CHAPTER 44 • SHOULDER INSTABILITY 2673.Lesser tuberosity transfer with subscap
tendon- Rotational osteotomy of the humerus
- Recurrent traumatic posterior:This is a less fre-
quent multifactorial condition with several modes of
presentation.
- Open capsular posterior shift: Associated with a
posterior Bankart lesion and good success.
Posterior capsule is shifted superiorly and laterally
through a posterior approach (Bigliani et al, 1995). - Arthroscopic: Suture anchor or bioabsorbable tack
fixation arthroscopically of the posterior Bankart
lesion, associated with an 8% re–operation rate for
failure (Williams et al, 2003).
- Acquired microinstability:This is a condition that
exists in the throwing or overhead athlete. Subtle ante-
rior instability may lead to an impingement of the
articular supraspinatus/infraspinatus tendons against
the posterior superior labrum termed internal
impingement. - Multidirectional: Open inferior shift: This procedure
first reported by Neer and Foster has been successful.
Reports of 2–8% failure rates in multidirectional
instability patients (Neer and Foster, 1980; Cooper
and Brems, 1992).
REFERENCES
Anderson D, Zvirbulis, Ciullo J: Scapular manipulation for
reduction of anterior shoulder dislocation. Clin Orthop
164:181–183, 1982.
Arciero RA: Acute Anterior Dislocations, in Warren RF, Craig
EV, Altchek DW (eds.): The Unstable Shoulder. Philadelphia,
PA, Lippincott–Raven, 1999, pp 159–175.
Arciero RA, Wheeler JH, Ryan JB, et al: Arthroscopic Bankart
repair versus nonoperative treatment for acute, initial anterior
shoulder dislocations. Am J Sports Med22(5):589–594, 1994.
Bacilla P, Field L, Savoie F: Arthroscopic Bankart repair in a high
demand patient population. Arthroscopy13(1):51–60, 1997.
Bigliani L, Pollock G, McIlveen S, et al: Shift of the posterior
inferior aspect of the capsule for recurrent posterior gleno-
humeral instability. J Bone Joint Surg77–A:1011–1020, 1995.
Blom S, Dahlback LO: Nerve injuries in Dislocations of the
Shoulder Joint and Fractures of the Neck of the Humerus: A
clinical and Electromyographical Study. Acta Chir Scand
136:461–466, 1970.
Burkhart S, De Beer J: Traumatic Glenohumeral bone defects and
their relationship to failure of arthroscopic Bankart repairs:
Significance of the inverted–pear glenoid and the humeral
engaging Hill Sachs lesion. Arthroscopy19(7):677–694, 2000.
Burkhead WZ, Rockwood CA, Jr: Treatment of instability of the
shoulder treated with an exercise program. J Bone Joint Surg
74A:890– 896, 1992.
Churchill R, Moskal M, Lippitt S, et al: Extracapsular anatomi-
cally contoured anterior glenoid bone grafting for complex
glenohumeral instability. Te ch Shldr and Elbow Surg
2(3):210–218, 2001.
Cooper RA, Brems JJ: The inferior capsular shift procedure for
multidirectional instability of the shoulder. J Bone Joint Surg
74A:1516– 1521, 1992.
DeCarlo M, Malone K, Geric B, et al: Evaluation of Shoulder
Instability Braces. J Sports Rehab 1996;5:143–150.
Hovelius L, Augustine BG, Fredin H, et al: Primary anterior dis-
location of the shoulder in young patients. A ten–year prospec-
tive study. J Bone Joint Surg78(11):1677–1684, 1996.
Itoi E, Lee S, Berglund L, et al: The effect of a glenoid defect on
anteroinferior stability of the shoulder after Bankart repair: a
cadaveric study. J Bone Joint Surg82–A(1):35–46, 2000.
Itoi E, Sashi R, Minigawa H, et al: Position of immobilization after
dislocation of the glenohumeral joint. A study with use of mag-
netic resonance imaging. J Bone Joint Surg84–A(5):661–667,
2001.
Kirkley A, Griffin S, Richards C: Prospective randomized clini-
cal trial comparing the effectiveness of immediate arthroscopic
stabilization versus immobilization and rehabilitation in first
traumatic anterior dislocations of the shoulder. Arthroscopy
155:507–514, 1999.
Matsen FA, Thomas SC, Rockwood CA, Jr: Anterior glenohumeral
instability, in Rockwood CA, Jr, Matsen FA (eds.): The Shoulder,
vol. 2, 2nd ed. Philadelphia, PA, Saunders, 1998, pp 669–672.
McLaughlin HL, MacLellan DI: Recurrent anterior dislocation of
the shoulder. J Trauma 7:191–201, 1967.
Mazzocca AD, Brown FM, Carriera DS, et al: Arthroscopic
Stabilization of Collision Athletes. AJS 2003. (in press)
Milch H: Treatment of Dislocation of the Shoulder. Surgery
3:732–740.
Neer CS, II, Foster CR: Inferior Capsular Shift for Inferior and
Multidirectional Instability of the Shoulder: A Preliminary
Report. J Bone Joint Surg A62:879–908, 1980.
Neer CS, Rockwood CA, Jr: Fractures and Dislocations of the
Shoulder, in Rockwood CA, Jr. Green DP (eds.): Fractures in
Adults,vol. 1, 4th ed. Philadelphia, PA, JB Lippincott, 1996.
Neviaser RJ, Neviaser TJ, Neviaser JS: Concurrent rupture of the
rotator cuff and anterior dislocation of the shoulder in the older
patient. J Bone Joint Surg 70A:1308–1311, 1988.
Ribbans WJ, Mitchell R, Taylor GJ: Computerized arthrotomog-
raphy of primary anterior dislocation of the shoulder. J Bone
Joint Surg 72B:181–185, 1990.
Rowe CR: Prognosis in dislocation of the shoulder. J Bone Joint
Surg 38A:957–977, 1956.
Rowe CR, Zarins B, Ciullo JV: Recurrent anterior dislocation of the
shoulder after surgical repair. J Bone Joint Surg 66A:159, 1984.
Thomas SC, Matsen FA, III: An approach to the repair of avul-
sion of the glenohumeral ligaments in the management of trau-
matic anterior glenohumeral instability. J Bone Joint Surg
71A:506–513, 1989.
Westin CD, Gill EA, Noyes ME, et al: Anterior shoulder disloca-
tion. A simple and rapid method for reduction. AJS
23:369–371, 1995.
Williams R, Strickland S, Cohen M, et al. Arthroscopic repair for
traumatic posterior shoulder instability. AJS31(2):203–209,
2003.