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Algorithm for 1st time dislocator (i.e. 19y.o. hockey player)
1. 4/52 sling (gunslinger best – 30deg. ER)
2. back to season
3. post-season – re-examine (N.B. apprehension sign)
if apprehension +ve, do arth. bankart + capsular shift –> 4-6/12 until return to sport
if apprehension -ve, continue non-operative management.
Increased risk of failure of Bankart repair
3 factors
1. capsular laxity
2. collision athletes
3. too few anchors — n.b. multiple anchors, multiple points of fixation (n.b. most below equator)
Elderly dislocated shoulder — n.b. n/v exam (brach. pexus + 2nd part of axillary artery)
Glenoid defect –> inverted pear (lose >1/3 of glenoid) –> ++ recurrence (?64% incr)
NB special views:
stryker notch = hand on forehead = look for Hill-Sachs
west point = look for bankart
one pearl in instability surgery is to convert an engagig Hill-Sachs lesion to a non-engaging Hill-sachs
— can do this by widening gelnoid, tightening capsule, or filling defect.
For further study:
“remplissage” – l.wolfe
ask sauder about load and shift test mechanics.
when to close rotator interval — burkhart says if sulcus +ve at 90deg ER (for AMBRI)
pearls – labrum detached below equator = pathology
above equator could be normal variant.
posterior instability – flexion and IR — think offensive lineman
40 y.o. 1st time dislocator — think cuff
70 y.o 1st time dislocator — think fracture, n/v injury, cuff tear
–> n.b. pulses different but still present d/t ++ collateral flow
—> look up vascular supply around shoulder
