AANA Lab Course 912 - Arthroscopic Shoulder Solutions-Instability Case-Based Presentations_ First-time Traumatic Anterior Instability, Recurrent Anterior Instability With Bone Loss All Master Faculty; Moderator

Instability Case-Based Presentations_ First-time Traumatic Anterior Instability, Recurrent Anterior Instability With Bone Loss All Master Faculty; Moderator_ Larry D. Field, M.D.

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This document presents a series of five clinical case studies on shoulder instability by Dr. Larry D. Field, MD, focusing on diagnosis, imaging, treatment options, and outcomes for various types of shoulder instability, including anterior, posterior, and combined lesions.<br /><br />Case #1 discusses a 22-year-old male with recurrent anterior shoulder dislocations and a Bankart lesion with bone loss and engaging Hill-Sachs lesion. Treatment options include arthroscopic labroligamentous mobilization, remplissage, rotator interval plication, and revision procedures such as open Latarjet after arthroscopic failure. Postoperative instability and the use of MRI and 3D CT for evaluation are highlighted.<br /><br />Case #2 features a 22-year-old with a reverse bony Bankart lesion after a fall, presenting with posterior shoulder pain and subluxations. Non-operative therapy was ineffective, leading to surgical recommendations. Management of posterior bony Bankart lesions emphasizes preservation using techniques like double-row fixation and transosseous fixation.<br /><br />Case #3 involves a 20-year-old football player with recurrent posterior instability, multiple dislocations, and associated lesions. Arthroscopic posterior stabilization and novel methods like “reverse remplissage” with subscapularis advancement showed good functional outcomes and return to sports.<br /><br />Case #4 covers a college tennis player with complex combined posterior inferior instability, possible SLAP lesion, and capsular insufficiency. Clinical exam challenges for SLAP diagnosis are noted, with emphasis on multimodal evaluation and the limitations of common provocative tests. Treatment includes initial physical therapy followed by arthroscopic surgery if symptoms persist.<br /><br />Case #5 describes a 40-year-old with recurrent anterior instability and a glenoid rim fracture after previous shoulder stabilization. Challenges of anchor placement and risks leading to fractures are discussed, along with options for fracture fixation or revision stabilization.<br /><br />Overall, the cases underscore the importance of individualized diagnostic work-ups, including MRI and CT imaging, tailored surgical approaches (arthroscopic vs open), and careful consideration of bone loss and associated lesions to optimize outcomes in shoulder instability patients.

Keywords

shoulder instability

anterior shoulder dislocation

Bankart lesion

Hill-Sachs lesion

posterior shoulder instability

arthroscopic stabilization

Latarjet procedure

SLAP lesion

MRI and 3D CT imaging

rotator interval plication