Difference between revisions of "Shoulder:Glenohumeral Instability/Posterior Instability"
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==Bullet Points== | ==Bullet Points== | ||
− | * | + | * Posterior shoulder instability is not as rare as previously though. |
− | Posterior shoulder instability is not as rare as previously though. | ||
− | * | + | * Diagnosing posterior instability may be difficult because patients often report vague symptoms not linked to a clear history of traumatic shoulder dislocation. |
− | Diagnosing posterior instability may be difficult because patients often report vague symptoms not linked to a clear history of traumatic shoulder dislocation. | ||
− | * | + | * This condition is consequently often misdiagnosed or patients experience a delay in diagnosis. |
− | This condition is consequently often misdiagnosed or patients experience a delay in diagnosis. | ||
− | * | + | * It that encompasses different acute and chronic pathologies involving the labrum, the cartilage, the capsule, bony lesions. |
− | It that encompasses different acute and chronic pathologies involving the labrum, the cartilage, the capsule, bony lesions. | ||
− | * | + | * A tear between the posterior labrum and the glenoid cartilage without complete detachment of the labrum is described as a Kim lesion. It is postulated that this lesion is due to posterior force acting on the posterior-inferior glenohumeral ligament as it attaches to the posterior labrum. |
− | A tear between the posterior labrum and the glenoid cartilage without complete detachment of the labrum is described as a Kim lesion. It is postulated that this lesion is due to posterior force acting on the posterior-inferior glenohumeral ligament as it attaches to the posterior labrum. | ||
− | * | + | * Numerous classifications exit, none having done unanimity. |
− | Numerous classifications exit, none having done unanimity. | ||
− | * | + | * Risk factors for recurrent instability are: (1) age below 40 at time of first instability; (2) dislocation during a seizure; (3) a large reverse Malgaigne (Hill-Sachs) lesion; (4) glenoid retroversion, and (5) a high and horizontally oriented acromion in the sagittal plan. |
− | Risk factors for recurrent instability are: (1) age below 40 at time of first instability; (2) dislocation during a seizure; (3) a large reverse Malgaigne (Hill-Sachs) lesion; (4) glenoid retroversion, and (5) a high and horizontally oriented acromion in the sagittal plan. | ||
− | * | + | * Hyperlaxity is multidirectional but instability is almost exclusively unidirectional. |
− | Hyperlaxity is multidirectional but instability is almost exclusively unidirectional. | ||
− | * | + | * Physical examination comprises the articular range of motion, the rotator cuff, and jerk, Kim and O’Brien tests. |
− | Physical examination comprises the articular range of motion, the rotator cuff, and jerk, Kim and O’Brien tests. | ||
− | * | + | * Three views plain radiographs, including true anteroposterior of the glenohumeral joint, scapular Y (scapular lateral), and Bernageau views are the mainstay of imaging in the setting of shoulder instability. |
− | Three views plain radiographs, including true anteroposterior of the glenohumeral joint, scapular Y (scapular lateral), and Bernageau views are the mainstay of imaging in the setting of shoulder instability. | ||
− | * | + | * An internally rotated humeral head gives a rounded appearance on anteroposterior view, which is called the lightbulb sign. |
− | An internally rotated humeral head gives a rounded appearance on anteroposterior view, which is called the lightbulb sign. | ||
− | * | + | * In case of a suspicion about posterior dislocation of the shoulder, additional imaging including, depending of the type of instability, magnetic resonance arthrography (MRA) or computed tomography (CT) is required. |
− | In case of a suspicion about posterior dislocation of the shoulder, additional imaging including, depending of the type of instability, magnetic resonance arthrography (MRA) or computed tomography (CT) is required. | ||
− | * | + | * Acute or recurrent posterior dislocations can be treated conservatively, by soft tissue or bony procedures. |
− | Acute or recurrent posterior dislocations can be treated conservatively, by soft tissue or bony procedures. | ||
− | * | + | * Surgical options include anatomic reconstruction as well as non-anatomic procedures such as subscapularis tendon transfer, allo-/autograft reconstruction, derotation osteotomy or shoulder arthroplasty. |
− | Surgical options include anatomic reconstruction as well as non-anatomic procedures such as subscapularis tendon transfer, allo-/autograft reconstruction, derotation osteotomy or shoulder arthroplasty. | ||
− | * | + | * Treatment of locked dislocation depends on the extent of the articular defect size of the humeral head, duration of the dislocation and patient-specific conditions such as age and activity levels. |
− | Treatment of locked dislocation depends on the extent of the articular defect size of the humeral head, duration of the dislocation and patient-specific conditions such as age and activity levels. |
Revision as of 07:53, 31 December 2019
Bullet Points
- Posterior shoulder instability is not as rare as previously though.
- Diagnosing posterior instability may be difficult because patients often report vague symptoms not linked to a clear history of traumatic shoulder dislocation.
- This condition is consequently often misdiagnosed or patients experience a delay in diagnosis.
- It that encompasses different acute and chronic pathologies involving the labrum, the cartilage, the capsule, bony lesions.
- A tear between the posterior labrum and the glenoid cartilage without complete detachment of the labrum is described as a Kim lesion. It is postulated that this lesion is due to posterior force acting on the posterior-inferior glenohumeral ligament as it attaches to the posterior labrum.
- Numerous classifications exit, none having done unanimity.
- Risk factors for recurrent instability are: (1) age below 40 at time of first instability; (2) dislocation during a seizure; (3) a large reverse Malgaigne (Hill-Sachs) lesion; (4) glenoid retroversion, and (5) a high and horizontally oriented acromion in the sagittal plan.
- Hyperlaxity is multidirectional but instability is almost exclusively unidirectional.
- Physical examination comprises the articular range of motion, the rotator cuff, and jerk, Kim and O’Brien tests.
- Three views plain radiographs, including true anteroposterior of the glenohumeral joint, scapular Y (scapular lateral), and Bernageau views are the mainstay of imaging in the setting of shoulder instability.
- An internally rotated humeral head gives a rounded appearance on anteroposterior view, which is called the lightbulb sign.
- In case of a suspicion about posterior dislocation of the shoulder, additional imaging including, depending of the type of instability, magnetic resonance arthrography (MRA) or computed tomography (CT) is required.
- Acute or recurrent posterior dislocations can be treated conservatively, by soft tissue or bony procedures.
- Surgical options include anatomic reconstruction as well as non-anatomic procedures such as subscapularis tendon transfer, allo-/autograft reconstruction, derotation osteotomy or shoulder arthroplasty.
- Treatment of locked dislocation depends on the extent of the articular defect size of the humeral head, duration of the dislocation and patient-specific conditions such as age and activity levels.