American Shoulder and Elbow Surgeons
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An athlete has recurrent anterior shoulder instability despite non-operative treatment including PT and bracing. He is noted to have anterior glenoid bone loss and a coracoid transfer (Latarjet) procedure is recommended. This is believed to improve stability through which of the following mechanism(s)?
Increasing the glenoid bony support and excursion distance prior to dislocation.
The conjoined tendon passing through the subscapularis becomes a supportive sling.
Answers 1, 2 and 5 are correct.
Both 1 and 2 are correct.
The remnant of the CA ligament can be used to aid in repair of the capsular tissues.
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What factor has highest risk for recurrent instability following a traumatic anterior shoulder dislocation?
History of contralateral shoulder dislocation
Young age (<25-years-old) at time of dislocation
Dislocation of the dominant shoulder
Family history of shoulder instability
History of patella instability
What is the most common finding during surgery for traumatic anterior shoulder instability?
Anterosuperior labral tear
Anteroinferior labral tear
Posterosuperior labral tear
Posteroinferior labral tear
Hill Sachs lesion
Open anterior shoulder stabilization procedures have failed twice for an active 22-year-old patient. Most recently he had another episode of instability when reaching into the back seat while driving. He has weakness performing the physical exam maneuver shown in Figure A. Images from his MRI are shown in Figures B and C. What is the most appropriate next surgical treatment?
Another course of physical therapy
Lesser tuberosity transfer
Pectoralis major transfer
Latissimus dorsi transfer
A 23-year-old man acutely dislocates his shoulder for the first time while kayaking. His shoulder MRI is shown in Figures A and B. He undergoes arthroscopic Bankart repair and re-dislocates his shoulder within 1 month after surgery. What other pathology, besides the Bankart lesion, is likely contributing to this patient's recurrent instability?
Superior labrum anterior posterior (SLAP) tear
Supraspinatus partial articular sided tendon avulsion (PASTA)
Humeral avulsion of the glenohumeral ligament (HAGL)
Engaging (>25%) Hill Sachs defect
Anterior labral periosteal sleeve avulsion (ALPSA)
A 38-year-old former professional football player complains of longstanding left shoulder pain. He admits to multiple previous shoulder dislocations in the past which were treated conservatively with physical therapy. He now complains of symptoms of repetitive instability and a "catching" feeling whenever he abducts and externally rotates his arm. On physical exam he has a positive apprehension test and crepitus in the 90/90 position. A current MRI image of his shoulder is seen in Figure A. Which of the following surgical treatments is most appropriate to address his symptoms?
Superior labrum anterior to posterior (SLAP) repair
Open approach for bone grafting of humeral defect with allograft
Open repair of humeral avulsion of glenohumeral ligament (HAGL) lesion
Arthroscopic Bankart repair and Remplissage procedure
A 17-year-old football player sustained an injury to his shoulder. The MRI images are seen in Figures A and B. What is the most likely finding seen at the time of arthroscopy?
Rotator cuff tear
Humeral avulsion of glenohumeral ligaments (HAGL)
Which patient would be ideal for an open shoulder reduction and glenoid bone augmentation?
25-year-old with first time acute traumatic dislocation
78-year-old with a rotator cuff tear arthropathy with superior escape
24-year-old with chronic dislocation and large engaging Hill-Sachs lesion
30-year-old with an acute bony Bankart fracture-dislocation
27-year-old with a chronic anterior dislocation and inverted pear-shaped glenoid
A patient undergoes an MRI arthrogram for recurrent shoulder instability. Based on the imaging, the surgeon feels that arthroscopic treatment is contra-indicated and recommends open treatment. What is the most likely diagnosis?
Glenolabral articular disruption (GLAD)
Humeral avulsion of the glenohumeral ligament (HAGL)
Superior labrum tear from anterior and posterior (SLAP)
Anterior labro-ligamentous periosteal sleeve avulsion (ALPSA)
Partial articular-sided supraspinatus tendon avulsion (PASTA)
A 23-year-old offensive lineman had an arthroscopic anteroinferior labral repair 1 year ago for shoulder instability. He has continued to have recurrent instability. Below is the preoperative MRI from 1 year ago. What is the most likely cause of the recurrent instability?
