 2012;20(1):34-38.
59. Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports PhysTher 2005;35(4):227-238.

How to Cite this article:. Negus OJ, Negus JJ. Investigations for the Unstable Shoulder. Asian Journal of Arthroscopy Jan – April 2017;1(2):7-14 .

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Patho-anatomy and Patho-mechanics of Glenohumeral Instability

Sagar Vivek Kakatkar, Jonathan Herald

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 3-6

Author: Sagar Vivek Kakatkar [1,2], Jonathan Herald [1]

[1] Vivaan Clinic, Nashik, Maharashtra, India.
[2] Dr. VPMCH, Nashik, Maharashtra, India.
[3] Orthoclinic, Sydney, Australia.

Address of Correspondence

Vivaan Clinic, First floor, N.S.B. center, Canada Corner, Nashik
Email: drsagarkakatkar@gmail.com

Abstract

Patho-anatomy and patho-mechanics form the basis of management of any pathology. Gleno-humeral joint is one of the most functionally complex joint in the body because of its greater range of motion and interrelationship of the forces acting on the joint. All these factors should be considered when planning the management of the glenohumeral instability since inability to address anatomical deficiencies may lead to failure; which may further complicate the treatment. The static and dynamic stabilizers of the glenohumeral joint have been described here in relation to the shoulder instability.
Keywords: Glenohumeral instability, pathoanatomy, pathomechanics, inferior glenohumeral ligament.

References

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19. Ticker JB, Bigliani LU, Soslowsky LJ, Pawluk RJ, Flatow EL, Mow VC. Viscoelastic and geometric properties of the inferior glenohumeral ligament. Orthop Trans 1992;16:304-305.
20. Bigliani LU, Pollock RG, Soslowsky LJ, Flatow EL, Pawluk RJ, Mow VC. Tensile properties of the inferior glenohumeral ligament. J Orthop Res 1992;10(2):187-197.
21. Savoie FH 3rd, Holt MS, Field LD, Ramsey JR. Arthroscopic management of posterior instability: Evolution of technique and results. Arthroscopy 2008;24(4):389-396.
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How to Cite this article:. Kakatkar SV, Herald J. Patho-anatomy and Patho-mechanics of Glenohumeral Instability. Asian Journal of Arthroscopy Jan – April 2017;2(1):3-6.

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Arthroscopic Repair for Massive Bony Bankart Lesions

Dinshaw N Pardiwala, Nandan Rao, Ankit Varshney

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 15-19.

Author: Dinshaw N Pardiwala [1], Nandan Rao [1], Ankit Varshney [1]

[1] Arthroscopy & Shoulder Service Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.

Address of Correspondence

Dr. Dinshaw Pardiwala
Head – Centre for Sports Medicine
Director – Arthroscopy & Shoulder Service, Kokilaben Dhirubhai Ambani Hospital
Mumbai, India.
Email: Dinshaw.Pardiwala@relianceada.com.

Abstract

A bony Bankart lesion is defined as a labro-ligamentous detachment of the glenoid rim along with a fragment of attached bone and is commonly associated with shoulder instability. When the fragment of bone extends over one quadrant of the glenoid, we have termed it as a “massive” bony Bankart lesion. Traditionally considered as a type of glenoid fracture, it is important to appreciate that these fractures are not isolated bony injuries. The bone fragments are always attached to the labrum and are avulsed along with the glenohumeral ligaments. Although these injuries have traditionally been treated with open reduction and fracture fixation techniques, in recent years, surgical repair for these lesions has shifted towards arthroscopic instability repair techniques. Although the choice of technique to fix bony Bankart lesions (single row suture anchor repair, suture bridge dual-row anchor repair, arthroscopic screw fixation) is surgeon-specific, this is often determined by a number of factors, including bone fragment size and quality, and the ease with which the fragment can be manipulated and viewed for reduction and fixation. There is no clinical data currently that proves the superiority of any technique, and all report a high rate of radiographic incorporation and clinical success. This paper describes the detailed technique for arthroscopic single row suture anchor massive bony Bankart repair.
Keywords: Bony Bankart Lesion, Arthroscopic Repair, surgical techniques.

