12 d’abr. 2015

Arthroscopic Treatment of Suprascapular Neuropathy from a Suprascapular Notch Cyst  Using a Lateral Subacromial Approach

Based on an original article: J Shoulder Elbow Surg. 2011 Sept;20(6):975-82.


Primary anterior dislocation glenohumeral joint adolescence


The natural history of primary anterior dislocation of the glenohumeral joint in adolescent
patients remains unclear and there is no consensus for management of these patients.
The objectives of this study were to report the natural history of primary anterior
dislocation of the glenohumeral joint in adolescent patients and to identify the risk factors
for recurrent dislocation.
We reviewed prospectively-collected clinical and radiological data on 133 adolescent
patients diagnosed with a primary anterior dislocation of the glenohumeral joint who had
been managed non-operatively at our hospital between 1996 and 2008. There were 115 male
(86.5%) and 18 female patients (13.5%) with a mean age of 16.3 years (13 to 18) and a mean
follow-up of 95.2 months (1 to 215).
During follow-up, 102 (absolute incidence of 76.7%) patients had a recurrent dislocation.
The median interval between primary and recurrent dislocation was ten months (95% CI 7.4 to
12.6). Applying survival analysis the likelihood of having a stable shoulder one year after the
initial injury was 59% (95% CI 51.2 to 66.8), 38% (95% CI 30.2 to 45.8%) after two years, 21%
(95% CI 13.2 to 28.8) after five years, and 7% (95% CI 1.1 to 12.9) after ten years. Neither age
nor gender significantly predicted recurrent dislocation during follow-up.

We conclude that adolescent patients with a primary anterior dislocation of the
glenohumeral joint have a high rate of recurrent dislocation, which usually occurs within
two years of their initial injury: these patients should be considered for early operative
stabilisation.

Arthroplasty in Posterior Glenoid Bone Loss

Shoulder Arthroplasty in the Presence of Posterior Glenoid Bone Loss
Current Concepts Review

Chronic osteoarthritis of the glenohumeral joint, traumatic injury, post-reconstruction arthropathy, and developmental conditions such as glenoid dysplasia can result in posterior glenoid bone loss and excessive retroversion of the glenoid. Shoulder replacement in this setting is technically challenging and characterized by higher rates of complications and revisions.

Current options that should be considered for managing glenoid bone loss that results in >15 of retroversion include bone-grafting, augmented glenoid components, and reverse total shoulder replacement.

Asymmetric reaming is commonly used to improve version but should be limited to correction of 10 to 15 of retroversion in order to preserve subchondral bone.

Bone-grafting of glenoid defects has had mixed results and has been associated with graft-related complications, periprosthetic radiolucencies, and glenoid component failure; however, it provides a biologic option for patients with severe bone loss.

Implantation of an augmented polyethylene glenoid component offers the potential to improve version while preserving subchondral bone, but the procedure is technically demanding and without clinical follow-up data at this point.

Reverse total shoulder arthroplasty offers improved fixation and stability compared with an anatomic prosthesis for elderly patients with severe glenoid bone loss but is associated with a high complication rate.

 Glenoid dysplasia is defined as a deformity that results in >25 of glenoid retroversion. Advanced imaging needs to be obtained in order to ensure enough glenoid bone stock is present to allow anatomic glenoid component placement.

Interessant.