Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-29  Postoperative Grashey (A) and axillary (B) x-rays show two screws securing the coracoid bone graft.

■ Active and passive elevation is 45°. He can externally rotate to neutral. ■ He has loss of the normal contour of the left shoulder consistent with anterior shoulder dislocation. Imaging: ■ X-rays show a locked subcoracoid anterior dislocation of the left shoulder, associated with a large Hill-Sachs lesion (Fig. 3-30).

■ 3D CT scan confirms the large Hill-Sachs lesion and also suggests a loss of about 20% of the inferior gle- noid diameter (Fig. 3-31). Arthroscopic Findings: ■ In the operating room, a closed reduction was attempted under fluoroscopic C-arm control. However, the humeral head was completely locked on the ante- rior rim of the glenoid, and it was impossible to reduce.

FIGURE 3-30  Plain x-rays. A: AP view shows a locked subcoracoid anterior dislocation of the left shoulder. B: Axillary view shows a large Hill-Sachs lesion, which is locked onto the anterior rim of the glenoid.