References

1. Porcellini G, Paladini P, Campi F, et al. Long-term outcome of acute versus chronic bony bankart lesions managed arthroscopically. AJSM 2007;35(12):2067-2072.
2. Bigliani LU, Newton PM, Steinmann SP, Connor PM, McIlveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. AJSM 1998;26(1):41-45.
3. Griffith JF. et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. American Journal of Radiology 2008;190:1247-1254.
4. Edwards TB, Boulahia A, Walch G. Radiographic analaysis of bone defects in chronic anterior shoulder instability. Arthroscopy 2003;19:732-739.
5. Burkhart SS, DeBeer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic bankart repairs: Significance of inverted pear glenoid and the humeral engaging Hill Sachs lesion. Arthroscopy 2000; 16: 677-694.
6. Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Newyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. JBJS 2006; 88(8):1755-1763.
7. Tauber M, Resch H, Forstner R, Raffl M, Schauer J. Reason for failure after surgical repair of anterior shoulder instability. JSES 2004; 13(3); 279-285.
8. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Gleoind rim morphology in recurrent anterior glenohumeral instability. JBJS 2003; 85-A5; 878-884.
9. Burkhart SS, Danaceau SM. Articular arc length mismatch as a cause of failed Bankart repair. Arthroscopyc 2000;16:740-744.
10. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anterioinferior stability of the shoulder after Bankart repair: A cadaveric study: JBJSA 2000;82(1) :35-46.
11. Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand. 1995;66(5):395-397.
12. Porcellini G, Campri F, Paladini P. Arthroscopic approach to acute bony Bankart lesion. Arthroscopy 2002 18(7);764-769.
13. Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A. Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. JBJS A 2005;87:1752-1760.
14. Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid. AJSM 2007; 35(8): 1276-1283.
15. Kim YK, Cho SH, Son WS, Moon SH. Arthroscopic Repair of small and medium sized bony Bankart lesions. AJSM 2014;42:86.
16. Zhang J, Jiang C. A new “double pulley” dual row technique for arthroscopic fixation of bony Bankart lesion. Knee Surg Sports Traumatol Arthrosc 2011;19(9):1558-1562.
17. Millett PJ, Horan MP, Martstschlager F. The “bony Bankart bridge” technique for restoration of anterior shoulder instability. AJSM 2013; 41:608-614.
18. Giles JW, Puskas GJ, Welsh MF, Johnson JA, Athwal GS. Suture anchor fixation of bony Bankart fractures: Comparison of single-point with double-point “suture bridge” technique. AJSM 2013; 41:2624.
19. Cameron SE. Arthroscopic reduction and internal fixation of anterior glenoid fracture. Arthroscopy 1998; 14: 743-746.
20. Park JY, Lee SJ, Lhee SH, Lee, SH. Follow-up CT arthrographic evaluation of bony Bankart lesions after arthroscopic repair. Arthroscopy 2012;28(4):465-473.
21. Jiang CY et al. Do reduction and healing of the bony fragment really matter in arthrosopic bony Bankart Reconstruction? A prospective study with clinical and computed tomography evaluations. AJSM 2013;4:12617-2623.

How to Cite this article:. Pardiwala DN. Rao N, Varshney A. Arthroscopic Repair for Massive Bony Bankart Lesions. Asian Journal of Arthroscopy Jan – April 2017;2(1):15-19.

