Baker and colleagues arthroscoped young shoulders within days of a first anterior dislocation to classify the intra‑articular lesions and see which might lead to recurrence.
Preliminary series of 45 first‑time traumatic dislocators aged 14 to 28, arthroscoped 1 to 10 days after injury (mean 3.5).
Key Findings
The most common pattern, in 28 of 45 shoulders (group 3), was complete detachment of the labrum with the inferior glenohumeral ligament. All 28 were grossly unstable under anesthesia.
Six shoulders in group 1 tore the capsule but not the labrum and were stable under anesthesia with minimal hemarthrosis.
Group 2, 11 shoulders, had partial labral detachments with varying anterior instability, most of them subluxating under anesthesia.
In group 3 the detached labrum left a subperiosteal pouch along the anterior scapular neck, and the humeral head could be seen dislocating into it.
Hill‑Sachs lesions were found in 18 of the 28 group 3 shoulders, ranging from moderate indentations to subchondral defects.
No recurrence data were reported. The authors believe lesion type, with age and the force of injury, predisposes to recurrence, but this series did not test it.
Authors' conclusion
We now believe that the age of the patient at the time of initial dislocation, the force of dislocation, and the type of initial traumatic lesion combine to predispose the shoulder to recurrent dislocation.
Baker and colleagues arthroscoped young shoulders within days of a first anterior dislocation to classify the intra‑articular lesions and see which might lead to recurrence.
Preliminary series of 45 first‑time traumatic dislocators aged 14 to 28, arthroscoped 1 to 10 days after injury (mean 3.5).
Key Findings
The most common pattern, in 28 of 45 shoulders (group 3), was complete detachment of the labrum with the inferior glenohumeral ligament. All 28 were grossly unstable under anesthesia.
Six shoulders in group 1 tore the capsule but not the labrum and were stable under anesthesia with minimal hemarthrosis.
Group 2, 11 shoulders, had partial labral detachments with varying anterior instability, most of them subluxating under anesthesia.
In group 3 the detached labrum left a subperiosteal pouch along the anterior scapular neck, and the humeral head could be seen dislocating into it.
Hill‑Sachs lesions were found in 18 of the 28 group 3 shoulders, ranging from moderate indentations to subchondral defects.
No recurrence data were reported. The authors believe lesion type, with age and the force of injury, predisposes to recurrence, but this series did not test it.
Authors' conclusion
We now believe that the age of the patient at the time of initial dislocation, the force of dislocation, and the type of initial traumatic lesion combine to predispose the shoulder to recurrent dislocation.