Tag Archive for: Shoulder instability

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.

References

1. Kim SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: A prospective randomized clinical study. Arthroscopy 2003;19(7):722-731.
2. Itoi E, Hsu HC, An KN. Biomechanical investigation of the glenohumeral joint. J Shoulder Elbow Surg 1996;5(5):407-424.
3. Abboud JA, Soslowsky LJ. Interplay of the static and dynamic restraints in glenohumeral instability. ClinOrthopRelat Res 2002;400:48-57.
4. Itoi E. Pathophysiology and treatment of atraumatic instability of the shoulder. J OrthopSci 2004;9(2):208-213.
5. Arciero RA, Wheeler JH, Ryan JB, McBride JT. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 1994;22(5):589-594.
6. Hawkins RH, Hawkins RJ. Failed anterior reconstruction for shoulder instability. J Bone Joint Surg Br 1985;67(5):709-714.
7. Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 1996;78(11):1677-1684.
8. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: A cadaveric study. J Bone Joint Surg Am 2000;82(1):35-46.
9. Robinson CM, Kelly M, Wakefield AE. Redislocation of the shoulder during the first six weeks after a primary anterior dislocation: Risk factors and results of treatment. J Bone Joint Surg Am 2002;84-A(9):1552-1559.
10. Rowe CR, Pierce DS, Clark JG. Voluntary dislocation of the shoulder. A preliminary report on a clinical, electromyographic, and psychiatric study of twenty-six patients. J Bone Joint Surg Am 1973;55(3):445-460.
11. Weber BG, Simpson LA, Hardegger F. Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion. J Bone Joint Surg Am 1984;66(9):1443-1450.
12. Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am 2006;88(11):2326-2336.
13. Hintermann B, Gächter A. Arthroscopic findings after shoulder dislocation. Am J Sports Med 1995;23(5):545-551.
14. Anakwenze OA, Hsu JE, Abboud JA, Levine WN, Huffman GR. Recurrent anterior shoulder instability associated with bony defects. Orthopedics 2011;34(7):538-544.
15. Provencher MT, Frank RM, Leclere LE, Metzger PD, Ryu JJ, Bernhardson A, et al.The Hill-Sachs lesion: Diagnosis, classification, and management. J Am AcadOrthopSurg 2012;20(4):242-252.
16. Skendzel JG, Sekiya JK. Diagnosis and management of humeral head bone loss in shoulder instability. Am J Sports Med 2012;40(11):2633-2644.
17. Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 1997;25(3):306-311.
18. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998;26(1):41-45.
19. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 2003;85-A(5):878-884.
20. Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid: Results in patients with bone loss of the anterior glenoid. Am J Sports Med 2007;35(8):1276-1283.
21. Sterling M, Jull G, Wright A. The effect of musculoskeletal pain on motor activity and control. J Pain 2001;2(3):135-145.
22. Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, et al.A new method of immobilization after traumatic anterior dislocation of the shoulder: A preliminary study. J Shoulder Elbow Surg 2003;12(5):413-415.
23. Miller BS, Sonnabend DH, Hatrick C, O’leary S, Goldberg J, Harper W, et al. Should acute anterior dislocations of the shoulder be immobilized in external rotation? A cadaveric study. J Shoulder Elbow Surg 2004;13(6):589-592.
24. McMahon PJ, Lee TQ. Muscles may contribute to shoulder dislocation and stability. ClinOrthopRelat Res 2002;403 Suppl:S18-S25.
25. McAuliffe TB, Pangayatselvan T, Bayley I. Failed surgery for recurrent anterior dislocation of the shoulder. Causes and management. J Bone Joint Surg Br 1988;70(5):798-801.
26. Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89(11):1470-1477.
27. Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: From “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 2014;30(1):90-98.
28. Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-sachs “remplissage”: An arthroscopic solution for the engaging hill-sachs lesion. Arthroscopy 2008;24(6):723-726.
29. Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000;16(7):677-694.
30. Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: An indicator of significant glenoid bone loss. Arthroscopy 2004;20(2):169-174.
31. Fedorka CJ, Mulcahey MK. Recurrent anterior shoulder instability: A review of the Latarjet procedure and its postoperative rehabilitation. PhysSportsmed 2015;43(1):73-79.
32. Frostick SP, Sinopidis C, Al Maskari S, Gibson J, Kemp GJ, Richmond JC. Arthroscopic capsular shrinkage of the shoulder for the treatment of patients with multidirectional instability: Minimum 2-year follow-up. Arthroscopy 2003;19(3):227-233.
33. Bigliani LU, Pollock RG, McIlveen SJ, Endrizzi DP, Flatow EL. Shift of the posteroinferior aspect of the capsule for recurrent posterior glenohumeral instability. J Bone Joint Surg Am 1995;77(7):1011-1020.
34. Antoniou J, Duckworth DT, Harryman DT 2nd. Capsulolabral augmentation for the the management of posteroinferior instability of the shoulder. J Bone Joint Surg Am 2000;82(9):1220-1230.
35. Pollock RG, Bigliani LU. Recurrent posterior shoulder instability. Diagnosis and treatment. ClinOrthopRelat Res 1993;291:85-96.
36. Wirth MA, Groh GI, Rockwood CA Jr. Capsulorrhaphy through an anterior approach for the treatment of atraumatic posterior glenohumeral instability with multidirectional laxity of the shoulder. J Bone Joint Surg Am 1998;80(11):1570-1578.
37. Kim SH, Ha KI, Yoo JC, Noh KC. Kim’s lesion: An incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy 2004;20(7):712-720.
38. Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint 1944. ClinOrthopRelat Res 1996;330:3-12.
39. Wilk KE, Arrigo C. Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports PhysTher 1993;18(1):365-378.
40. Bowen MK, Warren RF. Ligamentous control of shoulder stability based on selective cutting and static translation experiments. Clin Sports Med 1991;10(4):757-782.
41. O’Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 1990;18(5):449-456.
42. Cain PR, Mutschler TA, Fu FH, Lee SK. Anterior stability of the glenohumeral joint. A dynamic model. Am J Sports Med 1987;15(2):144-148.
43. Riemann BL, Lephart SM. The sensorimotor system, part I: The physiologic basis of functional joint stability. J Athl Train 2002;37(1):71-79.
44. Vangsness CT Jr, Ennis M, Taylor JG, Atkinson R. Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa. Arthroscopy 1995;11(2):180-184.
45. Rossi A, Grigg P. Characteristics of hip joint mechanoreceptors in the cat. J Neurophysiol 1982;47(6):1029-1042.
46. Pedersen J, Lönn J, Hellström F, Djupsjöbacka M, Johansson H. Localized muscle fatigue decreases the acuity of the movement sense in the human shoulder. Med Sci Sports Exerc 1999;31(7):1047-1052.
47. Johansson H, Sjölander P, Sojka P. A sensory role for the cruciate ligaments. ClinOrthopRelat Res 1991;268:161-178.
48. Dietz V, Noth J, Schmidtbleicher D. Interaction between pre-activity and stretch reflex in human triceps brachii during landing from forward falls. J Physiol 1981;311:113-125.
49. Smith RL, Brunolli J. Shoulder kinesthesia after anterior glenohumeral joint dislocation. PhysTher 1989;69(2):106-112.
50. Tibone JE, Fechter J, Kao JT. Evaluation of a proprioception pathway in patients with stable and unstable shoulders with somatosensory cortical evoked potentials. J Shoulder Elbow Surg 1997;6(5):440-443.
51. Carpenter JE, Blasier RB, Pellizzon GG. The effects of muscle fatigue on shoulder joint position sense. Am J Sports Med 1998;26(2):262-265.
52. Lephart SM, Henry TJ. Functional rehabilitation for the upper and lower extremity. OrthopClin North Am 1995;26(3):579-592.
