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inestabilidad anterior hombro

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revisión tema inestabilidad hombro con opciones terapéuticas

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inestabilidad anterior hombro

  1. 1. Inestabilidad anterior recurrente Dr. Max González Solovera Seminarios Cirugía Hombro
  2. 2. Inestabilidad • Eminentemente inestable • Menos del 30 % de la cabeza humeral en contacto con glena
  3. 3. Estabilizadores • Dinamicos Manguito rotador Cabeza larga del bíceps Ritmo escapulo torácico Propiocepción Deltoide
  4. 4. • Estaticos • Complejo capsulo labral • Presion negativa • Liquido sinovial • Manguito rotador • Arco coracoacromial • Ligamento coraco humeral
  5. 5. Complejo glenohumeral inferior • El mas importante. • Limita la traslación anterior en abducción y rotación externa. • Bandas anteriores y posterior actúan como “ hamaca” • Banda anterior limita rotacion externa en abduccion mayor de 90º
  6. 6. Complejo glenohumeral inferior
  7. 7. Ligamento glenohumeral medio • Al lado de subescapular. • Segundo restrictor de la traslacion anterior • Limita la rotacion externa a 45º de abduccion • 40% de la poblacion no lo presenta.
  8. 8. Clasificacion etiologica deThomas y Matsen • Poco usada actualmente. • AMBRII • TUBS
  9. 9. Historia • Evento traumático aislado • Microtraumas repetitivos • Dolor • Posición del brazo durante episodios de inestabilidad • Edad de primer episodio, dominancia, actividad que desarrolla, deportes
  10. 10. Examen físico • Inspeccion : asimetrias, rangos de movilidad, cicatrices previas, atrofia muscular • Signo del Sulcus
  11. 11. Sulcus
  12. 12. Gagey test
  13. 13. Test de hiperlaxitud
  14. 14. Test especificos de inestabilidad anterior aprensión
  15. 15. Test de relocación
  16. 16. Radiologia basica
  17. 17. Rx West Point
  18. 18. Rx Stryker
  19. 19. RNM • Lesiones labrum • Manguito rotador • Lesiones avulsivas tipo HAGL
  20. 20. Bankart
  21. 21. Hill Sacks
  22. 22. Medición de porcentaje Hill Sacks
  23. 23. Hill Sacks
  24. 24. HAGL
  25. 25. ALPSA
  26. 26. SLAP
  27. 27. Slap •
  28. 28. Que puede generar inestabilidad? • Lesiones Hill Sacks • Fracturas o defectos glenoideos. • Alteracion de la version humeral o glenoidea • Lesiones de Bankart • Hiperlaxitud.
  29. 29. Tratamiento No quirurgico • Kinesiologia. • Resultados en general poco satisfactorios pero considerar en adulto mayor, baja demanda fisica, comorbilidades o paciente que no este apto para seguir indicaciones post cirugia.
  30. 30. ISIS SCORE
  31. 31. Tratamiento quirurgico • Bankart : • Historicamente abierto ahora artroscopico. • Tasas de recurrencia post artroscopia han disminuido (10%) • Adecuada selección de pacientes
  32. 32. Bankart
  33. 33. Bankart Abierto
  34. 34. Bankart Artroscopico
  35. 35. Defectos oseos • Si el componente glenoideo es mayor de 30% se considera que Procedimiento de Bristow Latajet • Se configura imagen de pera invertida
  36. 36. Déficit glenoideo
  37. 37. Procedimiento Bristow- Latarjet
  38. 38. Causa de fracaso tto quirurgico • Falla en reconocer lesiones asociadas • Desestimar lesión capsular. • Desestimar lesión ósea ( 67% falla en Bankart Artroscopico) • Stephen S. Burkhart, M.D., and Joe F. De Beer, M.D. Traumatic Glenohumeral Bone Defects and Their Relationship to Failure of Arthroscopic Bankart Repairs: Significance of the Inverted-Pear Glenoid and the Humeral Engaging Hill-Sachs Lesion
  39. 39. Recurrencia post reparacion • Menor de 20 años • Deportes sobre cabeza • Nivel competitivo • Hiperlaxitud • Hill sacks visible en rx ap en rotacion externa • Defecto oseo en glena en rx ap
  40. 40. Remplissaje • Consiste en insertar Ancla 5.0 en defecto vcabeza umeral para luego fijar capsula y infraespinoso para cubrir defecto. • Hace el defecto extracapsular • Descrito por Wolff año 2007.
  41. 41. Remplissage
  42. 42. Injerto de cabeza humeral • Para cubrir grandes deficit. • Se realiza por abordaje deltopectoral
  43. 43. Injerto
  44. 44. Bibliografia • Arthroscopy 2014 sep 30(9) 1184-2011 Latarget, Bristow and Eden Hybinette Procedures Bulletin of Hospital for joint Disease 2014, 72(3) 210-6 Current Trend in mangment of recurrent Aterior instability. • J shoulder Elbow Surgery (2011) 20 , 173-182 Mangment of anterior Shoulder instabbility
  45. 45. Comentarios

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