Anterior Glenohumeral Instability

Streubel, Philipp N.; Krych, Aaron J.; Simone, Juan Pablo; Dahm, Diane L.; Sperling, John W.; Steinmann, Scott P.; O’Driscoll, Shawn W.; Sánchez-Sotelo, Joaquín

doi:10.5435/jaaos-22-05-283

Cited by 73 publications

(33 citation statements)

References 60 publications

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“…Our knowledge of the physiopathology of shoulder instability has evolved together with magnetic resonance imaging and arthroscopic techniques. This has lead to the definition of a vast spectrum of instability types with associated lesions affecting capsulolabral, ligamentous and osseous structures [ 6 ]. For the clinician, detecting instability of the shoulder may be considered an easy problem, as anterior traumatic glenohumeral dislocations account for more than 95% of the shoulder dislocations [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…This has lead to the definition of a vast spectrum of instability types with associated lesions affecting capsulolabral, ligamentous and osseous structures [ 6 ]. For the clinician, detecting instability of the shoulder may be considered an easy problem, as anterior traumatic glenohumeral dislocations account for more than 95% of the shoulder dislocations [ 6 ]. However, other glenohumeral instability types such as non-traumatic, posterior or multidirectional instability can be harder to diagnose when the most prominent symptom is pain [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Physical Exam and Evaluation of the Unstable Shoulder

Mora¹,

Ibán²,

Heredia³

et al. 2017

TOORTHJ

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Background:The clinical evaluation of the patient with shoulder instability can be challenging. The pathological spectrum ranges from the straightforward “recurrent anterior dislocation” patient to the overhead athlete with a painful shoulder but not clear instability episodes. Advances in shoulder arthroscopy and imaging have helped in understanding the anatomy and physiopathology of the symptoms. The aim of this general article is to summarize the main examination manoeuvres that could be included in an overall approach to a patient with a suspicion of instability.Material and Methods:In order to achieve the above-mentioned objective, a thorough review of the literature has been performed. Data regarding sensibility and specificity of each test have been included as well as a detailed description of the indications to perform them. Also, the most frequent and recent variations of these diagnostic tests are included.Results:Laxity and instability should be considered separately. For anterior instability, a combination of apprehension, relocation and release tests provide great specificity. On the other hand, multidirectional or posterior instability can be difficult to diagnose especially when the main complain is pain.Conclusion:A detailed interview and clinical examination of the patient are mandatory in order to identify a shoulder instability problem. Range of motion of both shoulders, clicking of catching sensations as well as pain, should be considered together with dislocation and subluxation episodes. Specific instability and hyperlaxity tests should be also performed to obtain an accurate diagnosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Physical Exam and Evaluation of the Unstable Shoulder

Mora¹,

Ibán²,

Heredia³

et al. 2017

TOORTHJ

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“…Arthroscopic or open techniques involving bone block procedures or coracoid transfer techniques are used more and more often in both revision and primary instability surgery, especially in the presence of >20-25% bone loss of the anteroinferior aspect of the glenoid [21, 22]. Recent cadaveric studies suggest that defects as big as almost 30% of the size of the antero-inferior glenoid can be adequately restored after coracoid transfer in a Latarjet procedure [23].…”

Section: Introductionmentioning

confidence: 99%

Long Term Outcomes of Arthroscopic Shoulder Instability Surgery

Karataglis

Agathangelidis

2017

TOORTHJ

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Background:Anterior shoulder instability has been successfully managed arthroscopically over the past two decades with refined “anatomic” reconstruction procedures involving the use of anchors for the repositioning and re-tensioning of the antero-inferior capsuloligamentous complex, in an effort to recreate its “bumper effect”.Methods:Research and online content related to arthroscopic treatment of shoulder instability was reviewed and their results compared.Results:The short- and mid-term results of this technique have been very satisfactory. The greatest number of recent reports suggests that long-term results (>5 years follow-up) remain rather satisfactory, especially in the absence of significant glenoid bone loss (>20-25%). In these studies recurrent instability, in the form of either dislocation or subluxation, ranges from 5.1 to over 20%, clinical scores, more than 5 years after the index procedure, remain good or excellent in >80% of patient population as do patient satisfaction and return to previous level of activities.As regards arthroscopic non-anatomic bony procedures (Latarjet or Bristow procedures) performed in revision cases or in the presence of >20-25% bone loss of the anteroinferior aspect of the glenoid, recent reports suggest that their long-term results are very satisfactory both in terms of re-dislocation rates and patient satisfaction.Conclusion:It appears that even “lege artis” performance of arthroscopic reconstruction decelerates but does not obliterate the degenerative procedure of dislocation arthropathy. The presence and grade of arthritic changes correlate with the number of dislocations sustained prior to the arthroscopic intervention, the number of anchors used and the age at initial dislocation and surgery. However, the clinical significance of radiologically evident dislocation arthropathy is debatable.