53. Davies GJ, Dickoff-Hoffman S. Neuromuscular testing and rehabilitation of the shoulder complex. J Orthop Sports PhysTher 1993;18(2):449-458.
54. Cavagna GA, Dusman B, Margaria R. Positive work done by a previously stretched muscle. J ApplPhysiol 1968;24(1):21-32.
55. Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the overhead athlete. Clin Sports Med 2013;32(4):637-651.
56. Sciascia A, Thigpen C, Namdari S, Baldwin K. Kinetic chain abnormalities in the athletic shoulder. Sports Med Arthrosc 2012;20(1):16-21.
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:. 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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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.

References

1. Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000;16(7):677-694.
2. Hovelius L. Incidence of shoulder dislocation in Sweden. ClinOrthopRelat Res 1982;166:127-131.
3. Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 1997;25(3):306-311.
4. Fujii Y, Yoneda M, Wakitani S, Hayashida K. Histologic analysis of bony Bankart lesions in recurrent anterior instability of the shoulder. J Shoulder Elbow Surg 2006;15(2):218-223.
5. Hill HA, Sachs MD. The grooved defect of the humeral head a frequently unrecognized complication of dislocations of the shoulder joint. Radiology1940;35(6):690-700.
6. Calandra JJ, Baker CL, Uribe J. The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy 1989;5(4):254-257.
7. de Beer J, Bhatia DN. Shoulder injuries in rugby players. Int J Shoulder Surg 2009;3(1):1-3.
8. Arrigoni P, Huberty D, Brady PC, Weber IC, Burkhart SS. The value of arthroscopy before an open modified latarjet reconstruction. Arthroscopy 2008;24(5):514-519.
9. Bhatia DN, DasGupta B. Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament (HAGL) lesions in anterior shoulder instability. Knee Surg Sports TraumatolArthrosc 2013;21(7):1603-1609.
10. Bushnell BD, Creighton RA, Herring MM. Bony instability of the shoulder. Arthroscopy 2008;24(9):1061-1073.
11. Bushnell BD, R. Creighton A, Herring MM. The Bony Apprehension Test for instability of the shoulder: A prospective pilot analysis. Arthroscopy: The Journal of Arthroscopic and Related Surgery 2008;24(9):974-982.
12. Edwards TB, Boulahia A, Walch G. Radiographic analysis of bone defects in chronic anterior shoulder instability. Arthroscopy 2003;19(7):732-739.
13. Rokous JR, Feagin JA, Abbott HG. Modified axillary roentgenogram. A useful adjunct in the diagnosis of recurrent instability of the shoulder. ClinOrthopRelat Res 1972;82:84-86.
14. Garth WP Jr, Slappey CE, Ochs CW. Roentgenographic demonstration of instability of the shoulder: The apical oblique projection. A technical note. J Bone Joint Surg Am 1984;66(9):1450-1453.
15. Pavlov H, Warren RF, Weiss CB Jr, Dines DM. The roentgenographic evaluation of anterior shoulder instability. ClinOrthopRelatRes 1985;194:153-158.
16. Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. ClinOrthopRelat Res 2002;400:65-76.
17. Murachovsky J, Bueno RS, Nascimento LG, Almeida LH, Strose E, Castiglia MT, et al. Calculating anterior glenoid bone loss using the Bernageau profile view. Skeletal Radiol 2012;41(10):1231-1237.
18. Itoi E, Lee SB, Amrami KK, Wenger DE, An KN. Quantitative assessment of classic anteroinferior bony Bankart lesions by radiography and computed tomography. Am J Sports Med 2003;31(1):112-118.
19. Sugaya H. Techniques to evaluate glenoid bone loss. Curr Rev Musculoskelet Med 2014;7(1):1-5.
20. Ito H, Takayama A, Shirai Y. Radiographic evaluation of the Hill-Sachs lesion in patients with recurrent anterior shoulder instability. J Shoulder Elbow Surg 2000;9(6):495-497.
