This document discusses posterior shoulder instability. It begins by describing the anatomy and biomechanics of the shoulder. Posterior instability is less common than anterior instability and can be caused by trauma or repetitive microtrauma. Clinical examination is important for diagnosis and may reveal posterior shoulder pain with flexion and internal rotation. Imaging such as x-rays, CT, and MRI can identify bony lesions. Surgical treatment options depend on the specific soft tissue or bony injuries identified and may include arthroscopic or open stabilization procedures like posterior capsulolabral repair. Rehabilitation is important after surgery.
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
Management of Shoulder dislocations and shoulder instability in sports BhaskarBorgohain4
acute shoulder dislocation is one of the most common sports injuries especially in contact sports. recurrent dislocations are quite common after anterior dislocation of shoulder especially in young athletes who are engaged in sports with lots of overhead activities during their games. Bankarts lesion, Hill sachs lesion are common predisposing factors for recurrence. Simple acute first time dislocations may be reduced on the field by a trained person but further referral is must for detail evaluation. recurrent dislocation can be reduced on field too by less trained. complicated dislocations, neurovascular deficits, fracture dislocation are to be referred to hospital immediately. Practical scientific algorithms are presented for their appropriate management here.
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
Rotator cuff tear is a very common orthopedic condition, which causes shoulder pain and stiffness. The slides are on rotator cuff tears and its management by open repair, mini open repair & by arthroscopy
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
Management of Shoulder dislocations and shoulder instability in sports BhaskarBorgohain4
acute shoulder dislocation is one of the most common sports injuries especially in contact sports. recurrent dislocations are quite common after anterior dislocation of shoulder especially in young athletes who are engaged in sports with lots of overhead activities during their games. Bankarts lesion, Hill sachs lesion are common predisposing factors for recurrence. Simple acute first time dislocations may be reduced on the field by a trained person but further referral is must for detail evaluation. recurrent dislocation can be reduced on field too by less trained. complicated dislocations, neurovascular deficits, fracture dislocation are to be referred to hospital immediately. Practical scientific algorithms are presented for their appropriate management here.
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
Rotator cuff tear is a very common orthopedic condition, which causes shoulder pain and stiffness. The slides are on rotator cuff tears and its management by open repair, mini open repair & by arthroscopy
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
1. ΤΑ Κ Τ Ι Κ Ό Μ Ε Τ Ε Κ Π Α Ι Δ Ε Υ Τ Ι Κ Ό Π Ρ Ό Γ ΡΑ Μ Μ Α Κ Ε ΟΧ
Π Α Θ ΟΛ Ο Γ Ί Α - Χ Ε Ι Ρ ΟΥ Ρ Γ Ι Κ Ή Ώ Μ ΟΥ
POSTERIOR SHOULDER
INSTABILITY
PRESENTED BY:
MANOS ANTONOGIANNAKIS
Κολλέγιο Ελλήνων Ορθοπαιδικών Χειρουργών
Ελληνική Εταιρεία Χειρουργικής Ορθοπαιδικής και Τραυματολογίας
9/5/2014w w w. s h o u l d e r. g r
2. The Shoulder
Greatest Range of Motion in the Body
Motion in all 3 planes of movement
Prone to instability
Sacrifices stability for mobility
3. What is Instability
Biomechanical Dysfunction
Failure of static and dynamic stabilizers
Ranges from mild subluxation to
traumatic dislocation
4. Contributors to stability
Static stabilizers
1. ligamentous structures labrum and
capsule
2. bony configuration of glenoid and
humeral head
Dynamic stabilizers
1. rotator cuff
2. scapula muscles
5. HISTORY
Hippocrates
First described reduction for posterior
dislocation of the shoulder
Sir Astley Cooper
First described posterior dislocation in a patient
with a seizure
Malgaigne
First described a series of 37 patients with
posterior instability in 1855
before the advent of radiology
6. POSTERIOR RESTRAINTS
1. Glenoid (version and shape)
Abnormalities in the glenoid shape and
version has been described as more common
in patients with atraumatic posterior
instability. (Weishaupt,2000).
The greater the retroversion of the glenoid
the more prone it is to posterior dislocation.
7. POSTERIOR RESTRAINTS
2. Capsule
IGHL plays a significant role at the extremes of internal humeral rotation.
Unlike the anterior structures, the posterior capsule is relatively thin with less
clearly defined ligamentous components, especially superiorly above the
equator.
8. POSTERIOR RESTRAINTS
3. Rotator Interval
Plays an important role with the humerus in neutral rotation
Incision of the rotator interval capsule increased posterior translation by 50%
and inferior translations by 100%, suggesting resultant overlap in magnitude
and direction of the various capsular regions to the overall instability pattern
(Harryman, 1992).
9. POSTERIOR RESTRAINTS
4. Labrum
Usually torn in Traumatic dislocations, with the formation of a posterior
Bankart lesion. The importance of the posterior labrum in posterior instability
has been neglected in the past. Since the advent of arthroscopy posterior
labral lesions have been more commonly found and treated.
