Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-128  Left shoulder, anterosuperolateral viewing portal. Hill-Sachs lesion is visible as calibrated probe is used to measure glenoid bone loss. The glenoid radius (R) is shown to be 15 mm, so the anterior bone loss is 5 mm since the length from the bare spot to the anterior glenoid rim is only 10 mm.

FIGURE 3-130  The width of the bone bridge between the posterior cuff attachments and the Hill-Sachs lesion (H-S) is found to span three probe tips: 3 × 4 mm = 12 mm. G, glenoid.

■ Determining if the Hill-Sachs lesion is on track of off track . ■ HSI = 24, and GT = 19.9. ■ Since HSI > GT, the Hill-Sachs lesion is off track and will require arthroscopic remplissage in addition to arthroscopic Bankart repair (Fig. 3-131). The Cowboy’s Conundrum: First- time Dislocation in a 37-year-old Law Enforcement Officer; Bankart Lesion and SLAP Lesion Both Are Present The Surgeon’s Solution: Arthroscopic Bankart Repair, SLAP Repair, and Repair of SGHL History: ■ A 37-year-old SWAT team officer dislocated the right shoulder during a conditioning drill at work. Closed reduction was performed within 15 minutes. ■ Patient has tried to resume his very demanding job as an SWAT team officer, but says that he “cannot trust the shoulder.” Physical Exam: ■ Positive O’Brien test ■ Positive O’Driscoll test (Mayo shear test) ■ Positive apprehension in abduction and external rotation

■ In this case, HS = 12 mm and BB = 12 mm, with each one equal to 3 diameters of the tip of the cali-

brated probe (Figs. 3-129 and 3-130). ■ Therefore, HSI = 12 + 12 = 24 mm.

Video 3-22

FIGURE 3-129  The width of the Hill-Sachs lesion is measured sequentially by the 4-mm tip of the probe. The Hill-Sachs lesion has a width equal to three probe tips: 3 × 4 = 12 mm. G, glenoid.