21. Bhatia DN, de Beer JF, du Toit DF. Coracoid process anatomy: Implications in radiographic imaging and surgery. ClinAnat 2007;20(7):774-784.
22. Bhatia DN, Dasgupta B, Rao N. Orthogonal radiographic technique for radiographic visualization of coracoid process fractures and pericoracoid fracture extensions. J Orthop Trauma 2013;27(5):e118-e121.
23. Goldberg RP, Vicks B. Oblique angled view for coracoid fractures. Skeletal Radiol 1983;9(3):195-197.
24. Griffith JF, Antonio GE, Tong CW, Ming CK. Anterior shoulder dislocation: Quantification of glenoid bone loss with CT. AJR Am J Roentgenol 2003;180(5):1423-1430.
25. Sekiya JK, Cutuk A. Humeral head defects – Biomechanics, measurements, and treatments. In: Provencher MT, Romeo AA, editors. Shoulder Instability: AComprehensive Approach. Philadelphia, PA:Elsevier, Saunders; 2012.p. 234-247.
26. Saito H, Itoi E, Minagawa H, Yamamoto N, Tuoheti Y, Seki N. Location of the Hill-Sachs lesion in shoulders with recurrent anterior dislocation. Arch Orthop Trauma Surg 2009;129(10):1327-1334.
27. Miniaci A, Gish M. Management of anterior glenohumeral instability associated with large Hill-Sachs defects. Tech Shoulder Elbow Surg2004;5(3):170-175.
28. Lee RK, Griffith JF, Tong MM, Sharma N, Yung P. Glenoid bone loss: Assessment with MR imaging. Radiology 2013;267(2):496-502.
29. Huijsmans PE, Haen PS, Kidd M, Dhert WJ, van der Hulst VP, Willems WJ. Quantification of a glenoid defect with three-dimensional computed tomography and magnetic resonance imaging: A cadaveric study. J Shoulder Elbow Surg 2007;16(6):803-809.
30. Bencardino JT, Gyftopoulos S, Palmer WD. Imaging in anterior glenohumeral instability. Radiology 2013;269(2):323-337.
31. Simão MN, Nogueira-Barbosa MH, Muglia VF, Barbieri CH. Anterior shoulder instability: Correlation between magnetic resonance arthrography, ultrasound arthrography and intraoperative findings. Ultrasound Med Biol 2012;38(4):551-560.
32. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998;26(1):41-45.
33. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: A cadaveric study. J Bone Joint Surg Am 2000;82(1):35-46.
34. Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: An indicator of significant glenoid bone loss. Arthroscopy 2004;20(2):169-174.
35. Greis PE, Scuderi MG, Mohr A, Bachus KN, Burks RT. Glenohumeral articular contact areas and pressures following labral and osseous injury to the anteroinferior quadrant of the glenoid. J Shoulder Elbow Surg 2002;11(5):442-451.
36. Flatow EL, Miniaci A, Evans PJ, Simonian PT, Warren RF. Instability of the shoulder: Complex problems and failed repairs: Part II. Failed repairs. Instr Course Lect 1998;47:113-125.
37. Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y, et al. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: A new concept of glenoid track. J Shoulder Elbow Surg 2007;16(5):649-656.
38. Huysmans PE, Haen PS, Kidd M, Dhert WJ, Willems JW. The shape of the inferior part of the glenoid: A cadaveric study. J Shoulder Elbow Surg 2006;15(6):759-763.
39. Bhatia S, Saigal A, Frank RM, Bach BRJr, Cole BJ, Romeo AA, et al. Glenoid diameter is an inaccurate method for percent glenoid bone loss quantification: Analysis and techniques for improved accuracy. Arthroscopy 2015;31(4):608-614.
40. Baudi P, Campochiaro G, Rebuzzi M, Matino G, Catani F. Assessment of bone defects in anterior shoulder instability. Joints 2013;1(1):40-48.