Recent posterior labral lesions described:
POPSLA lesion – posterior Periosteal Sleeve labral Avulsion
(Yu et al. Skel Radiol. 2002. 31:396-9)
Kim’s Lesion – Incomplete & concealed avulsion posteroinferior labrum
(Kim, 2001)
11. POSTERIOR RESTRAINTS
5. Subscapularis
Blasier et al identified the subscapularis as being the muscle providing the
greatest resistance to posterior subluxation of the humerus
J Bone Joint Surg Am, 1997
12. AETIOLOGY
Traumatic instability
typically follows a distinct history of dislocation or subluxation, sustained
during a significant injury.
Patients with atraumatic instability often have no history of true dislocations,
but on probing there often is a history of minor trauma or repetitive
microtrauma (sports). This is usually associated with capsular laxity
13. Posterior instability
clinical presentation
in forward flexion and internal rotation sometimes
after an anterior repair of a lux shoulder
2. Locked posterior dislocation after acute trauma .
1. Sense of insecurity and feeling of instability
14. Atraumatic posterior instability
clinical presentation
Frank dislocations with minimum violence often reduced by
the patient
Subluxations and positive apprehension sign in forward
flexion and internal rotation in a loose joint individual
usually teenager
Pain and functional impairment in a loose joint individual,
the patient mainly complaining for posterior pain in flexion
internal rotation and not for instability
15. HISTORY
These patients often don’t present with a typical history of true
dislocations
Symptoms of posterior joint pain and/or clicking.
Often this the pain occurs when loading the flexed and internally rotated shoulder.
This can be confused with subacromial impingement
Therefore careful clinical examination is essential.
16. CLINICAL EXAMINATION
It should include all of the followin
Laxity (both the shoulder and general)
Stability
Proprioception
Psychology
18. POSTERIOR DISLOCATION
Much less common than anterior (3-5 %)
May be difficult to diagnose and may often be missed
on up to 50% standard AP view
Electric shock
Seizures
Trauma (alchoholics)
19. MECHANISM OF INJURY
Axial loading of the adducted, internally rotated arm
because the internal rotator muscles are approx twice as powerful as the exernal
rotator muscles, a sudden contraction (such as from a seizure or shock) will cause
the humeral head to dislocate
Involuntary recurrent posterior subluxation may be associated w/ high
forces generated during follow thru phase of various sports activities
this develops as humerus is in adduction, flexion, and internal rotation, & maximal
contractions of subscapularis and deltoid
Voluntary dislocation
Internal rotation – Adduction – Flexion
23. POSTERIOR DISLOCATION
Athletes, such as weight lifters, throwers, racket sport athletes,
rugby players, and swimmers at higher risk.
inherently lax shoulders (advantage for their sports but prone to instability)
repetitive trauma (chronic instability)
25. CLINICAL EXAMINATION
Attempted abduction and external rotation are painful
The arm cannot be externally rotated to a neutral position
There is inability to supinate
Examination may resemble a frozen shoulder, especially
with a chronic, unreduced dislocation
Nerve and vascular injury are not common
32. EVALUATION
Radiographs (AP and axillary views)
CT with 3D reconstruction (bony lesions)
MR Arthrogram
.
Examination under anesthesia and arthroscopy aids the diagnosis, although
one should have most of the information before this.
35. HELPFUL RADIOGRAPHIC SIGNS
Trough line sign
2 parallel lines of cortical bone are seen on
medial cortex of HH, one line is medial
cortex of HH other line is “trough of
impaction fx (reverse Ηill-Sachs) anterior
articular surface of HH
38. DECISION MAKING
If the primary abnormality is found to be
structural (eg. Bankart lesion, bony lesion or
capsular injury) then surgery is often required
early and the rehab follows accordingly
40. POSTERIOR INSTABILITY SURGERY
Soft Tissue Injuries
Soft tissue injuries are much more common than bony.
Posterior Capsulolabral Repair: repair of the soft tissue posterior bony Bankart
lesion, often combined with a capsular shift.
Capsular Shift: A posterior capsular shift may be required for a hyperlax posterior
capsule in the absence of a labral injury
41. POSTERIOR INSTABILITY SURGERY
Bony Injuries
Bony abnormalities are rare, but should always be considered, especially in
patients with failed soft tissue surgery
Subscapularis Transfer
Glenoid Osteotomy: a glenoid retroversion of above 20 degrees should be
considered for glenoid osteotomy.
Posterior Bone Block: This procedure is only considered in extreme cases as a
bony block to posterior translation of the humeral head. High failure rates
42. ARTHROSCOPIC REPAIR
Lower morbidity
Easily assess the entire joint and treat associated pathology
SLAP lesion, Rotator Interval lesions and anterior labral injuries
Easier revision
44. ARTHROSCOPIC REPAIR OF
POSTERIOR INSTABILITY
Arthroscopic repair of posterior dislocation although rare is not
so difficult
The only think needed is just to reverse the portals
59. CONCLUSION
Unidirectional posterior shoulder instability
Is much less common than anterior instability
It should be strongly suspected in those high risk group of
athletes with posterior shoulder pain and/or clicking
The treatment involves a combination of skilled therapy and
surgery for optimal outcome
60. w w w. s h o u l d e r. g r
THANK YOU!
F O R YO U R AT T E N T I O N