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“…As the shoulder is the most unstable joint in the body, injuries to the shoulder with resultant glenohumeral dislocation are common in American football athletes. 33 , 40 Shoulder trauma composes roughly 10% to 20% of injuries in American football, the fourth most common musculoskeletal injury behind hand, knee, and ankle injuries. 27 , 38 Shoulder injury with resultant dislocation and/or subluxation is often accompanied by a bony avulsion fracture from the anteroinferior glenoid, a “bony Bankart lesion.” 14 , 41 In the presence of bony damage, continued participation places athletes at high risk for recurrent injury, time lost from sport, and long-term damage to the shoulder.…”

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confidence: 99%

“… 4 Because of the high rate of continued instability after nonsurgical management, surgical correction using the Bristow or Latarjet techniques is preferred in elite-level athletes to restore glenohumeral stability and to minimize additional injury and time lost from play. 5 , 11 , 16 , 40 Transfer of the coracoid to the anterior glenoid allows for restoration of the inherent articular arc of the glenoid, helping maintain the humeral head within the glenoid fossa during range of motion, preventing engagement of Hill-Sachs lesions, and effectively restoring stability. 3 , 34 Compared to the use of structural bone graft or allograft alone, transfer of the coracoid also allows for associated repositioning of the conjoint tendon (short head of the biceps and coracobrachialis), providing increased dynamic stability to the glenohumeral joint, known as the “sling effect.” 9 …”

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confidence: 99%

Prevalence and Impact of Glenoid Augmentation in American Football Athletes Participating in the National Football League Scouting Combine

Knapik¹,

Gillespie²,

Salata³

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Bony augmentation of the anterior glenoid is used in athletes with recurrent shoulder instability and bone loss; however, the prevalence and impact of repair in elite American football athletes are unknown.Purpose:To evaluate the prevalence and impact of glenoid augmentation in athletes invited to the National Football League (NFL) Scouting Combine from 2012 to 2015.Study Design:Case series; Level of evidence, 4.Methods:A total of 1311 athletes invited to the NFL Combine from 2012 to 2015 were evaluated for history of either Bristow or Latarjet surgery for recurrent anterior shoulder instability. Athlete demographics, surgical history, imaging, and physical examination results were recorded using the NFL Combine database. Prospective participation data with regard to draft status, games played, games started, and status after the athletes’ first season in the NFL were gathered using publicly available databases.Results:Surgical repair was performed on 10 shoulders in 10 athletes (0.76%), with the highest prevalence in defensive backs (30%; n = 3). Deficits in shoulder motion were exhibited in 70% (n = 7) of athletes, while 40% (n = 4) had evidence of mild glenohumeral arthritis and 80% demonstrated imaging findings consistent with a prior instability episode (8 labral tears, 2 Hill-Sachs lesions). Prospectively, 40% (n = 4) of athletes were drafted into the NFL. In the first season after the combine, athletes with a history of glenoid augmentation were not found to be at significant risk for diminished participation with regard to games played or started when compared with athletes with no history of glenoid augmentation or athletes undergoing isolated shoulder soft tissue repair. After the conclusion of the first NFL season, 60% (n = 6 athletes) were on an active NFL roster.Conclusion:Despite being drafted at a lower rate than their peers, there were no significant limitations in NFL participation for athletes with a history of glenoid augmentation when compared with athletes without a history of shoulder surgery or those with isolated soft tissue shoulder repair. Glenohumeral arthritis and advanced imaging findings of labral tearing and Hill-Sachs lesions in elite American football players with a history of glenoid augmentation did not significantly affect NFL participation 1 year after the combine.

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Anterior Glenohumeral Instability

Cited by 73 publications

References 60 publications

Physical Exam and Evaluation of the Unstable Shoulder

Physical Exam and Evaluation of the Unstable Shoulder

Long Term Outcomes of Arthroscopic Shoulder Instability Surgery

Prevalence and Impact of Glenoid Augmentation in American Football Athletes Participating in the National Football League Scouting Combine

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