This is a short presentation on shoulder instability, biomechanics, pathology, diagnostic modalities, clinical picture and treatment methods available.

1. Unstable Shoulder
Dislocations around Shoulder
Dr.A.Mohan krishna
M.S.Ortho., MCh Orth (U.K)
Consultant Orthopaedic surgeon
Apollo Hospitals, Hyderabad.
Consultant Orthopedic surgeon

2. NORMAL SHOULDER JOINT

3. BIOMECHANICS
Glenoid labrum
• Increases depth of cup by 20%
Ligaments
• Glenohumeral Ligaments
• Joint capsule
Muscles
• Rotatorcuff muscles
• Biceps
Dynamic
• Proprioceptive feedback

4. static Dynamic
Concavity
compression
Deltoid & biceps
Rotator cuff
muscles
Joint fluid
adhesiveness
Ligament & capsule
Glenoid Labrum
Negative
intraarticular
pressure

5. BIOMECHANICS
The glenohumeral joint will not
dislocate as long as the net humeral
joint reaction force is directed within
the effective glenoid arc

6. ANTERIOR
DISCLOCATION
POSTERIOR
DISLOCATION
MULTIDIRECTIONAL
DIRECTION OF
DISLOCATION

7. Congenital
Acute
traumatic
Atraumatic
Types of Instability

8. TUBS
Traumatic
Unidirectional
Bankart
Surgery
AMBRI
Atraumatic
Multidirectional
Bilateral
Rehab
Inferior Capsular
shift
Recurrent Instability

9. Anterior
- 97% of
dislocations.
- Subcoracoid
- Subglenoid
- Subclavicular
- Intrathoracic
Posterior
- 3%
- Seizures,
- Subacromial,
- Subglenoid,
- Subspinous
Direction of Instability

10. ASSOCIATED INJURIES
Bankarts Lesion
Hill Sachs Lesion

11. EVALUATION OF RECURRENTTRAUMATIC
INSTABILITY
History
trauma
sports
Throwing or
overhead
activities

12. EVALUATION OF RECURRENT ATRAUMATIC
INSTABILITY
Historytrauma
Generalised
ligament
laxity
Throwing or
overhead
activities
Voluntary
subluxation
History of
fear of
dislocating

13. Clinical Evaluation
Anterior
dislocation
Abducted and
externally
rotated
Limited internal
rotation
Loss of rounded
contour of
shoulder
Posterior
Dislocation
Sling position of
Adduction & Internal
Rotation
Limited External
Rotation & Elevation
of arm
Posterior prominence
of shoulder

14. Clinical Evaluation
Laxity
tests
Drawers test
Sulcus test
Push -Pull
Stability
tests
Fulcrum
Apprehension
test
JerkTest

15. INVESTIGATIONS
X-Rays
Bony bankarts
lesion
Hill Sach’s lesion
MRI
Status of soft
tissues
MR arthrogram
Bankarts lesion,
SlAP lesions

16. ANTERIOR DISLOCATION
APVIEW SCAPULAR
‘Y’VIEW
CLINICAL

17. POSTERIOR DISLOCATION
AP
View
Axillary
View
Clinical

18. GENERALISED LIGAMENT LAXITY

19. HABITUAL DISLOCATION

20. CONGENITAL DISLOCATION

21. MANAGEMENT
Closed manipulation
and reduction
IV Sedation
Anesthesia
Open reduction
Immobilization
for 4 to 6
weeks

22. SHOULDER STRENGTHENING

23. MANAGEMENT OF
RECURRENT ANTERIOR DISLOCATION
RECURRENT
TRAUMATIC
ANTERIOR
DISLOCATION
Surgical stabilization
Open
Arthroscopic
Poor response to
Non Operative
treatment
ATRAUMATIC
INSTABILITY
80% responds to
physio
Surgical stabilization
Capsulorraphy if non
operative feels

24. MULTIDIRECTIONAL INSTABILITY
MULTIDIRECTIONAL
INSTABILITY
Surgery only if
non-operative fails
Surgery –
Capsulorraphy

25. BANKARTS REPAIR

26. BANKARTS REPAIR

27. BRISTOW’S PROCEDURE
Coracoid tip along with the conjoined tendon is transferred
to the anteroinferior glenoid neck which acts acts like bone
block in front of the humeral head.

29. THANK YOU