AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Case Presentation-Grant E. Garrigues, M.D.

Case Presentation-Grant E. Garrigues, M.D.

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Dr. Grant Garrigues presented a case of bilateral posterior shoulder instability in a 45-year-old right-hand dominant male with epilepsy who experienced a grand mal seizure. The patient was initially scheduled for staged posterior labral repairs but presented to the ER with both upper extremities locked in internal rotation after the seizure. Attempts to reduce the dislocations were made in the ER; post-reduction radiographs were inconclusive, prompting CT imaging, which revealed a right locked posterior fracture-dislocation and a left reduced shoulder with a large reverse Hill-Sachs lesion.<br /><br />The key clinical question focused on management strategies to prevent engagement of the reverse Hill-Sachs lesion and thus recurrent instability. Treatment options include immobilization, posterior labral/bony Bankart repair, posterior glenoid bone block, anterior humeral osteoarticular allograft, acute defect reduction and bone grafting, reverse remplissage, modified McLaughlin procedure, hemiarthroplasty, and reverse total shoulder arthroplasty, tailored by patient factors such as chronicity and presence of arthritis.<br /><br />The right shoulder was treated with acute defect reduction and bone grafting, while the left shoulder underwent surgical intervention with devices from DJO. Follow-up showed excellent outcomes with no pain, full strength, symmetric range of motion, absence of further dislocations, and the patient’s return to work with high satisfaction.<br /><br />The case highlighted the importance of obtaining axial imaging promptly in acute posterior instability cases, awareness of options to address reverse Hill-Sachs lesions, and consideration of arthroplasty for patients with pre-existing arthritis or chronic instability with rotator cuff deficiency. Acute bone grafting is highly effective in these scenarios.<br /><br />Dr. Garrigues emphasized individualized treatment decisions and reminded clinicians not to overlook arthroplasty options in patients with complex pathology.

Keywords

bilateral posterior shoulder instability

grand mal seizure

reverse Hill-Sachs lesion

posterior labral repair

posterior glenoid bone block

acute defect reduction

bone grafting

reverse remplissage

modified McLaughlin procedure

shoulder arthroplasty