41. Dumont GD, Russell RD, Browne MG, Robertson WJ. Area-based determination of bone loss using the glenoid arc angle. Arthroscopy 2012;28(7):1030-1035.
42. Burkhart SS, Debeer JF, Tehrany AM, Parten PM. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy 2002;18(5):488-491.
43. Detterline AJ, Provencher MT, Ghodadra N, Bach BR Jr, Romeo AA, Verma NN. A new arthroscopic technique to determine anterior-inferior glenoid bone loss: Validation of the secant chord theory in a cadaveric model. Arthroscopy 2009;25(11):1249-1256.
44. Bakshi NK, Patel I, Jacobson JA, Debski RE, Sekiya JK. Comparison of 3-dimensional computed tomography-based measurement of glenoid bone loss with arthroscopic defect size estimation in patients with anterior shoulder instability. Arthroscopy 2015;31(10):1880-1885.
45. Rowe CR, Zarins B, Ciullo JV. Recurrent anterior dislocation of the shoulder after surgical repair. Apparent causes of failure and treatment. J Bone Joint SurgAm 1984;66(2):159-168.
46. Montgomery WH Jr, Wahl M, Hettrich C, Itoi E, Lippitt SB, Matsen FA 3rd. Anteroinferior bone-grafting can restore stability in osseous glenoid defects. J Bone Joint Surg Am 2005;87(9):1972-1977.
47. Hardy P. Bony Lesions Influence on the Result of the Arthroscopic Treatment of Glenohumeral Instability. Symposium: Shoulder Instability-Limits of Arthroscopic Surgery: Bone Deficiency, Shrinkage, Acute Instability. Presented at the 5th International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress, March 10-14, 2003; Auckland, New Zealand.
48. Forsythe B, Frank RM, Ahmed M, Verma NN, Cole BJ, Romeo AA, et al. Identification and treatment of existing copathology in anterior shoulder instability repair. Arthroscopy 2015;31(1):154-166.
49. Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89(11):1470-1477.
50. Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: From “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 2014;30(1):90-98.
51. Yamamoto N, Itoi E. Osseous defects seen in patients with anterior shoulder instability. ClinOrthopSurg 2015;7(4):425-429.
52. Bhatia DN, DeBeer JF. Management of anterior shoulder instability without bone loss: arthroscopic and mini-open techniques. Shoulder Elbow 2011;3:1-7.
53. Wolf EM, Arianjam A. Hill-Sachs remplissage, an arthroscopic solution for the engaging Hill-Sachs lesion: 2-to10-year follow-up and incidence of recurrence. J Shoulder Elbow Surg 2014;23(6):814-820.
54. Argintar E, Heckmann N, Wang L, Tibone JE, Lee TQ. The biomechanical effect of shoulder remplissage combined with Bankart repair for the treatment of engaging Hill-Sachs lesions. Knee Surg Sports TraumatolArthrosc 2016;24(2):585-592.
55. Haviv B, Mayo L, Biggs D. Outcomes of arthroscopic “remplissage”: Capsulotenodesis of the engaging large Hill-Sachs lesion. J OrthopSurg Res 2011;6:29.
56. Elkinson I, Giles JW, Faber KJ, Boons HW, Ferreira LM, Johnson JA, et al. The effect of the remplissage procedure on shoulder stability and range of motion: An in vitro biomechanical assessment. J Bone Joint Surg Am 2012;94(11):1003-1012.
57. Bhatia DN. The “double-barrel” knot: A new sliding knot for arthroscopic soft tissue fixation using single-pulley and double-pulley techniques. Tech Hand Up ExtremSurg 2013;17(3):128-133.
58. Bhatia DN. Double-barrel remplissage: An arthroscopic all-intra-articular technique using the double-barrel knot for anterior shoulder instability. Arthrosc Tech 2015;4(1):e65-e70.
59. HelfetAJ. Coracoid transplantation for recurring dislocation of the shoulder. J Bone Joint Surg Br 1958;40-B(2):198-202.
