Shoulder Instability Across the Life Span

290 Pages·2017·14.11 MB·English

by  Andreas B. Imhoff

Andreas B. Imhoff
Felix H. Savoie III
Editors
Shoulder
Instability Across
the Life Span
Shoulder Instability Across the Life Span
Andreas B. Imhoff • Felix H. Savoie III
Editors
Shoulder Instability
Across the Life Span
Editors
Andreas B. Imhoff Felix H. Savoie III
Department of Orthopaedic Department of Orthopaedics
Sports Medicine Tulane University School of Medicine
Technical University of Munich (TUM) Department of Orthopaedics
Munich New Orleans
Germany Louisiana
USA
ISBN 978-3-662-54076-3 ISBN 978-3-662-54077-0 (eBook)
DOI 10.1007/978-3-662-54077-0
Library of Congress Control Number: 2017938119
© ISAKOS 2017
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Contents
Part I The Young Patient with Shoulder Instability (Age <20)
1 Overview of the Spectrum of Instability
in the Very Young: Evolving Concepts . . . . . . . . . . . . . . . . . . . . . . 3
A.B. Imhoff, K. Beitzel, and A. Voss
2 Classification of Glenohumeral Instability:
A Proposed Modification of the FEDS System . . . . . . . . . . . . . . . . 7
Kevin P. Shea
3 Genetics of the Unstable Shoulder . . . . . . . . . . . . . . . . . . . . . . . . . 15
Carina Cohen, Paulo S. Belangero, Benno Ejnisman,
and Mariana F. Leal
4 Multidirectional Instability/Hyperlaxity
of the Glenohumeral Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Felix H. Savoie, Enrique Salas, and Michael O’Brien
5 Posterior Shoulder Instability in the Young Patient . . . . . . . . . . 35
Diana C. Patterson and Leesa M. Galatz
6 Management of Acute Shoulder Instability:
Conservative Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Rebecca A. Carr and Geoffrey D. Abrams
7 Arthroscopic Repair for Initial Anterior Dislocation . . . . . . . . . 57
Robert A. Arciero and Andreas Voss
8 Management of Acute Shoulder Instability:
The Combined Lax Shoulder with Added Acute Trauma . . . . . 65
S.C. Petterson, A.M. Green, and Kevin D. Plancher
9 Stabilization Options in the Adolescent:
Open Bankart Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Stephen C. Weber
Part II T he Young Athletic High Risk Patient with
Shoulder Instability (Age 18–30)
10 Spectrum of Instability in the Athletic Young Adult . . . . . . . . . . 81
K. Beitzel, A.B. Imhoff, and A. Voss
v
vi Contents
11 Overview of Evaluation and Management
of the Unstable Shoulder With and Without Bone Loss:
Definition, Measurement, and Guidelines on Treatment . . . . . 83
Eiji Itoi, Nobuyuki Yamamoto, Taku Hatta,
and Jun Kawakami
12 Arthroscopic Soft Tissue Repair: Bankart Repair
and Remplissage Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Jiwu Chen
13 Modified Open Bankart Repair and Capsular Shift
for Recurrent Traumatic Anterior Shoulder Instability . . . . . . 103
Robert A. Arciero and Felix Dyrna
14 Humeral Avulsion of the Glenohumeral Ligaments
(HAGL) in Shoulder Instability . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Mark Ferguson
15 Open Coracoid Transfer: Indications, Technique,
and Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Giovanni Di Giacomo and Mark Ferguson
16 Arthroscopic Latarjet: Technique and Results . . . . . . . . . . . . . 127
Emilio Calvo and María Valencia-Mora
17 Prevention of Complications of Bone Block
Procedures: Latarjet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Kevin D. Plancher, Allison M. Green, Margaret A. Harvey,
and Stephanie C. Petterson
18 Posterior Instability of the Shoulder . . . . . . . . . . . . . . . . . . . . . . 143
Blandine Marion, André Thès, and Philippe Hardy
19 Arthroscopic Repair of Extended Labral Tears
After a Traumatic Shoulder Dislocation . . . . . . . . . . . . . . . . . . . 169
Felix Dyrna, Jessica DiVenere, and Augustus D. Mazzocca
Part III Instability in the Middle Ages (Age 25–50)
20 Spectrum of Instability in the Middle-Age Range . . . . . . . . . . . 179
A.B. Imhoff, K. Beitzel, and A. Voss
21 The Association of Bankart and Rotator Cuff Tear