Anteroinferior labral nonunion
Unrecognized humeral avulsion of the glenohumeral ligament (HAGL)
Anteroinferior glenoid bone defect
Engaging Hill Sachs defect
Untreated SLAP lesion
What nerve is the most frequently injured in the condition shown in the radiograph?
The pathology seen in Figure A is most likely to result from trauma that occurred with the shoulder in which of the following positions?
Adduction, internal rotation
Adduction, external rotation
Abduction, external rotation
Extension, internal rotation
Axial traction in adduction
A 22-year-old collegiate football player has immediate onset of left shoulder pain after a tackle. He reports a history of multiple subluxations in the past, but this is the first time he had to "pop" his shoulder back into place. On examination 3 days later, he has weakness in the deltoid. CT axial image is displayed in Figure A. Which of the following is the MOST appropriate next step in management.
Humeral avulsion of the glenohumeral ligament (HAGL lesion) stabilization and EMG/NCV studies
Immobilization in sling with external rotation and EMG/NCV studies
Anterior labral periosteal sleeve avulsion (ALPSA) stabilization
Bony Bankart lesion stabilization
Transfer of the infraspinatus tendon and greater tuberosity to the humeral head
A 24-year-old male gymnast is scheduled for arthroscopic repair of the right shoulder. His preoperative MRI is seen in Figure A and the initial arthroscopic examination as viewed from an anterior portal in the lateral decubitus position is demonstrated in Figure B. Based on these images, which of the following diagnoses is correct?
Partial articular sided thickness rotator cuff tear (PASTA)
Glenoid labral articular defect (GLAD)
Superior labral anterior posterior lesion (SLAP)
A 21-year-old rugby player has recurrent pain and instability of the right shoulder recalcitrant to conservative management. Figure A is an image taken during diagnostic arthroscopy in the lateral decubitus position viewing from the posterior portal with instrument through a rotator interval anterior portal. In addition to the pathology seen in Figure A, what other associated intra-articular condition is most likely present?
Posterior labral tear
An 18-year-old football player sustains an anterior shoulder dislocation that is reduced on the field. When he presents to the office complaining of posterior pain, you suspect a Hill-Sachs defect. Which of the following is the best radiographic view for identifying a Hill-Sachs defect?
A 22-year-old basketball player has recurrent instability of the left shoulder. Magnetic resonance imaging is shown in Figures A and B. Which of the following ligaments is injured?
A 25-year-old basketball player sustains an anterior shoulder dislocation during a game that is subsequently reduced with traction. A MRI will most likely show which of the following?
Humeral avulsion of the glenohumeral ligaments
Long head of the biceps tear
Superior labrum anterior to posterior tear
A 19-year-old right hand dominant male high school wide receiver complains of recurrent right shoulder subluxation. Clinical examination is remarkable for a postive apprehension sign and a positive sulcus sign. A T2 coronal MRI is shown below in Figure A. What is the diagnosis?
A patient sustains the injury seen on the radiograph in Figure A. Which nerve is most likely to be injured?
Upper or lower subscapular
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HPI - A 21-y/o RHD male c/o recurrent left shoulder instability. He reports ~20 instability events (all self-reduced) prior to arthroscopic Prior Bankart repair + remplissage. Now 9 months s/p stabilization, he reports recurrent instability that began ~5 months post-op. Now reports instability while sleeping. He has taken a medical leave from college due to symptoms.
He plays golf, soccer, and basketball.
How would you treat this patient?
HPI - 33 yr old with traumatic initial dislocation about a year ago. Passed out and shoulder hit a dresser. Was reduced in ER. Since then has been managed non op by other surgeons. Has had about 7 dislocations since almost all of them have to be reduced under sedation bc of engaging hill sachs. Presents to me after seeing two other orthopods.
After reviewing images it seems there is a large engaging hill sachs. The anterior glenoid rim is without large bony bankart. MRI does show labral tearing.
I believe this needs surgical fixation. My question is how to address the engaging hill sachs. Will remplissage be enough or should I be thinking about allograft / bony procedure?
Thank you in advance for the input and advice.
How would you address the instability?
HPI - Patient was involved in a car accident 1 year ago with severe head injury, coma for 1 month, neglected humeral head fracture for 10 months, underwent open rotator cuff repair 2 months ago.
How would you treat the patient at this time (P1 images above)?