shoulder instability

Question 1

reduction manouvre for posterior shoulder dislocation?

Answer 1

• internal rotation and adduction, then axial traction
• head pushed laterally

locked post shoulder dislocation
- gently internally rotate first

Failed closed reduction
- deltopectoral approach for open
- subscap taken with lesser tub - modified Mc Laughlin

Question 2

Posterior shoulder dislocation

Answer 2

Predisposing factors:
- bony abnormality - glenoid hypoplasia and retroversion
- chronic microtrauma - weight lifters/ over head throwers

Stabilisers to posterior dislocation:
- STATIC - Post band of IGHL - primary restraint in IR
- DYNAMIC - subscap - primary restraint in ER

clinical features
- IR and adduction
- limited ER
- posterior capsule tightening in chronic

Question 3

Anterior shoulder dislocation
- Risk factors
- typical injuries
- BESS management
- operative management
- GT fracture management

Answer 3

Risk factors
- age
- male
- contact sport
- hyperlaxity
- bankart lesion or hill sachs lesion
- Instability severity score > 6 = 70% risk of redisclocation - needs a bony op

Injuries
- bankart lesion - anteroinferior labral tear and ant band of IGHL avulsion (main ant stabiliser)
- Hill sachs lesion - posterosuperior
- Glenoid loss - >13.5% is critical

BESS guidance:
- <25yrs - physio, MRA +/- bankart repair
- 25-40yrs - physio, reassess +/- scan
- >40yrs - MRI or US - rotator cuff repair

Operative management
- Glenoid defect - laterjet procedure
- Humeral defect - remplissage
- labral defect - bankart repair
- GT fracture ORIF
- rotator cuff repair/ reverse

Laterjet
- coracoid bone block
- conjoined tendon - sling
- capsule reconstruction

Remplissage
- posterior capsule and infraspinatous tendon into the hill sachs lesion

GT fracure
- risk of undisplaced surgical neck fracture
- ORIF if: >5mm superior or >10mm posterior displacement