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anterior glenohumeral instability.

Jianqiang Lian, Lele Dong, Yanjun Zhao, Jinlei Sun, Wenlong Zhang, Chunzheng Gao
BACKGROUND: The Latarjet procedure addresses recurrent anterior shoulder instability in the context of a significant bony defect. However, the bony and soft tissue anatomy of the coracoid in coracoid transfer procedures has not yet been defined in Mongolian men. The aims of this study were to describe the soft tissue attachments of the coracoid regarding the bony anatomy, define the average amount of bone available for coracoid transfer, analyze the characteristics of the pectoralis minor and coracoid, and study the relationship between the bony dimensions of the coracoid and body length in Mongolian men...
October 24, 2016: Journal of Orthopaedic Surgery and Research
Jayd Lukenchuk, Laura A Sims, Jason J Shin
PURPOSE: The purpose of this study was to quantify the degree of variability in outcomes assessed after surgery for anterior shoulder instability in recent high-impact literature. METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, an extensive review of the literature during a 5-year period from January 2011 through December 2015 was performed across 6 orthopaedic journals with high impact factors to identify all studies investigating outcomes after anterior shoulder instability...
October 18, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Xinning Li, Antonio Cusano, Josef Eichinger
Shoulder dislocations are a common injury, with anterior shoulder dislocation among male patients being the most common presentation. A patient with recurrent shoulder instability, anterior-superior escape, and chronic subscapularis tendon rupture following multiple shoulder stabilization surgeries presents the surgeon with a complex and challenging case. This report describes a 40-year-old man with an extensive left shoulder history that included a failed Latarjet procedure, an irreparable, chronic subscapularis tear with grade 4 Goutallier fatty infiltration, and associated anterior-superior escape...
October 13, 2016: Orthopedics
Rachel M Frank, Anthony A Romeo, Matthew T Provencher
Anterior glenoid bone loss is present in nearly all cases of recurrent anterior glenohumeral instability. Treating glenoid bone loss in the setting of recurrent instability is challenging, and often, soft tissue stabilization procedures in isolation are inadequate. The nonanatomic, incongruous joint resulting from most bony augmentation procedures has motivated investigators to find an alternative solution. Recently, the use of fresh distal tibia allograft has been reported as an anatomic, osteoarticular reconstructive option for restoring the glenoid arc and maintaining glenohumeral congruency...
October 13, 2016: Orthopedics
Julien Clément, Jérémie Ménard, Maxime Raison, Jennifer Dumais, Laura Dubois, Dominique M Rouleau
BACKGROUND: Although recurrent anterior shoulder instability (RASI) is a common condition in young patients, no studies to date have measured the 3-dimensional (3D) locked position of the glenohumeral joint during an anterior dislocation. Therefore, our goal was to estimate it with 3D computed tomography (CT) scans. METHODS: Patients in this prospective observational study were separated in 3 groups: normal laxity, hyperlaxity, and epilepsy. They were characterized by questionnaires (Western Ontario Shoulder Instability Index, 11-item version of the Disabilities of the Arm, Shoulder and Hand, and Beighton Laxity Score), and a CT scan revealing bipolar bone defects...
October 7, 2016: Journal of Shoulder and Elbow Surgery
Tineke De Coninck, Steven S Ngai, Monica Tafur, Christine B Chung
The shoulder joint is the most unstable articulation in the entire human body. While this certainly introduces vulnerability to injury, it also confers the advantage of broad range of motion. There are many elements that work in combination to offset the inherent instability of the glenohumeral joint, but the glenoid labrum is perhaps related most often. Broadly, clinical unidirectional instability can be subdivided into anterior and posterior instability, which usually raise concern for anteroinferior and posteroinferior labral lesions, respectively...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Jason T Hamamoto, Timothy Leroux, Jorge Chahla, Sanjeev Bhatia, John D Higgins, Anthony A Romeo, Adam B Yanke, Nikhil N Verma
The preoperative assessment of anterior glenoid bone loss is a critical step in surgical planning for patients with recurrent anterior glenohumeral instability. The structural integrity of the glenoid has been identified as one of the most important factors influencing the success of operative repair. The currently accepted gold standard for glenoid structural assessment among most orthopaedic surgeons is the use of 3-dimensional reconstructed computed tomography images with the humeral head digitally subtracted, yielding an en face sagittal oblique view of the glenoid...
