Chronic recurrent shoulder instability treated with a hemiarthroplasty, Glenojet allograft glenoid reconstruction, and anterior capsular reconstruction: a case report

Abstract

Shoulder instability is a relatively common orthopedic condition with a variety of treatment options. Patients with chronic instability due to recurrent seizures are particularly difficult to treat due to bone loss and high recurrences of shoulder dislocations. Our report describes a rare case of chronic shoulder instability in a patient experiencing recurrent tonic-clonic seizures that was successfully treated with hemiarthroplasty, a Glenojet allograft bone block glenoid reconstruction, and an anterior capsular reconstruction. A 36-year-old male presented with complaints of chronic right shoulder pain and instability secondary to numerous shoulder dislocations occurring during epilepsy-induced tonic-clonic seizures. He was experiencing significant functional limitations due to subsequent glenohumeral arthritis. Imaging demonstrated a large Hill-Sachs deformity of the right humeral head and a chronic malunited bony Bankart fragment with end-stage glenohumeral posttraumatic arthritis. He was initially treated with conservative measures with minimal improvement and ultimately underwent operative intervention. His procedure included a right shoulder hemiarthroplasty, biceps tenodesis, allograft glenoid reconstruction, and anterior capsular reconstruction. The patient recovered his range of motion, experienced reduced pain, and despite continued seizures his shoulder has remained stable without additional instability. Chronic instability of the shoulder can be difficult to treat. Our case study indicates that patients with instability may be successfully treated using hemiarthroplasty, biceps tenodesis, Glenojet allograft glenoid reconstruction, and anterior capsular reconstruction. Our patient continues to do well in the postoperative period and demonstrates minimal pain, improved range of motion, and no subsequent shoulder dislocations.