ACR Index: 4.4
Anterior glenohumeral dislocation is more common (95%) than posterior glenohumeral dislocation (5%). Anterior dislocation results from abduction, external rotation, and extension forces at the glenohumeral joint. The humeral head assumes a position inferior and medial to the glenoid. As the humeral head dislocates and contacts the glenoid, the posterosuperior aspect of the humeral head can undergo impaction injury, resulting in a cortical contour deformity called a Hill-Sachs lesion. The anteroinferior portion of the glenoid is a second common location of impaction injury during anterior glenohumeral dislocation, and a contour deformity at this location is termed an osseous Bankart lesion (see reference 2). The classic Bankart lesion is a soft tissue avulsion injury of the inferior glenohumeral ligament/labral complex (3). It should be noted that inferior and lateral displacement of the humeral head with respect to the glenoid is not a true dislocation and, as such, is called a psuedodislocation of the glenohumeral joint. Pseudodislocation most commonly represents a space-occupying hemarthrosis occurring secondary to a fracture of the humeral head or neck (2). The conservative treatment of anterior dislocation involves reduction followed by immobilization with or without rehabilitation. However, recurrent dislocation is not uncommon, and one author has reported a decreased incidence of recurrences in patients treated with early arthroscopic repair of Bankart lesions (3). Another group from Keller Army Hospital in West Point, New York, recommends acute operative stabilization in the following situations: (1) initial dislocation which requires a reduction, (2) young (<25 years old) and athletic patient who cannot modify his/her lifestyle, (3) patients without prior history of shoulder subluxation or impingement syndrome, (4) patients without signs of neurologic compromise, and (5) patients without a fracture of the greater tuberosity (see reference 1). |