Historical
Edwin Smith Papyrus; tomfb of Upuy; Hippocrates
Humeral Head defect – (i.e. Hill-Sachs lesion) described as groove between the articular head and greater tuberosity (posterolaterally)
Anterior Capsule and Muscle Defects – capsule laxity (dePalermo 1967)
Anterior labral detachment (Bankart)
detachment of subscap, variance in inf. GHL (Reeves & Townley)
Cuff injuries
rupture of posterolateral cuff
fractures of humeral head and glenoid rim
Reduction techniques
Hippocratic – heel ACROSS axilla
Kocher – levering humeral head in (n.b. nobel prize 1909)
Milch – ABD / Er, anterior pressure
scapular manipulation
gravity method (?Stimson)
Operative reconstructions for anterior instability
Perthes (1909) – repair the underlying lesion (capsule, labrum, Rot. cuff)
Deltoid sling myoplasty — high recurrence rate.
Bankart – repair of labrum and plication of capsule.
Posterior Glenohumeral Instability
epileptic, pain > anterior, ER impeded, no elevation, anterior flatness & posterior fullness, reverse hill-sachs lesion
Malgaigne (1855) classic article – with physical exam dx can be made.
