Chapter 3 Instability


CHAPTER 3 | Instability

The Cowboy’s Conundrum: First-time Anterior Dislocation in Dominant Arm of Overhead Athlete (High School Volleyball Player) with Hyperlaxity The Surgeon’s Solution: Arthroscopic Bankart Repair Incorporating Capsular Plication History: ■ A 16-year-old female volleyball player dislocated her dominant right shoulder 3 months earlier while div- ing headfirst for a ball during a game. She had an anterior dislocation. There was a doctor on the side- lines that reduced the shoulder within 10 minutes. She had tried to continue to play with a brace on that shoulder, but says she “cannot trust it” and that it continues to feel unstable even though it has not redislocated. Physical Exam: ■ She has generalized hyperlaxity. Both elbows hyper- extend 10°. She had thumb-to-forearm hyperlaxity bilaterally. ■ Strength is normal. ■ She has apprehension with combined abduction and external rotation.

Video 3-19

FIGURE 3-108  Right shoulder, anterosuperolateral viewing portal. The inverted pear glenoid is obvious, signifying significant glenoid bone loss. G, glenoid; H, humeral head.

■ Often, at arthroscopy, the surgeon will find unex- pected pathology that would have gone undiagnosed without arthroscopy. In this case, there was a poste- rior HAGL lesion that was recognized and repaired arthroscopically. This reverse HAGL lesion did not show on the pre-op MRI and would have gone unde- tected without a diagnostic arthroscopy. ■ After addressing concomitant pathology arthroscopi- cally, the anterior instability with significant bone loss is treated by an open Latarjet reconstruction.

Imaging: ■ Plain radiographs are normal (Fig. 3-111).

■ MRI scan shows edema in the posterior humeral head consistent with Hill-Sachs lesion from anterior

FIGURE 3-109  Right shoulder, posterior viewing portal. A: SLAP lesion. B: SLAP lesion after repair with LabralTape and a PushLock suture anchor (Arthrex, Inc., Naples, FL). G, glenoid; BT, biceps tendon.

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