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. |
==Key words== | ==Key words== | ||
| + | <br /> | ||
Revision as of 07:58, 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.
Key words
