Shoulder instability

Case
This 16-year-old right handed female player presents with a history of recurring shoulder dislocations. She describes up to eight incidents where her shoulder has dislocated. On each occasion the shoulder has spontaneously reduced within one minute. The injuries appear to be happening with reducing force – but have always occurred during football. On examination she had a positive anterior apprehension/relocation test. There was no evidence of generalised or glenohumeral joint (GHJ) laxity and further examination was otherwise unremarkable.

Findings
The MRI sequences show a moderate Hill-Sachs impaction injury involving the posterosuperior humeral head. This measures 15 mm in diameter x 4 mm in depth. Small subcortical cysts without medullary oedema underlies the lesion. No bony Bankart fracture is seen. The glenoid maintains a normal contour, however there is extensive tearing of the anterior labrum from 1 o’clock – 6 o’clock. At 5 o’clock the labrum has very subtle medialisation with a thickened periosteal sleeve. The anterior band inferior GHJ ligament attaches at this site.

Discussion
Given that this young woman was having recurring instability surgical treatment was suggested. In the absence of any significant GHJ laxity she underwent an arthroscopic stabilisation procedure. She was able to return to football five months following her surgery.

There are a several typical anatomical findings following an anterior instability episode. A Hill-Sachs lesion is a compression fracture of the posterior and superior aspect of the humeral head caused by a blow to the anterior glenoid. This lesion is found in more than 80% of traumatic instability cases. While the injury can be seen on the x-ray in this patient, in many cases it is only visualised on cross sectional imaging. In most cases the Hill-Sachs lesion does not require any specific treatment however large humeral defects may need to be addressed (most often with an osteochondral graft). Lesions involving more than 30% of the proximal humeral head play a role in recurrent instability. Bankart lesions (injuries involving the anterior glenoid/labrum) are also very common following anterior instability, occurring in up to 95% of acute dislocations. Lesions affecting the glenoid (as well as the labrum) can be seen on x-rays. A humeral avulsion glenohumeral ligament (HAGL) is another relatively common anatomical variant, occurring in 10% of cases. In these patients the inferior GHJ ligament is avulsed from the humerus, rather than the glenoid. This is more common in patients who are older, after a first-time traumatic dislocation or when there is no visible Bankart lesion.

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Carlos A. Rodríguez-MijaresBangoura Recent comment authors
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Bangoura
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Bangoura

Les traumatismes de l épaule sont très sérieux surtout quand c est du côté juvénile.
Faire d abord une consultation approfondie suivie d une bonne imagerie.(RADIOGRAPHIE NUMÉRISÉE.IRM).
Dans les cas de luxations recidivente il faut toujours penser à une lésion au niveau de la coiffe desrotateursavec une rupture du ligament coracoide..
Une intervention chirurgicale s impose surtout que nous avons à faire à une cadette qui doit garder toute sa plénitude sur le plan sportif.

fifacaromi
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Diagnosticos: lesión de Bankart y lesión de Hill-Sachs.
Tratamiento: reparación artroscópica de lesión del labrum antero-inferior mediante anclaje gleno-labral + reparación capsula-tendinoso postero-superior con tecnica remplíssage ( capsulotenodesis con el tendón del infraespinoso).