Specialists

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Stiffness

Stiffness after surgery for open anterior instability is infrequently noted in literature and the incidence of this complication is probably under-reported. Certain repairs were designed to limit external rotation and hence the risk of recurrence, so loss of motion was not considered a complication.

In some settings (e.g., capsular reconstruction or revision surgery), limited external […]

Complications and Pitfalls-Recurrence

Recurrence is the most frequently reported complication after open and arthroscopic surgery for anterior instability. Recurrence may be secondary to new trauma or to atraumatic events.Patients with traumatic recurrence of their instability usually have better post-operative results after revision surgery than patients with atraumatic recurrence. The recurrence rate is related to the number of prior […]

Humeral Bone Deficiency

Humeral head defects are commonly present in patients with shoulder instability. The defects are usually small and carry the eponym Hill-Sachs lesion when secondary to anterior instability and reverse Hill-Sachs lesions when secondary to posterior instability.

Although quite ubiquitous in recurrent anterior shoulder instability, the management of large Hill-Sachs defects remains controversial especially in […]

Techniques-Glenoid Bone Deficiency

Although osteoarticular pathology rarely is a cause of anterior instability, it is essential that it be ruled out prior to proceeding with any soft-tissue stabilization procedure or in the revision setting. A small subset of patients may be predisposed to instability due to developmental glenoid dysplasia, or pathologic flattening or hypoconcavity of the glenoid as […]

Capsulolabral Repair with Suture Anchors

For capsulolabral repair with suture anchors, the 30 degree arthroscope should be placed in the posterior viewing portal. It also can be placed in the anterosuperior portal (“bird’s eye” portal) to view the anterior labrum. Working instruments can be then placed in the anteroinferior portal. In some instances, it is helpful to use a 70 […]

Posterior Instability and MDI

One to two posterior arthroscopic portals are used for the suture anchor placement/capsular advancement and suture shuttling. The arthroscope remains in the anterior superior portal for the majority of the case. The posterior portal needs to be more lateral than usual to allow better access to the posterior glenoid rim and posterior inferior capsule. A […]

Portals-Anterior Instability

Two anterior portals (superior and inferior) are established using an “outside-in” technique with a spinal needle. These portals function as utility portals for instrument passage, glenoid preparation, suture management, and knot tying. It is important to separate these anterior cannulas widely so cannula crowding in the joint is not a problem.

The second cannula is […]

Imaging

The minimum radiographic workup necessary for evaluation of an acute dislocation or suspected subluxation is a true anteroposterior (AP) view and an axillary lateral view. These images will allow accurate determination of the position of the humeral head relative to the glenoid.

A true AP radiograph is obtained by angling the x-ray beam 45 […]

Hill-Sachs Lesions

The most common bony lesion associated with traumatic glenohumeral instability is a compression fracture at the posterolateral margin of the humeral head Commonly known as a Hill-Sachs lesion, this fracture occurs as the humeral head impacts the glenoid edge during dislocation.

The lesion is present in 80% of anterior dislocations, 25% of anterior subluxations, […]

Nerve Injuries/Entrapment

Nerve injuries can occur with both arthroscopic and open shoulder procedures. The axillary nerve courses from anterior to posterior from the posterior cord of the brachial plexus, 3 to 5 mm medial to musculotendinous junction of the inferior lateral border of the subscapularis muscle. It lies in contact with the GH joint capsule until it […]