This document discusses the management of traumatic anterior shoulder dislocations. It begins by describing the shoulder's anatomy and how its mobility makes it prone to instability. It then reviews the history and clinical examination findings that help determine appropriate treatment. Arthroscopic findings from studies of acute and chronic dislocations are presented, showing common lesions like Bankart tears. Treatment options are explored, including arthroscopic stabilization which can address all lesions with minimal morbidity. Arthroscopy allows accurate diagnosis and repair of injuries while facilitating early rehabilitation. The conclusion is that arthroscopy is now often the treatment of choice for traumatic shoulder dislocations.
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Traumatic anterior shoulder
dislocation
Changing concepts of
management
Manos Antonogiannakis
O r t h o p a e d i c S u r g e o n
Director 3rd Orthopaedic department
Centre of Shoulder Arthroscopy & Surgery
Hygeia Hospital
Athens Seminar, Scapular Dyskinesis related to shoulder pathology
Athens, 9&10 June 2017 .
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Intra-articular Lesions in Acute and Chronic Anterior
Shoulder Instability
C.K. Yiannakopoulos, E Mataragas
Emm Antonogiannakis
Arthroscopy 2007
Level IV, prognostic case series
127 patients
with acute and chronic traumatic
anterior instability were recorded
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Major lesions discovered from the first
dislocation
Becoming worse as the episodes are being
repeated
What is important
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• Multicenter study
• 245 patients aged 12-40 years
• 10 years follow up
• 52% recurrence rate
• 23% were operated
Prognosis of recurrence after
traumatic first time dislocation
Primary anterior dislocation of the shoulder in
young patients. A 10 year prospective study -
Hovelius 1996 JBJS(A)
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Does immobilization
reduce recurrence?
Prospective multi-center study
257 primary anterior shoulder dislocations
25 year follow up
Results:
Immobilization for 3-4 weeks after shoulder
dislocation does NOT change the prognosis
compared with immediate mobilization
Hovelius JBJS 2008
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Bankart Lesion
the essential lesion
Avulsion of the IGHL from the glenoid rim
from 2 o’clock to 6 o’clock
Primary restraint to anterior translation
at 90o of abduction
85% in traumatic anterior dislocations
Not the only lesion usually.
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What is successful Treatment
Avoid recurrence
No limitations in Range of motion
Minor morbidity
Few complication
Return to preinjury activity level
Reproducible results
These are possible with arthroscopic treatment
of traumatic shoulder dislocation in selected
patients
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Arthroscopic Shoulder Reconstruction
Goal of the Operation:
Restoration of the Labrum to
its anatomic attachment
Reestablishment of the appropriate tension
in the GH ligaments and capsule
Address bone deficiencies
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From January 2007 to December 2010
(4 years)
48 patients
Average age: 28.9 ± 7.8 years
Average fu: 37.2 ± 9.9 months
Recurrence percentage: 6.3%
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Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion:
From “Engaging/Non-Engaging” Lesion to “On-Track/Off-Track” Lesion
Giovanni Di Giacomo, Eiji Itoi, Stephen S. Burkhart
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Glenoid Bone Loss >25%
Arthroscopic Latarjet procedure
L. Lafosse
Arthroscopic shoulder stabilization with a bone block
E. Taverna
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Postoperative Rehabilitation
Sling for comfort
Isometrics and pendulum exercises immediately
Active forward elevation may begin after 3/52
External rotation to 30° to 40° at 4/52
Progressive strengthening at 8/52
Return to sport at 18 to 36 weeks
supervised and individualized
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Findings after shoulder dislocation in
patients older than 40 years
52 pts follow up more than 2 years
Redislocation rate 4%
Rotator cuff tears 35%
T Penvy, R Hunter, J Freeman
Arthroscopy 1998
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Arthroscopy can be performed in an outpatient
setting
The anatomy can be restored with minimum
morbidity and pain for the patient
Careful assessment will allow repair of all lesions
The patient can resume most of his every day
activities early in the rehabilitation program
Conclusions