60. Schroder DT, Provencher MT, Mologne TS, Muldoon MP, Cox JS. The modified Bristow procedure for anterior shoulder instability: 26-year outcomes in Naval Academy midshipmen. Am J Sports Med 2006;34(5):778-786.
61. Boileau P, Bicknell RT, El Fegoun AB, Chuinard C. Arthroscopic Bristow procedure for anterior instability in shoulders with a stretched or deficient capsule: The “belt-and-suspenders” operative technique and preliminary results. Arthroscopy 2007;23(6):593-601.
62. Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon Chir 1954;49(8):994-997.
63. Allain J, Goutallier D, Glorion C. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am 1998;80(6):841-852.
64. Mizuno N, Denard PJ, Raiss P, Melis B, Walch G. Long-term results of the Latarjet procedure for anterior instability of the shoulder. J Shoulder Elbow Surg 2014;23(11):1691-1699.
65. Patte D, Debeyre J. Luxations recidivantes de l’epaule. Encycl Med Chir (Ed. Elsevier, Paris), Techniques chirurgicales–orthopédie–traumatologie 1980;44-265.
66. de Beer JF, Roberts C. Glenoid bone defects- Open latarjet with congruent arc modification. OrthopClin North Am 2010;41(3):407-415.
67. Burkhart SS, De Beer JF, Barth JR, Cresswell T, Roberts C, Richards DP. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy 2007;23(10):1033-1041.
68. Noonan B, Hollister SJ, Sekiya JK, Bedi A. Comparison of reconstructive procedures for glenoid bone loss associated with recurrent anterior shoulder instability. J Shoulder Elbow Surg 2014;23(8):1113-1119.
69. Ghodadra N, Gupta A, Romeo AA, Bach BR Jr, Verma N, Shewman E, et al. Normalization of glenohumeral articular contact pressures after Latarjet or iliac crest bone-grafting. J Bone Joint Surg Am 2010;92(6):1478-1489.
70. Bhatia DN. Dual-window subscapularis-sparing approach: A new surgical technique for combined reconstruction of a glenoid bone defect or bankart lesion associated with a HAGL lesion in anterior shoulder instability. Tech Hand Up ExtremSurg 2012;16(1):30-36.
71. Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy 2007;23(11):1242.e1-e5.
72. Bhatia DN. Arthroscopic Latarjet and Capsular Shift (ALCS) procedure: A new “freehand” technique for anterior shoulder instability associated with significant bone defects. Tech Hand Up ExtremSurg 2015;19(1):11-17.
73. Hindmarsh J, Lindberg A. Eden-hybbinette’soperation for recurrent dislocation of the humero-scapular joint. ActaOrthopScand 1967;38:459-478.
74. Niskanen RO, Lehtonen JY, Kaukonen JP. Alvik’sglenoplasty for humeroscapular dislocation 6-year follow-up of 52 shoulders. ActaOrthopScand 1991;62(3):279-283.
75. Auffarth A, Schauer J, Matis N, Kofler B, Hitzl W, Resch H. The J-bone graft for anatomical glenoid reconstruction in recurrent posttraumatic anterior shoulder dislocation. Am J Sports Med 2008;36(4):638-647.
76. Provencher MT, Bhatia S, Ghodadra NS, Grumet RC, Bach BR Jr, Dewing CB, et al. Recurrent shoulder instability: Current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am 2010;92Suppl 2:133-151.

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.

References

1. Kim SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: A prospective randomized clinical study. Arthroscopy 2003;19(7):722-731.
2. Itoi E, Hsu HC, An KN. Biomechanical investigation of the glenohumeral joint. J Shoulder Elbow Surg 1996;5(5):407-424.
3. Abboud JA, Soslowsky LJ. Interplay of the static and dynamic restraints in glenohumeral instability. ClinOrthopRelat Res 2002;400:48-57.
