This document discusses bone loss of the glenoid and humeral head that can occur with anterior shoulder instability. It defines the static and dynamic stabilizers of the shoulder. It describes the difference between laxity and instability, and how instability is best diagnosed by reproducing a patient's symptoms rather than using strict metrics. It discusses traumatic unilateral instability requiring surgery versus atraumatic multidirectional instability often responding to rehabilitation. It covers tests for assessing instability like apprehension and suppression tests. It provides information on prevalence of injuries seen with first time and recurrent dislocations. It outlines investigations like x-rays, CT, and MRI views used to evaluate the shoulder. It focuses in detail on assessing and quantifying glenoid bone loss, defining

1. BONE LOSS (GLENOID & HUMERAL HEAD)-
ANTERIOR SHOULDER INSTABILITY
ASSEMENT
Sai krishna MLV

2. Anatomy
STATIC STABILISERS
● Bony architecture
● Capsule
● Labrum
● Gleno-humeral ligaments- Superior,
middle and inferior
DYNAMIC STABILISERS
● Rotator cuff muscles
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3. LAXITY--------INSTABILITY

4. TESTS FOR LAXITY
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5. Laxity and Instability
● Normal for one person may be abnormal
for another
● Ability to sublux the shoulder over the
glenoid rim in an asymptomatic is normal
● Ability to produce a high grade sulcus sign
in an asymptomatic is normal
● Asymmetry of laxity doesn’t equate to
instability
● Laxity can then be defined as the normal,
painless, acceptable range of motion for
that patient and his or her needs
● Instability then becomes the pathologic,
painful, undesired motion of the gleno-
humeral joint for that patient and his or her
needs
● Best way to diagnose the instability is the
reproduction of symptoms rather than
usage of strict metrics
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6. INSTABILITY
● Traumatic Unilateral instability often with a
Bankart lesion and usually requires
Surgery (TUBS)
● Atraumatic, Multidirectional laxity,
frequently Bilateral, responds well to
Rehabilitation, however, should surgery be
performed, an Inferior capsular shift
procedure is the treatment of choice
(AMBRI)
● Mid range instability
● End range instability
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7. TESTS- APPREHENSION
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8. APPRENHESION SUPPRESSION TEST
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9. Prevalence
First time dislocation
● 87-100% Bankart lesion
● 64-100% Hill-Sachs lesion
● 10-40% SLAP tear
● 80-90% Recurrence
Recurrent dislocation
● 90-100% Bankart lesion
● 77-100% Hill-Sachs lesion
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11. INVESTIGATIONS
X-rays, CT & MRI

12. AP view
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13. Grashey view
● True AP of the shoulder.
● Where the beam is directed
45 degrees medial to
lateral.
● No overlap between
humerus and glenoid.
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14. West point view
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15. Stryker notch view
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20. Glenoid bone loss
In 1998 Bigilani et al. coined the term bony
bankart.
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21. ● Edwards et al. – 90% have glenoid bone lesion- chronic anterior shoulder
instability.
● Sugaya et al. -90% have glenoid bone lesion- (40% erosion compression,
50%- bony bankart).
● Bigilani et al.- 25% reduction in glenoid width as critical bone loss.
● Brukhart et al.(2002&2004)- critical glenoid bone loss as an arthroscopic
method.
● The critical anterior defect was 8.6+_2.2 mm of the anterior glenoid with
barespot as the land mark. Creating an image of inverted pear.
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22. Glenoid rim distance
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23. Glenoid index
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24. Width length ratio
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25. Sugaya et al.
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28. GLENOID TRACK
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32. ● Retrospective review of 57 shoulders treated with isolated arthroscopic
bankart repair.
● Avg age- 25, follow up- 4 years.
● 49 on track- 8% recurrence rate.
● 8 off track- 75% recurrence rate.
● The on-track, off-track concept is predictive of recurrent instablilty.
● Extend the articular arc with bone block or remplissage for off-track
lesions.
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34. Thank You.
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