The document discusses anterior labro-ligamentous periosteal sleeve avulsion injuries and their classification as a type of gleno-humeral instability, particularly common in teenagers. It outlines clinical symptoms, diagnostic tests, and imaging techniques, along with the surgical procedures for treatment. Key surgical interventions include arthroscopic labral repair and addressing Hill-Sachs lesions.

1. By
Dr. Prakhar Chhawchharia
Orthopaedic Surgeon
MBBS, D(Ortho)
Mch(Ortho)
Fellowship in Arthroscopy

2. • ALPSA- ANTERIOR LABRO-LIGAMENTOUS PERIOSTEAL SLEEVE
AVULSION INJURY
• Type of Gleno-humeral instability.
• TUBE- Traumatic Anterior Unidirectional Bankart lesion requiring
Surgery
• Can be called medialized Bankart
• INCIDENCE is 1.7% in general population with 80% injury in
teenagers

3. IGHL-
90 ABD ER
MGHL-
45 ABD ER
SGHL
AT REST/LIMB BY SIDE
STATIC RESTRAINTS

6. *ANTERO-INFERIOR LABRUM GETS AVULSED WITH THE PERIOSTEAL
SLEEVE OF THE GLENOID
*THE LABRUM+LIGAMENT+PERIOSTEUM COMPLEX GETS
1. ROTATED INTERNALLY
2. DISPLACED MEDIALLY
3. AND FALLS BEHIND THE GLENOID

7. *ACUTE AND RECURRENT DISLOCATION
*FEELING OF INSTABILITY
*SHOULDER PAIN
*CLINICAL TESTS
1. APPREHENSION SIGN-90/90 POSITION -SUPINE
2. RELOCATION TEST -SUPINE
3. SULCUS SIGN -SITTING

8. CLINICAL EXAMINATION
XRAY – WEST POINT VIEW- GLENOID BONE LOSS
- STRYKER VIEW - HILL SACH’S LESION
MRI PREFERABLY WITH CONTRAST

9. OPERATIVE
1. ARTRHOSCOPIC LABRAL REPAIR WITH CAPSULAR REPAIR
2. REPAIR OF HILL SACHS’S OR ENGAGING HILL SACH’S LESION