4. Itoi E. Pathophysiology and treatment of atraumatic instability of the shoulder. J OrthopSci 2004;9(2):208-213.
5. Arciero RA, Wheeler JH, Ryan JB, McBride JT. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 1994;22(5):589-594.
6. Hawkins RH, Hawkins RJ. Failed anterior reconstruction for shoulder instability. J Bone Joint Surg Br 1985;67(5):709-714.
7. Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 1996;78(11):1677-1684.
8. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: A cadaveric study. J Bone Joint Surg Am 2000;82(1):35-46.
9. Robinson CM, Kelly M, Wakefield AE. Redislocation of the shoulder during the first six weeks after a primary anterior dislocation: Risk factors and results of treatment. J Bone Joint Surg Am 2002;84-A(9):1552-1559.
10. Rowe CR, Pierce DS, Clark JG. Voluntary dislocation of the shoulder. A preliminary report on a clinical, electromyographic, and psychiatric study of twenty-six patients. J Bone Joint Surg Am 1973;55(3):445-460.
11. Weber BG, Simpson LA, Hardegger F. Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion. J Bone Joint Surg Am 1984;66(9):1443-1450.
12. Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am 2006;88(11):2326-2336.
13. Hintermann B, Gächter A. Arthroscopic findings after shoulder dislocation. Am J Sports Med 1995;23(5):545-551.
14. Anakwenze OA, Hsu JE, Abboud JA, Levine WN, Huffman GR. Recurrent anterior shoulder instability associated with bony defects. Orthopedics 2011;34(7):538-544.
15. Provencher MT, Frank RM, Leclere LE, Metzger PD, Ryu JJ, Bernhardson A, et al.The Hill-Sachs lesion: Diagnosis, classification, and management. J Am AcadOrthopSurg 2012;20(4):242-252.
16. Skendzel JG, Sekiya JK. Diagnosis and management of humeral head bone loss in shoulder instability. Am J Sports Med 2012;40(11):2633-2644.
17. Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 1997;25(3):306-311.
18. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998;26(1):41-45.
19. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 2003;85-A(5):878-884.
20. Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid: Results in patients with bone loss of the anterior glenoid. Am J Sports Med 2007;35(8):1276-1283.
21. Sterling M, Jull G, Wright A. The effect of musculoskeletal pain on motor activity and control. J Pain 2001;2(3):135-145.
22. Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, et al.A new method of immobilization after traumatic anterior dislocation of the shoulder: A preliminary study. J Shoulder Elbow Surg 2003;12(5):413-415.
23. Miller BS, Sonnabend DH, Hatrick C, O’leary S, Goldberg J, Harper W, et al. Should acute anterior dislocations of the shoulder be immobilized in external rotation? A cadaveric study. J Shoulder Elbow Surg 2004;13(6):589-592.
24. McMahon PJ, Lee TQ. Muscles may contribute to shoulder dislocation and stability. ClinOrthopRelat Res 2002;403 Suppl:S18-S25.
25. McAuliffe TB, Pangayatselvan T, Bayley I. Failed surgery for recurrent anterior dislocation of the shoulder. Causes and management. J Bone Joint Surg Br 1988;70(5):798-801.
26. Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89(11):1470-1477.
27. Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: From “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 2014;30(1):90-98.
28. Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-sachs “remplissage”: An arthroscopic solution for the engaging hill-sachs lesion. Arthroscopy 2008;24(6):723-726.
29. Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000;16(7):677-694.
30. Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: An indicator of significant glenoid bone loss. Arthroscopy 2004;20(2):169-174.
31. Fedorka CJ, Mulcahey MK. Recurrent anterior shoulder instability: A review of the Latarjet procedure and its postoperative rehabilitation. PhysSportsmed 2015;43(1):73-79.
32. Frostick SP, Sinopidis C, Al Maskari S, Gibson J, Kemp GJ, Richmond JC. Arthroscopic capsular shrinkage of the shoulder for the treatment of patients with multidirectional instability: Minimum 2-year follow-up. Arthroscopy 2003;19(3):227-233.