August 2016: Arthroscopy Techniques
Chad M Fortun, Ivan Wong, Joseph P Burns
Failed arthroscopic soft-tissue stabilization and anterior glenoid bone loss have been shown to have high failure rates after standard arthroscopic stabilization techniques. For patients with recurrent glenohumeral instability, the Bristow-Latarjet procedure is currently the standard of care. It is predominantly performed through an open deltopectoral approach but has recently been described arthroscopically. Although providing excellent clinical outcomes, the Bristow-Latarjet procedure violates the subscapularis muscle, has a steep learning curve with a high complication rate, and permanently changes the anterior shoulder anatomy, making any future revision surgery more challenging...
August 2016: Arthroscopy Techniques
Robert A Duerr, John J Christoforetti
Posterior glenohumeral capsular rupture is a rare cause of posterior glenohumeral instability. With advances in imaging and arthroscopic techniques, diagnosis and treatment of posterior glenohumeral instability are becoming more common in practice. We present a technique for arthroscopic repair of a posterior glenohumeral capsular rupture with concomitant anterior and posterior labrum detachment. Arthroscopic fixation was facilitated by use of a 70° arthroscope through an anterior viewing portal to allow accurate placement of the posterior portal in preparation for knot tying...
August 2016: Arthroscopy Techniques
Justin A Ly, Erin M Coleman, Eric J Kropf
The treatment of anterior shoulder instability is well described with various techniques, including arthroscopic double-row repair, an alternative to open stabilization procedures in high-risk groups. The surgical management of posterior instability in high-risk and athletic populations is a less-explored entity. We describe our technique for an all arthroscopic double-row suture anchor repair of a large posterior bony Bankart lesion. We prefer this technique over percutaneous cannulated screw fixation because the double-row suture technique allows for incorporation of capsular plication with bony fixation in an effort to better restore normal anatomy for capsulolabral complex...
August 2016: Arthroscopy Techniques
Nata Parnes, Maryellen Blevins, Brian Carr, Paul Carey
Inferior labrum anterior to posterior lesions as an isolated injury or as part of an extensive traumatic labral tear are uncommon and may present as multidirectional instability of the shoulder. These lesions are hard to visualize radiographically and many times are diagnosed only during surgery. Arthroscopic repair of these lesions requires advanced arthroscopic skills and is required for restoration of glenohumeral stability. We report a combined double-pulley simple knot technique that anatomically reconstructs the inferior labrum while overcoming the typical technical challenges, providing a large footprint for healing along the inferior glenoid rim and minimizing the amount of suture material in direct contact with the articular cartilage and the risk of knot migration...
August 2016: Arthroscopy Techniques
Abbas Rashid, Christopher Lawrence, Graham Tytherleigh-Strong
Traumatic glenohumeral joint dislocation and acromioclavicular joint subluxations tend to occur in young active males. Use of the coracoid process either as a transfer in recurrent instability or in suspensory reconstructions of the coracoclavicular ligaments have gained popularity. However this requires careful consideration in the event of concomitant injuries if they both require surgery.
October 2016: Shoulder & Elbow
S Schröter, M Krämer, B Welke, C Hurschler, R Russo, M Herbst, U Stöckle, A Ateschrang, M Maiotti
BACKGROUND: Anterior shoulder dislocation is common. The treatment of recurrence with glenoid bone defect is still considered controversial. A new arthroscopic subscapularis augmentation has recently been described that functions to decrease the anterior translation of the humeral head. The purpose of the presented study was to examine the biomechanical effect on glenohumeral joint motion and stability. METHODS: Eight fresh frozen cadaver shoulders were studied by use of a force guided industrial robot fitted with a six-component force-moment sensor to which the humerus was attached...
October 2016: Clinical Biomechanics
Marc-Frederic Pastor, Manuel Kraemer, Mathias Wellmann, Christof Hurschler, Tomas Smith
INTRODUCTION: The aim of this study was to investigate the stabilizing influence of the rotator cuff as well as the importance of glenosphere and onlay configuration on the anterior stability of the reverse total shoulder replacement (RTSR). MATERIALS AND METHODS: A reverse total shoulder replacement was implanted into eight human cadaveric shoulders, and biomechanical testing was performed under three conditions: after implantation of the RTSR, after additional dissection of the subscapularis tendon, and after additional dissection of the infraspinatus and teres minor tendon...
