Abos - Shoulder And Humerus:shoulder:pathologic States: Shoulder Dislocation, Instability, & Management

Front 1

If a manual reduction of an anterior shoulder dislocation is required, one should also evaluate for what associated injury?

Back 1

Bankart lesion

Front 2

What are the two components of the ideal position for shoulder immobilization after reduction?

Back 2

Adduction
External rotation

Front 3

What is an important consideration when deciding duration of immobilization in an adult?

Back 3

Shoulder stiffness

Front 4

What is the most common complication associated with dislocation in a patient <2O years old?

Back 4

Recurrence

Front 5

What are the three most commoncomplications in patients >4O years old?

Back 5

35% associated rotator cuff tear 10 to 15% recurrence 8% axillary nerve palsy

Front 6

Among adolescents, recurrent instability is likely a consequence of what two associated injuries?

Back 6

Bankart lesion
Disrupted anterior band of inferior glenohumeral ligament complex (IGHLC)

Front 7

Among adults, what is the likely cause of recurrent instability after dislocation?

Back 7

Humeral avulsion of glenohumeral ligament (I-IAGL) lesion

Front 8

Among the elderly, what is the likely cause of recurrent instability?

Back 8

Rotator cuff tear

Front 9

With this fracture-dislocation, what post-reduction view should be obtained?

Back 9

Axillary view

Front 10

What are the indications for operative treatment of greater tuberosity fracture in the general population and in the overhead athlete?

Back 10

General population: >5 mm
displacement
Overhead athlete: consider surgery if >3 mm because of impingement risk

Front 11

lf the greater tuberosity is too osteopenic for screw Hxation, what is the preferred alternative?

Back 11

Nonabsorbable sutures passed through fracture fragment and rotator cuff tendon

Front 12

If greater tuberosity is displaced >1 cm, what injury may also be present?

Back 12

Rotator cuff tear

Front 13

At what location does this injury generally occur?

Back 13

Near the rotator interval

Front 14

What are the two clinical
consequences of an incompetent rotator interval?

Back 14

Isolated rotator interval tear: posteroinferior instability Large rotator interval tear with another cuff tear: superior head migration

Front 15

What is the preferred treatment for rotator interval injury with greater tuberosity fracture?

Back 15

Suture closure at the time of surgery
One to three sutures placed from lateral to medial

Front 16

What arc the two clinical consequences of a tight rotator interval?

Back 16

Decreased inferior translation
Decreased posterior translation

Front 17

What is the most commonly reported complication of operative treatment of if a greater tuberosity fracture associated with shoulder dislocation?

Back 17

Subacromial scarring

Front 18

What are the four reported advantages of arthroscopic treatment over open surgical techniques?

Back 18

Increased postoperative external rotation
Decreased postoperative pain
Decreased morbidity
Improved cosmesis

Front 19

What has been the classic advantage of open treatment?

Back 19

Decreased recurrence
Recent work suggests techniques approaching equivalence

Front 20

What are the two possible late complications of open treatment?

Back 20

Subscapularis detachment
Bicipital subluxation

Front 21

A closed reduction is very unlikely to be successful after how many weeks of
dislocation?

Back 21

3

Front 22

What is the treatment of Hill-Sachs lesion involving <25% articular surface at the time of open reduction?

Back 22

Often do not require treatment
lf shoulder remains unstable after reduction, perform infraspinatus transfer

Front 23

What are the three options for a Hill—Sachs lesion involving 25 to 50% of the articular surface?

Back 23

Disimpaction with bone grafting injury <3 weeks old, good bone stock)
Allograft reconstruction (injury 3 or more weeks old, good bone stock)
Arthroplasty (poor bone stock or cartilage wear)

Front 24

What is the option for a Hill-Sachs lesion if over 50% of the articular cartilage is involved?

Back 24

Arthroplasty

Front 25

Patients with what two anatomic characteristics are particularly likely to benefit from open and/or nonanatomic repair?

Back 25

Engaging Hill—Sachs lesio
Inverted—pear—shaped glenoid

Front 26

What are the two major components of the differential diagnosis for posterior shoulder pain?

Back 26

Posterior instability
Internal impingement

Front 27

How can internal rotation be used to help differentiate between the two conditions?

Back 27

Increased internal rotation: posterior instabili
Decreased internal rotation: posterior (internal) impingement

Front 28

What two patient populations are classically at risk for posterior instability?

Back 28

Football linemen
Patients with seizure disorders

Front 29

What is the characteristic

Back 29

Posterior labral detachment
intraarticular finding in these
patients?

Front 30

A closed reduction is very unlikely to be successful after how many weeks?

Back 30

4

Front 31

What is the treatment of a reverse Hill-Sachs lesion involving <20% articular surface?

Back 31

Often does not require treatment
lf treatment necessary, consider subscapularis tendon transfer

Front 32

What are the two components of the treatment of a reverse Hill—Sachs lesion involving 20 to 40% of the articular option surface?

Back 32

Lesser tuberosity transfer
Disimpaction grafting may be an if injury <3 weeks and good bone stock

Front 33

What is the treatment of a reverse Hill—Sachs lesion involving 40-50% of
articular surface?

Back 33

Allograft reconstruction

Front 34

What is the treatment of a reverse Hill-Sachs lesion involving >50% articular surface?

Back 34

Hemiarthoplasty or total shoulder if glenoid degenerative changes are
present

Front 35

What is the preferred position for postoperative immobilization? Why?

Back 35

Slight external rotation/extension
Relieves posterior capsular tension

Front 36

What is the preferred rehabilitation approach for multidirectional instability or scapular dyskinesis?

Back 36

Closed kinetic chain strengthening

Front 37

What are the effects of thermal capsulorraphy on cell number?

Back 37

Decreased

Front 38

What are the effects of thermal capsulorraphy on tissue length?

Back 38

Shortened

Front 39

What are the effects of thermal capsulorraphy on stiffness?

Back 39

Decreased

Front 40

What are the effects of thermal capsulorraphy after 1 month?

Back 40

Scar and new collagen form

Front 41

How has this affected treatment?

Back 41

Thermal capsulorraphy is no longer routinely used in the treatment of instability