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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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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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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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