in Patients Aged 25–50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Francesco Franceschi, Edoardo Franceschetti,
and Enrique Alberto Salas
22 SLAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Carina Cohen, Bernardo Terra, Benno Ejnisman,
Dan Guttmann, and Andreas Voss
23 Biceps Injuries: What to Do and Where? . . . . . . . . . . . . . . . . . . 203
Stephen C. Weber
Contents vii
24 The Unstable and Painful Long Head of the Biceps . . . . . . . . . 211
Juan P. Previgliano and Guillermo Arce
25 Subscapularis Tears and Instability . . . . . . . . . . . . . . . . . . . . . . 217
Geoffrey D. Abrams
26 Cartilage Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Julian Mehl and Knut Beitzel
Part IV Instability in the “Older” Patient (Age >50)
27 Spectrum of Instability in the Older Patient . . . . . . . . . . . . . . . 239
A.B. Imhoff, K. Beitzel, and A. Voss
28 Acute RCT as a Part of Dislocation . . . . . . . . . . . . . . . . . . . . . . . 243
Francesco Franceschi, Edoardo Franceschetti, and
Enrique Alberto Salas
29 Acute Dislocation Superimposed on Chronic RCT . . . . . . . . . . 247
Mike H. Baums
30 Dislocation Arthropathy of the Shoulder . . . . . . . . . . . . . . . . . . 251
María Valencia and Emilio Calvo
Part V Miscellaneous Instability Topics in the Various Ages
31 Glenoid Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Jean Michel Hovsepian, Felix Dyrna, and Knut Beitzel
32 Locked Posterior Shoulder Dislocation (LPSD) . . . . . . . . . . . . . 269
J. Pogorzelski and A.B. Imhoff
33 Chronic Locked Anterior and Posterior Dislocations . . . . . . . . 277
Felix H. Savoie and Michael O’Brien
34 Brachial Plexus Injuries and Rotator Cuff Tears
with Dislocations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Kevin D. Plancher, Joseph Ajdinovich,
and Stephanie C. Petterson
Part VI Complications
35 Complications After Instability Surgery . . . . . . . . . . . . . . . . . . 291
Andrew J. Sheean and Stephen S. Burkhart
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Part I
The Young Patient with Shoulder
Instability (Age <20)
1
Overview of the Spectrum
of Instability in the Very Young:
Evolving Concepts
A.B. Imhoff, K. Beitzel, and A. Voss
Content To encounter the challenges of shoulder instabil-
ity in a population younger than 20 years old, it is
References ................................................................... 4
important to distinguish between the skeletally
mature and immature population. It has been
shown that because of the growing skeletally
immature patient with open physes, traumatic
shoulder events resulting in a shoulder dislocation
are relatively rare. One of the first studies by
Rowe investigating 500 shoulder dislocations
found that 20% of these dislocations occurred to
patients at the age between 10 and 20 but only
about 2% to patients younger than 10 years [15].
Therefore, these pediatric traumas more often
result in humeral physeal or metaphyseal frac-
tures. In addition the younger patient population
is showing a higher recurrence rate after first-t ime
traumatic shoulder dislocation with a rate up to
100% in patients younger than 10 [15] and
60–94% between 10 and 20 years of age [5, 7,
15]. Children between 14 and 18 years of age are
24 times more likely to experience recurrent
instability compared to infants aged 13 years and
less, with a 14 times more likelihood of recurrent
instability with a closed physis compared with
those with an open physis [12]. There are several
factors reported which may explain the high
recurrence rate in this collective: (1) structural
age-related factors such as a higher composition
of collagen type III fibers in the glenohumeral
A.B. Imhoff (*) • K. Beitzel • A. Voss
Department of Orthopaedic Sports Medicine, capsule [18], (2) anatomical-related factors like a
Technical University of Munich (TUM), more lateral insertion of the capsules on the gle-
Munich, Germany
noid [14], or (3) the severity of impact during
e-mail: [email protected]