November 2016: Archives of Orthopaedic and Trauma Surgery
Przemysław Lubiatowski, Jan Długosz, Marta Ślęzak, Piotr Ogrodowicz, Jakub Stefaniak, Joanna Walecka, Leszek Romanowski
PURPOSE: The evaluation of glenohumeral joint volume in both unstable (with/without laxity) and stable shoulders (subacromial impingement) and volume reduction potential of arthroscopic techniques: (labral anchor repair vs. capsular shift). METHODS: Material was based on 133 patients: anterior shoulder instability without laxity (group I, n = 49), with laxity (group II, n = 22) and subacromial impingement (control group, n = 62) operated in 2010-2011...
August 19, 2016: International Orthopaedics
Joseph W Galvin, Stephen A Parada, Xinning Li, Josef K Eichinger
BACKGROUND: Posterior shoulder instability is less common and potentially more difficult to diagnose clinically and radiographically compared with anterior shoulder instability. Radiographic findings including posterior labral tears, increased retroversion, presence of glenoid dysplasia, and increased capsular area are associated with symptomatic recurrent posterior shoulder instability. PURPOSE: This study aimed to determine the prevalence and severity of associated radiographic parameters found on magnetic resonance arthrograms (MRAs) in patients with arthroscopically confirmed isolated posterior labral tears and symptomatic recurrent posterior shoulder instability, compared with an age-matched cohort of patients without posterior instability or labral injury confirmed with shoulder arthroscopy...
August 15, 2016: American Journal of Sports Medicine
Shadpour Demehri, Nima Hafezi-Nejad, Elliot K Fishman
The inherently unstable anatomy of glenohumeral (GH) joint predisposes it to shoulder dislocation. Shoulder dislocation can occur either due to acute trauma or due to chronic microtraumas in the setting of underlying morphological abnormality. A plain radiograph is the initial imaging modality for diagnosis and management of shoulder dislocation and its associated osseous abnormalities such as Hill-Sachs deformity or osseous Bankart lesion. However, advanced imaging techniques such as multidetector CT (MDCT) with three-dimensional (3D) volume rendering and MRI can be helpful in further characterization of osseous abnormalities and detection of associated soft tissue injuries, respectively...
August 13, 2016: Emergency Radiology
Rajeev Mannem, Melissa DuBois, Matthew Koeberl, Damian Kosempa, Scott Erickson
Shoulder dislocations are frequently seen in the general population and can be a cause of instability. Instability can lead to debilitating symptoms and morbidity as a result of progressive damage to the shoulder. Anterior shoulder dislocations are the most frequent type of dislocations and have been studied extensively with MRI. The soft tissue Bankart lesion is the most well-known entity associated with anterior instability; however, additional structural lesions arising from traumatic events have been described in recent literature which also predispose to anterior shoulder instability...
October 2016: Skeletal Radiology
David M Burns, Jaskarndip Chahal, Shahram Shahrokhi, Patrick Henry, David Wasserstein, Cari Whyne, John Theodoropoulos, Darrell Ogilvie-Harris, Tim Dwyer
BACKGROUND: Anatomic studies have demonstrated that bipolar glenoid and humeral bone loss have a cumulative effect on shoulder instability and that these defects may engage in functional positions depending on their size and location, potentially resulting in failure of stabilization procedures. Determining which lesions pose a risk for engagement remains challenging, with arthroscopic assessments and a 3-dimensional computed tomography (CT)-based glenoid track method being accepted approaches at this time...
August 5, 2016: American Journal of Sports Medicine
Alexandre Lädermann, Patrick J Denard, Jérôme Tirefort, Frank C Kolo, Sylvain Chagué, Grégory Cunningham, Caecilia Charbonnier
Despite the fact that surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation. The purpose of this prospective clinical study was to analyze the effect of surgical stabilization on glenohumeral translation.Glenohumeral translation was assessed in 11 patients preoperatively and 1 year postoperatively following surgical stabilization for anterior shoulder instability. Translation was measured using optical motion capture and computed tomography...
August 2016: Medicine (Baltimore)
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