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What is a bankart lesion? When does it commonly occur? What is a bankart fracture?
- -Detachment of the anterior glenoid labrum
- -85% incidence in anterior dislocations
- -Break off piece of glenoid
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What is a Hill-Sachs lesion?
When does it commonly occur?
- -Compression fracture or depression defect to the postero-superior aspect of the humeral head
- -Often occurs with anterior dislocation and accompanied Bankart lesion
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Signs/symptoms of anterior dislocation
- -Loss of rounded shoulder contour
- -Prominent acromion
- -Arm held locked in abd, slight ER
- -All mvmts limited and painful
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Jobe's four P's of Rehab
- 1) GH PROTECTORS: infra, teres minor, subscap, supra
- 2) Scapular PIVOTERS: traps, serratus, levator, rhomboids
- 3) Humeral POSITIONERS: Deltoid
- 4) Humeral PROPELLERS: Lats and pecs
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Arthroscopic Bankart Procedure
- -reattachment of capsule and/or labrum to glenoid rim
- -if no rotator cuff tightening then shoulder ROM should not be affected
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Capsular shift
- -Inferior capsular pouch tightened with an anterior repair if there is anterior/inferior instability
- -Good results in athletes
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Thermal Capsulorraphy
- -Thermal capsular "shrinking"
- -Use lasers to heat lax joint capsule and cause collagen to shrink in length which tightens capsule
- -Not suitable for hypermobile pts
- -Long term outcomes not as good
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Bristow
- -Transfer of coracoid (with conjoined tendons of biceps and coracobrachialis)
- -Antero-medial restraint of shoulder
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Putti-Platt
Subscapularis shortening
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Magnuson-Stack
Transfer subscapularis tendon lateral to bicipital groove
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Half Moon Sign
What does its absence indicate?
- normal sign: medial border overlaps with glenoid fossa
- -absence indicates post dislocation
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When might you see a reverse Hill-Sachs lesion?
- -After a posterior shoulder dislocation
- -(on anterior aspect of humerus)
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