AANA/SOMOS Enduring Shoulder Program 2024-Case Presentations: Civilian/Military Cases on Complex Shoulder Instability: Revision, HAGL, Bone Loss, SLAP

Video Transcription

Video Summary

The panel discussed complex shoulder cases, focusing on Hagel lesions, instability, nerve symptoms, and rotator cuff tears, particularly in athletic and military populations. They highlighted the challenges of diagnosing Hagel lesions, especially in hypermobile young athletes, emphasizing the value of MR arthrograms and careful physical exams including scapular assessment and nerve function. Nerve symptoms, common in hypermobile patients, often prompt discussion on the use of nerve conduction studies, with some experts relying more on clinical exams than EMGs.<br /><br />For arthroscopic repairs, posterior Hagel lesions are generally easier to address arthroscopically, while anterior lesions may require mini-open approaches due to anatomical difficulties and nerve risks. Surgical techniques, including portal establishment and suture strategies, were debated, with emphasis on anatomical considerations and knot-tying challenges.<br /><br />Another case involved a middle-aged man with a shoulder dislocation causing rotator cuff tear and glenoid fracture, where the consensus favored prioritizing cuff repair and labral stabilization arthroscopically, with caution about stiffness and open approaches if needed. <br /><br />Lastly, long thoracic nerve injuries causing scapular winging were presented, stressing thorough neck and shoulder exams to avoid misdiagnosis. Surgical tendon transfers (split-pec) were shown to aid recovery after prolonged nerve dysfunction, especially relevant in military and active duty populations. The panel underscored the importance of multidisciplinary care, continued education, cadaver practice, and regional centers of excellence for managing complex, rare shoulder pathologies.

Asset Caption

Moderators: James R. Bailey, M.D., FAANA, Luke S. Oh, M.D.
Panel: William J. Ciccone II, M.D., FAANA, Aaron E. Barrow, M.D., David J. Tennent, M.D., Julie A. Dodds, M.D., Cassandra A. Lee, M.D., Alan L. Zhang, M.D., FAANA, Jessica (J.J.) Ryu, M.D., FAANA

Keywords

Hagel lesions

shoulder instability

nerve symptoms

rotator cuff tears

arthroscopic repair

scapular winging

long thoracic nerve injury

military athletes