Shoulder: Anatomy and Instability

Recurrent Shoulder Instability: Current Concepts for Evaluation and Management of Glenoid Bone Loss

Provencher MT, Bhatia S, Ghodadra NS, et al (Naval Med Ctr San Diego, CA; Rush Univ Med Ctr, Chicago, IL) J Bone Joint Surg Am 92:133-151, 2010^§

Abstract

Background

The most common cause of recurrent instability of the glenohumeral joint is a Bankart tear, which is a soft tissue injury of the glenoid labrum attachment. Often osseous injury of the glenoid and humeral head is also found. The integrity of the osseous architecture of the glenoid is a vital component in the success of surgical repair. Glenoid bone deficiency with recurrent shoulder instability is a recognized cause of failed shoulder stabilization surgery. All patients with recurrent shoulder instability should be assessed for the presence of osseous injuries to the glenoid. This includes obtaining a complete history, performing a thorough physical examination, and diagnosing and quantifying any anterior glenoid deficiency. Appropriate preoperative imaging is essential for detecting and quantifying osseous abnormalities in patients with recurrent shoulder stability. The surgical approach can then be determined. The principles guiding surgical management include the extent of osseous deficiencies, consideration of the combined glenoid and humeral bone defects, the surgeon’s personal experience with specific reconstructive techniques, and patient-specific factors such as work and athletic demands. Techniques for soft-tissue stabilization, type and orientation of the glenoid bone graft, and treatment of accompanying pathologic conditions must be considered to obtain a well-functioning shoulder joint after repair.

Diagnosis

Patients must provide a thorough orthopedic history. Glenoid bone loss should be suspected when the patient suffered a high-energy injury, especially if the arm was abducted 70° or more and extended 30° or more when initially dislocated. Shoulder instability that occurs within the range of 20° to 60° of abduction is also indicative of glenoid bone loss. Patients may report that it is gradually easier to subluxate the glenohumeral joint and report a long history of shoulder instability or coping with instability. Other shoulder disorders must also be considered.

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