Recurrent Dislocation of the Shoulder

Abstract

December I962 Book Reviews 715 or hand surgeon. On the other hand it is felt that more emphasis might be placed on the importance of hand positioning in this branch of surgery. The reviewer realises that to include the treatment of such conditions as cleft lip and palate, hypospadias, burns, pharyngeal defects etc. would involve the author in the production of a major work on plastic surgery.It is to be hoped nevertheless that he will do this, and that his lucid style, and the informative illustrations of this present work may be extended to cover a wider field.Let this remark, however, not be construed as a criticism of this book which can be strongly recommended to all surgeons who may be concerned with the problems of providing skin cover.

The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint

“…The majority of these operative procedures can be separated into two major groups: those that focus on the subscapularis as the most important anterior stabilizing structure,l, 16,26,29 and those that address the anterior capsular structures as the most important stabilizing mechanism to be restored. 8,9,27,33,38,39,48 Other studies have been directed at the functional anatomy and significance of the glenohumeral ligaments and their contribution toward preventing anterior dislocation of the shoulder.…”

“…This includes detachment of the anterior capsule, with or without the labrum, from the anterior glenoid, 3, 8, 9, 11, 32, 33, 35 anoma-lous attachment or insufficient development of the middle glenohumeral ligament (MGHL) '21 generalized anterior capsular laxity or weakness,15, 27,35,48 and a deficiency in the shoulder capsule below the superior glenohumeral ligament (SGHL) in the interval between the supraspinatus and subscapularis tendons.39 The other major defects most often implicated are laxity and functional lengthening of the subscapularis muscle. 17,25,26,35,47 Other factors that have been postulated as possible causes are a posterolateral defect in the humeral head secondary to an impaction fracture of the head from the anterior rim of the glenoid as the head dislocates anteriorly, 2,1,23 and humeral torsional abnormalities affecting the glenohumeral relationship.13,14 In addition, muscular deficiencies have been investigated as possible causative factors in recurrent shoulder instability.40-44 These theories have spawned a multitude of different operations for recurrent anterior shoulder instability.The majority of these operative procedures can be separated into two major groups: those that focus on the subscapularis as the most important anterior stabilizing structure,l, 16,26,29 and those that address the anterior capsular structures as the most important stabilizing mechanism to be restored.8, …”

“…The majority of these operative procedures can be separated into two major groups: those that focus on the subscapularis as the most important anterior stabilizing structure,l, 16,26,29 and those that address the anterior capsular structures as the most important stabilizing mechanism to be restored.8,…”

Analysis of Bristow-Later jet procedure in the treatment of recurrent traumatic anterior dislocation of shoulder

“…There was uniform restriction of the external rotation-terminal 5 to 20 degrees of external rotation is restricted (average 12.5 degrees) in 5 patients there is restriction of terminal 15 degrees of extern rotation. The patients were unware of this as they had rarely experienced any difficulty with this restriction [30][31][32][33][34][35][36][37][38][39][40][41][42] . In follow-up, it was found in all the patients the transferred coracoids graft is well united and none had screw loosening.…”

“…The Bankart procedure repair of the detached capsule from the glenoid-not only has technical difficulty, but also results in restriction of lateral rotation by approximately 20 deg [37,38] . Magnuson and Stack [39] are of the opinion that the shoulder muscles are the only structures that maintain the head of humerus in contact with the glenoid and in proper position. In their operation, the insertion of the subscapularis tendon into the lesser tuberosity of the humerus is transferred laterally to the greater tuberosity.…”