Assessment of Bone Loss in the Shoulder

Abstract

The accurate identification and quantification of both glenoid bone loss and the presence of a Hill-Sachs lesion is essential in the setting of anterior shoulder instability as it directly dictates patient outcomes. The ability to diagnose and address these potential osseous defects of the glenohumeral joint based on patient history, physical exam, and the findings of various imaging modalities in a clinical setting is fundamental to the overall success of a surgeon's treatment algorithm. Multiple methods exist to quantify bone loss based on diagnostic imaging or arthroscopy, and the surgeon should be mindful of the respective pearls and pitfalls of each imaging modality and their ability to accurately diagnose shoulder bone loss. Pertinent findings in a patient's history such as age, level of activity, enlistment status, and events of recurrent anterior glenohumeral instability can help one not only predict the presence of bone loss, but the location and size of the defect as well. Furthermore, symptoms and signs of chronic instability along with accurate quantification of glenoid bone loss are essential in the algorithm of selecting the correct surgical procedure to provide optimal stabilization and maximize clinical outcomes.