This document discusses anterior recurrent shoulder dislocation. It begins with an introduction stating that the shoulder is one of the most unstable joints and anterior dislocation is the most common type, affecting around 2% of the population. It then covers the anatomy and stabilizing structures of the shoulder joint. It describes the mechanism of injury as anterior dislocation occurring during abduction and external rotation. Classification, risk factors, pathoanatomy, clinical features, investigations, and various surgical and non-surgical treatment options are discussed. Common procedures mentioned include Bankart repair, Laterjet procedure, and remplissage.

1. ANTERIOR RECURRENT
SHOULDER DISLOCATION
Dr. Bipul Borthakur (PROF.)
Dept. of Orthopaedics, SMCH

2. Introduction
• most unstable and frequently dislocated joints
in the body
• 50% of all dislocations
• 2% incidence in the general population

3. Anatomy
• Comprises of glenoid cavity of scapula and
humoral head
• Factors providing stability of joint –
– Static stabilisers
• Glenoid cavity
• Glenoid labrum- increases the depth of glenoid cavity
by 50%
• Negative intra-articular pressure
• Glenohumeral ligament complex

4. • Dynamic stabilisers
– rotator cuff-
a) Supraspinatus
b) infraspinatus
c) teres minor
d) subscapularis
– Muscles around the shoulders

6. Mechanism of injury
• Anterior dislocation- abduction and external
rotation of arm
– E.g- throwing of ball

7. Classification
• Based on direction of force-
– Anterior dislocation –
• most common (95%)
• humeral head dislocated anteriorly
• according to position of humeral head it is subdivided
into
– Subcoracoid
– Subglenoid
– Subclavicular
– intrathoracic

8. Classification
• Posterior dislocation- 5%
• Inferior dislocation- rare

9. Risk factor
• Factors that influence the probability of
recurrent dislocations are-
• Age- youngr the age more the chance of
recurrence,
• Return to contact or collision sports.
• hyperlaxity,
• a significant bony defect in the glenoid or
humeral head.

10. Pathoanatomy
• No essential lesion for every dislocation.
• There are pathological changes in stabilizing
components.
• Hyperlaxity of the capsule- due to collagen
vascular disease or microtrauma.
• Tears of the capsulolebral complex.
• Bony defect of the glenoid or humerol head.

11. • Ligament injury or laxity.
• There are secondary changes wth repeated
dislocation. Like Erosion of the anterior
glenoid rim, stretching of the anterior
capsule
subscapularis tendon, and fraying and
degeneration of the glenoid

12. Bankert lesion
• humeral head is forced anteriorly out of the glenoid
cavity
• Tears the fibrocartilaginous labrum from almost
the entire anterior half of the rim of the glenoid cavity
• and the capsule and periosteum from the anterior
surface of the neck of the scapula.
• This traumatic detachment of the glenoid labrum has
been called the Bankart lesion.
• Single most imp factor in ant recurrent dislocation

13. Classification
• Based on duration-
– Acute dislocation- less than 6 weeks duration
– Chronic dislocation- more than 6 weeks
– Recurrent dislocation

14. History
• The history important in recurrent instability
of the shoulder joint
• The amount of initial trauma, if any, should be
determined.
• High-energy traumatic collision sports and
motor vehicle accidents are associated with
increased risk of glenoid or humeral bone
defects. Recurrence with minimal

15. • history of repeated microtrauma.
• Position at which dislocation occurs.

16. Clinical feature
• Pain may be absent.
• Swelling
• Attitude of the shoulder- shoulder abducted and
external rotation ( anterior dislocation)
• Prominent acromion
• Loss of contour
• Loss of range of motion .

17. Physical examination
• Both shoulders should be thoroughly
examined, with the normal shoulder used as
reference.
• Asymmatry or atrophy of shoulder,
• Tenderness over ant and post. Capsule and
rotator cuff and AC joint.
• Examination of rotator cuff and muscles
• Neurovascular examination.

