Glenohumeral dislocation. Injury patterns and combination injuries

Flückiger, R.; Raniga, S.; Moor, B. K.; Zumstein, M. A. (2015). Glenohumeral dislocation. Injury patterns and combination injuries. Arthroskopie, 28(4), pp. 292-300. Springer 10.1007/s00142-015-0039-9

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Background

Almost 90 % of first time shoulder dislocations are associated with other injuries involving the glenohumeral joint complex. It is important to make an accurate diagnosis even if this does not always influence the choice of an appropriate therapy.
Content

In the acute setting it is imperative that X-ray imaging is performed before and after repositioning in at least two planes, i.e. anteroposterior (AP), Neer and if possible axial views. Fracture dislocations must not be overlooked as repositioning maneuvers can lead to secondary displacement or complete displacement of a fracture. If there is any evidence of an unstable glenoid fracture, humeral fracture or combined osseous lesions, they should be immediately treated with open reduction and internal fixation. Patients with an incongruent glenohumeral articulation or who suffer from recurrent instability require a surgical intervention. In recurrent shoulder instability with evidence of osseous lesions arthrography computed tomography (arthro-CT) is the most valuable investigation. Injuries to the capsulolabral complex and rotator cuff can be diagnosed with this modality but arthrography magnetic resonance imaging (arthro-MRI) can provide greater details with respect to rotator cuff lesions.
Discussion

Acute large or massive rotator cuff lesions require semi-urgent repair. Off-track Hill-Sachs lesions with medial extension should be addressed with a remplissage or bone grafting. The long-term results of a Latarjet procedure at 25-year follow-up showed a very low redislocation rate (< 4 %), good external rotation, very high patient satisfaction and a rate of degenerative changes comparable with the natural development of first time shoulder dislocations without recurrent instability.

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