Controversies In The Surgical Management Of Shoulder Instability: Associated Soft Tissue Procedures.

Santos Moros Marco,Miguel Angel Ruiz Ibán,José Luis Ávila Lafuente,Jorge Diaz Heredia

doi:10.2174/1874325001711010989

Abstract

Background:The glenohumeral joint is a ball-and-socket joint that is inherently unstable and thus, susceptible to dislocation. The traditional and most common anatomic finding is the Bankart lesion (anterior-inferior capsule labral complex avulsion), but there is a wide variety of anatomic alterations that can cause shoulder instability or may be present as a concomitant injury or in combination, including bone loss (glenoid or humeral head), complex capsule-labral tears, rotator cuff tears, Kim´s lesions (injuries to the posterior-inferior labrum) and rotator interval pathology.Methods:A review of articles related to shoulder anatomy and soft tissue procedures that are performed during shoulder instability arthroscopic management was conducted by querying the Pubmed database and conclusions and controversies regarding this injury were exposed.Results:Due to the complex anatomy of the shoulder and the large range of movement of this joint, a wide variety of anatomic injuries and conditions can lead to shoulder instability, specially present in young population. Recognizing and treating all of them including Bankart repair, capsule-labral plicatures, SLAP repair, circumferential approach to pan-labral lesions, rotator interval closure, rotator cuff injuries and HAGL lesion repair is crucial to achieve the goal of a stable, full range of movement and not painful joint.Conclusion:Physicians must be familiarized with all the lesions involved in shoulder instability, and should be able to recognize and subsequently treat them to achieve the goal of a stable non-painful shoulder. Unrecognized or not treated lesions may result in recurrence of instability episodes and pain while overuse of some of the techniques previously described can lead to stiffness, thus the importance of an accurate diagnosis and treatment when facing a shoulder instability.

Highlights

The shoulder is the least constrained [1] and most mobile of all the joints in the human body and preservation of its stability is crucial to its function [2]
The glenohumeral joint stability relies on a complex combination of static and dynamic stabilizers [4] and compromise of these structures can lead to dislocation and often, recurrent instability
The aim of this article is to make a review of the soft tissue injuries that are present in shoulder instability, the procedures performed to address them during surgery and the controversies around this issue

Summary

Introduction

The shoulder is the least constrained [1] and most mobile of all the joints in the human body and preservation of its stability is crucial to its function [2]. The bony architecture of the glenohumeral joint is often associated to a ball-andsocket geometry This shape provides a large arc of motion, and an inherent instability that can result in shoulder dislocations. The mechanisms and structures that confer static stability to the glenohumeral joint include bone architecture, negative intra-articular pressure, glenoid labrum, glenohumeral ligaments around the joint and coracohumeral ligament [5]. The traditional and most common anatomic finding is the Bankart lesion (anterior-inferior capsule labral complex avulsion), but there is a wide variety of anatomic alterations that can cause shoulder instability or may be present as a concomitant injury or in combination, including bone loss (glenoid or humeral head), complex capsule-labral tears, rotator cuff tears, Kims lesions (injuries to the posterior-inferior labrum) and rotator interval pathology

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Results

Conclusion