Abstract
Recurrent shoulder instability and resultant glenoid and humeral head bone loss are not infrequently encountered in the population today, specifically in young, athletic patients. This review on the management of bone loss in recurrent glenohumeral instability discusses the relevant shoulder anatomy that provides stability to the shoulder joint, relevant history and physical examination findings pertinent to recurrent shoulder instability, and the proper radiological imaging choices in its workup. Operative treatments that can be used to treat both glenoid and humeral head bone loss are outlined. These include coracoid transfer procedures and allograft/autograft reconstruction at the glenoid, as well as humeral head disimpaction/humeroplasty, remplissage, humeral osseous allograft reconstruction, rotational osteotomy, partial humeral head arthroplasty, and hemiarthroplasty on the humeral side. Clinical outcomes studies reporting general results of these techniques are highlighted.
Highlights
Glenohumeral instability is a common orthopaedic problem that affects a significant number of young, active patients, with anterior instability having a reported prevalence as high as 2% [1]
The purpose of this review is to provide a brief overview of the anatomy of the glenohumeral joint relevant to its stability and to illustrate the pertinent history and physical examination findings in patients with bone loss and recurrent shoulder instability
Recurrent glenohumeral instability is a difficult orthopaedic problem that requires specific history and physical examination to delineate whether bony deficiency may be the root of the problem
Summary
Glenohumeral instability is a common orthopaedic problem that affects a significant number of young, active patients, with anterior instability having a reported prevalence as high as 2% [1]. In symptomatic recurrent glenohumeral instability, advanced imaging techniques are strongly recommended before proceeding to surgery in order to quantify glenohumeral bone loss, including defect size and location [2]. While nonoperative treatment options are available, surgical treatment is often the gold-standard of the therapeutic options for both glenoid and humeral head bone loss when significant bony defects exist [3]. The purpose of this review is to provide a brief overview of the anatomy of the glenohumeral joint relevant to its stability (and instability) and to illustrate the pertinent history and physical examination findings in patients with bone loss and recurrent shoulder instability. Imaging options in the workup and management of this patient population are discussed and both nonoperative and operative treatment options are described, including surgical treatment options for bone loss at both the glenoid rim and the humeral head. Numerous outcome studies are discussed in the evaluation of the efficacy of these relevant surgical procedures
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