Abstract
Background: In the last years, basic research and arthroscopic surgery, have improved our understanding of shoulder anatomy and pathology. It is a fact that arthroscopic treatment of shoulder instability has evolved considerably over the past decades. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases.Methods: A review of the current literature regarding arthroscopic shoulder anatomy, anatomic variants, and arthroscopic findings in anterior shoulder instability, is presented. In addition, correlation of arthroscopic findings with physical examination and advanced imaging (CT and MRI) in order to improve our understanding in anterior shoulder instability pathology is discussed.Results: Shoulder instability represents a broad spectrum of disease and a thorough understanding of the pathoanatomy is the key for a successful treatment of the unstable shoulder. Patients can have a variety of pathologies concomitant with a traditional Bankart lesion, such as injuries of the glenoid (bony Bankart), injuries of the glenoid labrum, superiorly (SLAP) or anteroinferiorly (e.g. anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), and accompanying osseous-cartilage lesions (Hill-Sachs, glenolabral articular disruption). Shoulder arthroscopy allows for a detailed visualization and a dynamic examination of all anatomic structures, identification of pathologic findings, and treatment of all concomitant lesions.Conclusion: Surgeons must be well prepared and understanding the normal anatomy of the glenohumeral joint, including its anatomic variants to seek for the possible pathologic lesions in anterior shoulder instability during shoulder arthroscopy. Patient selection criteria, improved surgical techniques, and implants available have contributed to the enhancement of clinical and functional outcomes to the point that arthroscopic treatment is considered nowadays the standard of care.
Highlights
The glenohumeral joint presents with the greatest range of motion of all joints in the human body, and preservation of its stability is essential to its function [1]
Anterior shoulder instability accounts for 95% of acute traumatic dislocations
There are patients who suffer an initial shoulder dislocation and never experience a second episode of shoulder instability [12] a significant percentage present with recurrent instability that results in morbidity and decreased functionality, in respect to the demands placed on the joint during every day, occupational and athletic activities [12]
Summary
The glenohumeral joint presents with the greatest range of motion of all joints in the human body, and preservation of its stability is essential to its function [1]. The shoulder joint is an inherently unstable ball and-socket joint, and it is susceptible to a variety of injuries This joint has complex anatomy and its stability is conferred by a combination of bone, soft tissue and muscular structures. It is the most commonly dislocated joint, with an overall incidence of approximately 24/100.000 per year [2] and over 90% of dislocations are anteriorly displaced [3]. There are patients who suffer an initial shoulder dislocation and never experience a second episode of shoulder instability [12] a significant percentage present with recurrent instability that results in morbidity and decreased functionality, in respect to the demands placed on the joint during every day, occupational and athletic activities [12]. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases
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