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Treatment of ant. Shoulder instability

Treatment of ant. Shoulder instability. M.N. Naderi. Shoulder Joint Stabilizers. Mobility Stability . Bony anatomy Glenoid labrum Joint capsule Rotator cuff muscles Glenoid version Negative intraarticular pressure Synchronous mobility of the scapula and humeral head.

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Treatment of ant. Shoulder instability

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  1. Treatment of ant. Shoulder instability M.N. Naderi

  2. Shoulder Joint Stabilizers Mobility Stability • Bony anatomy • Glenoid labrum • Joint capsule • Rotator cuff muscles • Glenoid version • Negative intraarticular pressure • Synchronous mobility of the scapula and humeral head

  3. Polar Type I TraumaticStructural Less MusclePatterning Polar Type III Polar Type II Muscle PatterningNon-Structural AtraumaticStructural Less Trauma Stanmore Classification (Bayley Triangle) Lewis, Kitamura & BayleyCurrent Orthopaedics. 18:97-108. 2004

  4. Operative Treatment of Anterior Shoulder Instability Soft tissue procedures: • Subscapularis Muscle Procedures (Putti-Platt , Magnuson-Stack ) • Bankart Procedure • Capsular Reconstruction (Neer capsular shift) Bony procedures: • Coracoid Transfer (Bristow-Latarjet Procedure) • Osteotomy of the Proximal Humerus (Weber rotational osteotomy) • Bone Block (Eden-Hybbinette Procedure ) • Osteotomy of the Neck of the Glenoid

  5. Soft tissue procedures: Subscapularis Muscle Procedures • Not correcting a labral or capsular defect • Restriction of ER

  6. Soft tissue procedures: Bankart Procedure • gold standard • recurrence rates from 3% to 10% • Open or arthroscopic

  7. Soft tissue procedures: Capsular Reconstruction (Neer capsular shift) • Procedure for multidirectional instability • Correct loose ,redundant inf. pouch

  8. Osteotomy of the Proximal Humerus (Weber subcapital osteotomy) Bony procedures: • increased the humeral head retroversion • Indicated in posterolateral humeral head defect • Requirement for second operation for plate removal

  9. Coracoid Transfer(Bristow-Latarjet Procedure) Bony procedures: • Not correcting a labral or capsular defect • Restriction of ER • Possibility of musculocutaneus N. damage • Decrease of IR power • Osteoarthritis

  10. Osteotomy of the Neck of the Glenoid Change the glenoid version posterior closing-wedge or anterior opening-wedge osteotomy too hazardous Bony procedures:

  11. Bone Block (Eden-Hybbinette Procedure) Extend the anterior glenoid by iliac graft Postoperative degenerative change J-Span plasty / Resch Bony procedures:

  12. Burkhart SS, DeBeer JF. Arthroscopy 16:677, 2000.)

  13. Burkhart SS, DeBeer JF. Arthroscopy 16:677, 2000.)

  14. Engaging Hill-Sachs Lesion Remplissage

  15. Conclusion • Treatment in shoulder instability? • Oriented in anatomy : • Bankart lesion  Repair • Bone loss  Bone graft • Capsular redundancy  Capsular shift, close rotator interval • Cuff rupture  Repair

  16. Large Bankart Lesion Bony Bankart Large Hill-Sachs Associated Lesions Consider Bony Procedure Repair all coexisting lesions Capsular Laxity Small Bankart Tear Small Hill-Sachs Address capsular laxity Summary Polar Type Itraumatic structural Polar Type III Muscle patterning Non-structural Polar Type II Atraumatic Structural Thank you for attention

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