Owens, J Bone Joint Surg Am 2010 - Pathoanatomy of First-Time, Traumatic, Anterior Glenohumeral Subluxation Events

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Pathoanatomy of First-Time, Traumatic, Anterior Glenohumeral Subluxation Events

Owens, DeBerardino, et al.·J Bone Joint Surg Am·2010·178 citations

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Owens and colleagues described the lesions found after first‑time traumatic anterior subluxation of the shoulder and proposed a third type of instability event, the transient luxation.

One academic year (2004 to 2005) of prospective tracking among 4141 West Point cadets. 27 of 38 first‑time subluxations had MRI within 2 weeks.

Labral injury would be common after a first‑time traumatic anterior subluxation.

Key Findings

MRI showed a Bankart lesion in 26 of 27 shoulders (20 soft‑tissue, 6 osseous) and a Hill‑Sachs lesion in 25 of 27. Labral detachments with intact periosteum were counted as Bankart tears.
Plain radiographs showed far fewer lesions: 3 osseous Bankart lesions (11%) and 2 Hill‑Sachs lesions (7%).
Of the 14 patients who had arthroscopy, 13 had a Bankart lesion. The other had labral cracking and scuffing without a frank avulsion.
Only 7 MRI Hill‑Sachs lesions were confirmed at surgery (2 osteochondral, 5 chondral). The authors suggest MRI was showing bone edema or bruising.
Of 13 patients who declined surgery, 4 had recurrent instability and 2 were lost to follow‑up. The study was not designed to define natural history.

Authors' conclusion

First-time, traumatic, anterior subluxation events result in a high rate of labral and Hill-Sachs lesions. These findings suggest that clinical subluxation events encompass a broad spectrum of incomplete events, including complete separations of the articular surfaces with spontaneous reduction. A high index of suspicion for this injury in young athletes is warranted, and magnetic resonance imaging may reveal a high rate of pathologic changes, suggesting that a complete, transient luxation of the glenohumeral joint has occurred.

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|

Pathoanatomy of First-Time, Traumatic, Anterior Glenohumeral Subluxation Events

Owens, DeBerardino, et al.·J Bone Joint Surg Am·2010·178 citations

|||

Owens and colleagues described the lesions found after first‑time traumatic anterior subluxation of the shoulder and proposed a third type of instability event, the transient luxation.

One academic year (2004 to 2005) of prospective tracking among 4141 West Point cadets. 27 of 38 first‑time subluxations had MRI within 2 weeks.

Labral injury would be common after a first‑time traumatic anterior subluxation.

Key Findings

MRI showed a Bankart lesion in 26 of 27 shoulders (20 soft‑tissue, 6 osseous) and a Hill‑Sachs lesion in 25 of 27. Labral detachments with intact periosteum were counted as Bankart tears.
Plain radiographs showed far fewer lesions: 3 osseous Bankart lesions (11%) and 2 Hill‑Sachs lesions (7%).
Of the 14 patients who had arthroscopy, 13 had a Bankart lesion. The other had labral cracking and scuffing without a frank avulsion.
Only 7 MRI Hill‑Sachs lesions were confirmed at surgery (2 osteochondral, 5 chondral). The authors suggest MRI was showing bone edema or bruising.
Of 13 patients who declined surgery, 4 had recurrent instability and 2 were lost to follow‑up. The study was not designed to define natural history.

Authors' conclusion

First-time, traumatic, anterior subluxation events result in a high rate of labral and Hill-Sachs lesions. These findings suggest that clinical subluxation events encompass a broad spectrum of incomplete events, including complete separations of the articular surfaces with spontaneous reduction. A high index of suspicion for this injury in young athletes is warranted, and magnetic resonance imaging may reveal a high rate of pathologic changes, suggesting that a complete, transient luxation of the glenohumeral joint has occurred.

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