18. Clinical tests
• Duga’s test – difficulty to touch the opposite
shoulder
• Callaway’s test – increase circumference of
the axilla compared to opposite side
• Hamilton ruler test – normally ruler placed
over the lateral aspect of arm will not touched
acromion & lateral epicondyle simultaneously
but here it can

19. HAMILTON RULER TEST CALLAWAY’S TEST
DUGA’S TEST

20. Shift and load test
• one hand placed along the edge of the scapula
to stabilize it and grasping the humeral head
with the other hand and applying a
slight compressive.
• Anterior and posterior translation is
measured.

21. Sulcus test
• Done in 0 and 45 degree abduction.
• Done by pulling distally and observing for
sulcus.

22. Apprehension test
• Positive reaction indicated
by an apprehension
reaction by patient

23. Other tests
• Anterior drawer test- done in various degree
od abduction and external rotation.
• Jobes relocation test.
• Beighton hyperlaxity scale .

24. investigations
• X-rays shoulder–
– AP
– AXILLARY
– SCAPULAR Y VIEW
• Special views
– West point view – to see the Bankart’s lesion
– Stryker notch view – to see the Hill Sach’s lesion
– AP in internal rotation- bankert lesion.

25. West point view

26. Styrker notch view

27. NORMAL DISLOCATION

29. CT scan
• CT with three dimensional view most
sensitive test for detecting and measuring
bone deficiency or retroversion of the glenoid
or humerus.
• also indicated for evaluating recurrences that
occur with trivial trauma, low angle instability,
and failed surgical procedures .

30. • MRI- imp. For shoft tissue pathology.
• Arthrgraphy- xray or CT arthrography can
show capsular laxity, tear, soft tissue
abnormality and bony abnormality.
• Examination under anaesthesia sometime
help in clinical diagnosis.

31. treatment
• Mostly surgical
• Non operative treatment done in case-
1. Old low demanding patient
2. Hyperlaxity due to collagen vascular disease
• Muscle strengthening and avoiding vulnarbale
position

32. TREATMENT
• Reduction technique
– Hippocratic technique

33. Treatment
• Stimson (gravity aided) technique

34. Treatment
• Kocher’s maneuver – TEAI
T – TRACTION
E – EXTERNAL ROTATION
A – ADDUCTION
I – INTERNAL ROTATION

35. Surgical Treatment
• Lots of operative procedure have been
described
• But no single best procedure
• Choice of procedure depends on-(
– has a low recurrence rate
– has a low complication rate
– has a low reoperation rate,

36. 4) does no harm (arthritis)
5) maintains motion
6) is applicable in most cases
7) allows observation of the joint
8) corrects the pathological condition
9) is not too difficult.

37. • Can be done open or arthroscopy
• Repairable defects – arthroscopic procedures
– Bankart and capsular plication preferred
• Open procedure Jobe capsulolabral
reconstruction or NEER capsular shift
preferred.
• For glenoid bony defect – Laterjet procedure

38. • Humeral head defect-
– Moderately sized treated with arthroscopic
remplissage procedure and bankart repair
– Larger defect(35-45%)- Laterjet procedure

39. Bankart operation
• Subscapularis and shoulder capsule open
vertically
• Lateral leaf of capsule reattach to anterior
glenoid rim
• Medial leaf of capsule imbricated

40. Laterjet procedure
• Coracoid process is devided at the junction of
horizontal and vertical portion
• Vertical part is transferred to antero-inferior part
of glenoid rim
• Additional iliac graft can be done for bony defect
• Post OP care
– immobilization in a sling for 2 weeks
– Forward flexion is begun thereafter
– External rotation started at 6 weeks

41. Laterjet procedure
• Post OP care
– immobilization in a sling for 2 weeks
– Forward flexion is begun thereafter
– External rotation started at 6 weeks
– Strengthening exercise at 8 weeks

42. THANK YOU