shoulder instability current concepts mike walton
TRANSCRIPT
Current Concepts in Shoulder Instability
Mr Mike Walton BMedSci BMBS MSc FRCS(T&O) MFSEM(UK)
Consultant Shoulder Surgeon
Natural Selection
• The ability to throw / hunt revolutionised our survival
Armed And Deadly: Shoulder, Weapons Key To Hunt by Christopher Joyce Charles Darwin
Humans
• Clavicle Lengthens
• Scapula moves further to dorsum
• GHJ Externally rotates
• We can Throw
Instability
• GlenoHumeral joint is Inherently Unstable
• The most commonly dislocated joint in body
• Usually Anterior
• Combined ER and ABduction
Instability
Lewis A, Kitmura T & Bayley JIL. The classification of shoulder instability: new light through old windows!Current Orthopaedics, 2004; 18(2):97-108.
Instability
Lewis A, Kitmura T & Bayley JIL. The classification of shoulder instability: new light through old windows!Current Orthopaedics, 2004; 18(2):97-108.
Assessment
• Mechanism of injury
• Apprehension Tests
• Xrays
• MR Arthrogram
• Gadolinium joint injection
Modified O’Briens Test
• Forward Elevation to 90
• Adduction / Internal Rotation
• Pain - SLAP
• WEAKNESS - Post Instability
Modified O’Briens Test
• Posterior Translation occurs in simulated Active Compression Test
J Shoulder Elbow Surg. 2013 Mar;22(3):365-74. doi: 10.1016/j.jse.2012.02.003. Epub 2012 May 19. Glenohumeral contact pressure in a simulated active compression test using cadaveric shoulders. Lin T1, Javidan P, McGarry MH, Gonzalez-Lomas G, Limpisvasti O, Lee TQ.
Assessment
• Mechanism of injury
• Apprehension Tests
• Xrays
• MR Arthrogram
• Gadolinium joint injection
Investigations
• MR Arthrogram
• Accurate for isolated anterior and posterior lesions (78.5%, 69%)
• Accuracy ONLY 37% in combined lesions
Bone Loss
• Predictors of failure
• Age
• Glenoid Bone Loss
• Engaging Hill-Sachs
Ahmed I, Ashton F, Robinson CM. Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence. J Bone Joint Surg Am. 2012 Jul 18;94(14):1308-15
Atraumatic Instability
Lewis A, Kitmura T & Bayley JIL. The classification of shoulder instability: new light through old windows!Current Orthopaedics, 2004; 18(2):97-108.