© ISAKOS 2017 3
A.B. Imhoff, F.H. Savoie III (eds.), Shoulder Instability Across the Life Span,
DOI 10.1007/978-3-662-54077-0_1
4 A.B. Imhoff et al.
first-time traumatic shoulder d islocation with and [6]. Most of the recent literature proposed a con-
without bony deficiency [9]. For these patients, servative treatment in these atraumatic hyperlax
treatment options are still debatable. Whether a shoulder instabilities, expecting a decline of symp-
conservative or an operative treatment is the best toms through aging and maturation. The treatment
option has not finally been shown, due to the lack consists of a specific program for muscular control
of differentiation between skeletally mature and [3]. If conservative treatment fails, these patients
immature patients. Most of the studies refer to an may benefit from surgical stabilization. The
adolescent population, and some propose a surgical arthroscopic techniques nowadays provide similar
procedure due to the mentioned high recurrence results to the traditional used open capsular shift
rate. But each of these cases has to be considered procedures [4, 11].
individually, and factors like activity level, sports, There is still a high demand for clinical stud-
and general conditions have to be taken into ies to investigate the differences among this
account before proposing a treatment option. young population, especially the differences in
Another aspect that has to be considered in skeletal mature and immature patients. The sub-
these young patients is the occurrence of hyperlax- sequent chapters should help and provide further
ity with joint hypermobility. The incidence in the information on how to treat these patients in the
skeletal immature population is estimated to be context of traumatic and atraumatic instability as
between 4% and 13% and not associated with soft well as hyperlaxity.
tissue disease like the Ehlers-Danlos or Marfan
syndrome [2, 19]. Among these individuals, the
condition of shoulder hyperlaxity is somewhat References
higher in women with poor muscular development
and adolescent overhead athletes, due to the activ- 1. Alpert JM, Verma N, Wysocki R, Yanke AB,
ity demanding with increased flexibility and range Romeo AA. Arthroscopic treatment of multidi-
rectional shoulder instability with minimum 270
of motion [8, 13]. These patients are able to main-
degrees labral repair: minimum 2-year follow-up.
tain their stability by a balancing act of dynamic
Arthroscopy. 2008;24(6):704–11. doi:10.1016/j.
muscular compensation. However, these patients arthro.2008.01.008.
can suffer from a traumatic shoulder event inter- 2. Biro F, Gewanter HL, Baum J. The hypermobility
syndrome. Pediatrics. 1983;72(5):701–6.
rupting this balancing act with a consequently
3. Burkhead Jr WZ, Rockwood Jr CA. Treatment of
structural damage, resulting in unidirectional
instability of the shoulder with an exercise program.
shoulder instability [17]. Most of the time though, J Bone Joint Surg Am. 1992;74(6):890–6.
this young population with an increased laxity 4. Chalmers PN, Mascarenhas R, Leroux T, Sayegh ET,
Verma NN, Cole BJ, Romeo AA. Do arthroscopic
experiences several subluxations resulting in an
and open stabilization techniques restore equivalent
elongation of the static shoulder stabilizing struc-
stability to the shoulder in the setting of anterior gle-
tures [16]. This pathological change between static nohumeral instability? a systematic review of overlap-
bony and capsulo-labral anatomy and dynamic ping meta-analyses. Arthroscopy. 2015;31(2):355–63.
doi:10.1016/j.arthro.2014.07.008.
muscular stabilizers leads to a symptomatic multi-
5. Deitch J, Mehlman CT, Foad SL, Obbehat A, Mallory
directional instability (MDI), an atraumatic insta-
M. Traumatic anterior shoulder dislocation in adoles-
bility in two or more directions [1, 17]. The recent cents. Am J Sports Med. 2003;31(5):758–63.
literature reveals a variation of definitions of MDI, 6. Good CR, MacGillivray JD. Traumatic shoulder dis-
location in the adolescent athlete: advances in surgical
which makes the classification difficult, leading to
treatment. Curr Opin Pediatr. 2005;17(1):25–9.
a high variation of MDI diagnoses [10]. Even
7. Hovelius L, Olofsson A, Sandstrom B, Augustini
though there is limited data particularly regarding BG, Krantz L, Fredin H, Tillander B, Skoglund U,
children and adolescents, the incidence of MDI is Salomonsson B, Nowak J, Sennerby U. Nonoperative
treatment of primary anterior shoulder dislocation in
estimated to be approximately 10% because of
patients forty years of age and younger. a prospective
increased capsular laxity associated with youth
twenty-five-year follow-up. J Bone Joint Surg Am.
and seems to be even higher in overhead athletes 2008;90(5):945–52. doi:10.2106/JBJS.G.00070.