Post instability walton
This document discusses the arthroscopic management of posterior shoulder instability. It finds that posterior instability is more common than traditionally estimated, occurring in 17-35% of shoulder stabilization surgeries especially among contact athletes like rugby players. Posterior instability often presents with anterior instability symptoms, weakness, or cuff pain. Assessment involves special tests like the modified O'Brien's test. MR arthrogram can diagnose isolated anterior or posterior labral tears but has lower accuracy for combined lesions. Key steps of arthroscopic management include utilizing proper portal placement and angles, addressing reverse Hill-Sachs lesions, and specialized post-op rehabilitation involving the kinetic chain and rotator cuff. Bone loss increases risk of failure so it must also be addressed.
Post instability walton
- 1. Arthroscopic Management of Posterior Instability Mike Walton @mrmikewalton mikewalton@shoulderdoc.co.uk Santander 2015
- 2. How Common is it? • Traditional estimates of posterior instability were 2-5% • Often discussed with atraumatic and MDI • Our practice seemed to be very different • High volume of athletes Am J Sports Med. 2011 Apr;39(4):874-86. doi: 10.1177/0363546510384232. Posterior instability of the shoulder: diagnosis and management. Provencher MT1, LeClere LE, King S, McDonald LS, Frank RM, Mologne TS, Ghodadra NS, Romeo AA
- 3. How Common is it? • 3 Surgeons, 3 years • 442 shoulder arthroscopic stabilisations • Specialist Shoulder practice • Mean age 26, 87% Male
- 4. How Common is it? • 75% Sporting Population (Recreational to Elite) • 48% Isolated Anterior, 17% Isolated Posterior • 35% Combined Lesions • Non-Sporting population older with 68.5% isolated anterior labral tear
- 5. How Common is it? • RUGBY (n=231) • 53% Posterior labral lesion (13% Posterior, 40% combined lesions) • If you treat these patient you MUST be able to treat this lesion.
- 7. Presentation • Anterior instability • Occasionally posterior dislocations • Subluxation episodes • WEAKNESS • CUFF PAIN
- 8. Assessment Lewis A, Kitmura T & Bayley JIL.The classification of shoulder instability: new light through old windows! Current Orthopaedics, 2004; 18(2):97-108.
- 10. Modified O’Briens Test • Forward Elevation to 90 • Adduction / Internal Rotation • Pain - SLAP • WEAKNESS - Post Instability
- 11. Modified O’Briens Test • Posterior Translation occurs in simulated Active Compression Test J Shoulder Elbow Surg. 2013 Mar;22(3):365-74. doi: 10.1016/j.jse.2012.02.003. Epub 2012 May 19. Glenohumeral contact pressure in a simulated active compression test using cadaveric shoulders. Lin T1, Javidan P, McGarry MH, Gonzalez-Lomas G, Limpisvasti O, Lee TQ.
- 12. Investigations • MR Arthrogram • Accurate for isolated anterior and posterior lesions (78.5%, 69%) • Accuracy ONLY 37% in combined lesions
- 14. Sitting or Spoons DONT FORGET THE EUA
- 20. If the angle is wrong..
- 21. Reverse HAGL
- 22. Reverse HAGL
- 23. Reverse HAGL
- 27. Rehabilitation • External Rotation brace 2 weeks • Highly specialist physiotherapy • More Atraumatic - More Physio • Kinetic Chain and Cuff Rehabiliation
- 28. Failures and Bone Loss
- 29. Failures and Bone Loss