Traumatic Anterior Shoulder Instability (TUBS) Flashcards
What correlates with increased risk of recurrent anterior shoulder dislocations?
Patient age; almost 80-90% in teenagers
Pts with HAGL lesion also a/w higher risk
What position is the arm in an anterior dislocation of the shoulder?
Abduction and external rotation; usually with an anteriorly directed force
What are common associated lesions with a shoulder dislocation?
1) Bankhart- avulsion of the anterior labrum and anterior band of the IGHL from the anterior inferior glenoid’ present in 8-90% of shoulder dislocations
2) HAGL- Humeral avulsion of the glenohumeral ligament (HAGL); occurs in slightly older pts
3) ALPSA and GLAD
4) Bony Bankhart; in up to 49% recurrent dislocations
5) Hill-Sachs defect- chondral impaction injury in the posterosuperior humeral head secondary to contact with the glenoid rim; present in 80% of traumatic dislocations
What is the incidence of RCT in patients with a traumatic shoulder dislocation?
> 40yo 30%
>60yp 80%
What view shows Hill-Sachs defect? Bankhart lesion?
Hill-Sachs: Stryker notch
Bankhart: Westpoint view
What surgical technique is used for an engaging Hill-Sachs defect of >25%?
Remplissage procedure; infraspinatus and posterior capsule sutured into defect; 20-30%
If glenoid deficiency >40% consider hemiarthroplasty
How do open and arthroscopic repairs for Bankhart lesions compare?
Equally efficacious as with arthroscopic having advantage of less pain and greater motion preservation
What surgical procedure is indicated in chronic shoulder dislocaters with large glenoid bone deficiency?
Bristow-Laterjet; coracoid transfer to anterior inferior glenoid bone defect through the proximal 1/3 of subscapularis
Laterjet coracoid transfer has been described as creating a triple blocking effect due to the function of the conjoint sling, bony augmentation, and CA ligament support to the capsule