33. Bigliani LU, Pollock RG, McIlveen SJ, Endrizzi DP, Flatow EL. Shift of the posteroinferior aspect of the capsule for recurrent posterior glenohumeral instability. J Bone Joint Surg Am 1995;77(7):1011-1020.
34. Antoniou J, Duckworth DT, Harryman DT 2nd. Capsulolabral augmentation for the the management of posteroinferior instability of the shoulder. J Bone Joint Surg Am 2000;82(9):1220-1230.
35. Pollock RG, Bigliani LU. Recurrent posterior shoulder instability. Diagnosis and treatment. ClinOrthopRelat Res 1993;291:85-96.
36. Wirth MA, Groh GI, Rockwood CA Jr. Capsulorrhaphy through an anterior approach for the treatment of atraumatic posterior glenohumeral instability with multidirectional laxity of the shoulder. J Bone Joint Surg Am 1998;80(11):1570-1578.
37. Kim SH, Ha KI, Yoo JC, Noh KC. Kim’s lesion: An incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy 2004;20(7):712-720.
38. Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint 1944. ClinOrthopRelat Res 1996;330:3-12.
39. Wilk KE, Arrigo C. Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports PhysTher 1993;18(1):365-378.
40. Bowen MK, Warren RF. Ligamentous control of shoulder stability based on selective cutting and static translation experiments. Clin Sports Med 1991;10(4):757-782.
41. O’Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 1990;18(5):449-456.
42. Cain PR, Mutschler TA, Fu FH, Lee SK. Anterior stability of the glenohumeral joint. A dynamic model. Am J Sports Med 1987;15(2):144-148.
43. Riemann BL, Lephart SM. The sensorimotor system, part I: The physiologic basis of functional joint stability. J Athl Train 2002;37(1):71-79.
44. Vangsness CT Jr, Ennis M, Taylor JG, Atkinson R. Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa. Arthroscopy 1995;11(2):180-184.
45. Rossi A, Grigg P. Characteristics of hip joint mechanoreceptors in the cat. J Neurophysiol 1982;47(6):1029-1042.
46. Pedersen J, Lönn J, Hellström F, Djupsjöbacka M, Johansson H. Localized muscle fatigue decreases the acuity of the movement sense in the human shoulder. Med Sci Sports Exerc 1999;31(7):1047-1052.
47. Johansson H, Sjölander P, Sojka P. A sensory role for the cruciate ligaments. ClinOrthopRelat Res 1991;268:161-178.
48. Dietz V, Noth J, Schmidtbleicher D. Interaction between pre-activity and stretch reflex in human triceps brachii during landing from forward falls. J Physiol 1981;311:113-125.
49. Smith RL, Brunolli J. Shoulder kinesthesia after anterior glenohumeral joint dislocation. PhysTher 1989;69(2):106-112.
50. Tibone JE, Fechter J, Kao JT. Evaluation of a proprioception pathway in patients with stable and unstable shoulders with somatosensory cortical evoked potentials. J Shoulder Elbow Surg 1997;6(5):440-443.
51. Carpenter JE, Blasier RB, Pellizzon GG. The effects of muscle fatigue on shoulder joint position sense. Am J Sports Med 1998;26(2):262-265.
52. Lephart SM, Henry TJ. Functional rehabilitation for the upper and lower extremity. OrthopClin North Am 1995;26(3):579-592.
53. Davies GJ, Dickoff-Hoffman S. Neuromuscular testing and rehabilitation of the shoulder complex. J Orthop Sports PhysTher 1993;18(2):449-458.
54. Cavagna GA, Dusman B, Margaria R. Positive work done by a previously stretched muscle. J ApplPhysiol 1968;24(1):21-32.
55. Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the overhead athlete. Clin Sports Med 2013;32(4):637-651.
56. Sciascia A, Thigpen C, Namdari S, Baldwin K. Kinetic chain abnormalities in the athletic shoulder. Sports Med Arthrosc 2012;20(1):16-21.
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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