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First Anniversary Issue of Asian Journal of Arthroscopy

Sachin Tapasvi, Parag Sancheti , Ashok Shyam

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 1- 2

Author: Sachin Tapasvi [1], Parag Sancheti [2] , Ashok Shyam [2, 3]

[1] Orthopaedic Speciality Clinic, Pune Mahatrahtra.
[2] Sancheti Institute for Orthopaedics & Rehabilitation, Pune, India
[3] Indian Orthopaedic Research Group, Thane, India

Address of Correspondence

Dr Ashok Shyam
AJA Editorial Officie, A-203, Manthan Apts, Shreesh CHS, Hajuri Road, Thane [w], Maharashtra, India.
Email: editor@asianarthroscopy.com

Dear Colleagues,
we proudly present to you the anniversary issue of Asian Journal of Arthroscopy. Also we take this opportunity to thanks all our authors, reviewers and readers for supporting the journal. Special Thanks to all our symposium editors who have done excellent work with all three symposia’s. In last three issues we had three symposia on ‘Graft choices in ACL reconstruction’, ‘Meniscal tear and its management’, and ‘Shoulder Instability’. All three symposia’s were well received and attracted readership from all across the globe. Forthcoming symposia on Wrist arthroscopy and Elbow Arthroscopy are in process of getting ready and will be soon in your hands.
From this year we are soliciting original articles, case reports and technical notes. AJA has received ISSN and has basic indexing with major indexing bodies. The outreach of AJA is more than 20,000 orthopaedic surgeons through the network of Indian Orthopaedic Research Group. Also AJA is open access and all articles are easily downloadable and assessed from all across the globe. This presents a unique opportunity and advantage for all authors and there work can reach maximum readers through our network. We invite authors to submit their work to AJA using the online submission system ‘Scripture’ and if you have any queries please write to us. For special interest to us are video techniques of arthroscopy surgeries. We have received two video techniques which are under peer review and will probably show up soon in the forthcoming issues. We understand that there is always a small variations in techniques that every surgeon had developed over a period of time. These variations represent true experience based learning. Also at times during complex procedures or in cases with intraoperative complications, we have to innovate certain techniques to achieve good results. We at AJA will like to showcase these as ‘Surgical Tips’. Videos of common procedures with such surgical variations or complex procedures with variations are welcomed. Please prepare a video with voiceover and send to us with a brief write up of the technique or variation. The AJA team will help authors in video editing and processing. These video resources are fast becoming one of the most valuable resources and AJA is all geared up to support the authors to showcase their techniques.
This is the first anniversary issue of AJA and this is a major landmark for any journal. It shows the ability and commitment of the editors and the editorial board. Starting and running an academic Journal is not an easy venture. It requires co-ordinating many things including section editors, authors, reviewers, designers, copyeditors and many others. The combined effort of everyone is needed to create every issue and errors by any department will show up in the articles. To maintain the high quality its pertinent that every department does it work sincerely and efficiently. In this one year we are able to build up this co-ordination and a well-oiled mechanism is in place that can take care of submissions and review process. We also request the authors to take care while submitting to AJA. Please read the instructions to authors carefully and format your submissions. This will prevent unnecessary delays and resubmissions. Reviewers are the backbone of any journal. We have managed to get some every good reviewers for AJA but we would sincerely request our readers to participate in the reviewing process in large numbers.
The future of AJA looks very promising. We have received support from many national and international surgeons who have appreciated the platform and many have also joined us in this endeavour. AJA as a journal is young and full of potential. We will take help of advanced technology and our experienced editorial team to create an experience that is truly unique. Journal have to come out of their routine and fixed attitudes and grow with new generation and advancements. We shall leave no stone unturned to make AJA one of the most valuable journal in the world. We will need support from all our colleagues in doing this and if you wish to join the AJA team please feel free to write to us with your visions and plans for joining the team. We will need your comments and suggestions on the past issues of AJA as well as on the probable future course that AJA should take. With this we again thank all our supporters and leave you to enjoy the latest issue of AJA .

How to Cite this article:. Tapasvi S, Sancheti PK, Shyam AK. First Anniversary Issue of Asian Journal of Arthroscopy. Asian Journal of Arthroscopy Jan – April 2017;2(1):1-2Tapasvi S, Sancheti PK, Shyam AK. First Anniversary Issue of Asian Journal of Arthroscopy. Asian Journal of Arthroscopy Jan – April 2017;2(1):1-2.

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