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Review
. 2020 Nov 13;5(11):815-827.
doi: 10.1302/2058-5241.5.200049. eCollection 2020 Nov.

Clinical and radiological examination of bony-mediated shoulder instability

Jakub Stefaniak  1   2 , Przemyslaw Lubiatowski  2 , Anna Maria Kubicka  3 , Anna Wawrzyniak  2 , Joanna Wałecka  2 , Leszek Romanowski  1
Affiliations
Review

Clinical and radiological examination of bony-mediated shoulder instability

Jakub Stefaniak et al. EFORT Open Rev. .

Abstract

The coexistence of glenoid and humeral head bone defects may increase the risk of recurrence of instability after soft tissue repair.Revealed factors in medical history such as male gender, younger age of dislocation, an increasing number of dislocations, contact sports, and manual work or epilepsy may increase the recurrence rate of instability.In physical examination, positive bony apprehension test, catching and crepitations in shoulder movement may suggest osseous deficiency.Anteroposterior and axial views allow for the detection of particular bony lesions in patients with recurrent anterior shoulder instability.Computed Tomography (CT) with multiplanar reconstruction (MPR) and various types of 3D rendering in 2D (quasi-3D-CT) and 3D (true-3D-CT) space allows not only detection of glenoid and humeral bone defects but most of all their quantification and relations (engaging/not-engaging and on-track/off-track) in the context of bipolar lesion.Magnetic resonance imaging (MRI) is increasingly developing and can provide an equally accurate measurement tool for bone assessment, avoiding radiation exposure for the patient. Cite this article: EFORT Open Rev 2020;5:815-827. DOI: 10.1302/2058-5241.5.200049.

Keywords: Hill–Sachs lesion; glenoid bone loss; glenoid track; shoulder instability.

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Conflict of interest statement

ICMJE Conflict of interest statement: PL reports board membership of the Rehasport Clinic, employment by Rehasport Clinic, University of Medical Sciences, payment for lectures including service on speakers’ bureaus from Smith&Nephew and Arthrex, payment for development of educational presentations from Smith&Nephew and is an Associate Editor of EFORT Open Reviews, all outside the submitted work. The other authors declare no conflict of interest relevant to this work.

Figures

Fig. 1
Fig. 1
Radiography: shoulder in AP view with external (a) and internal (b) rotation.
Fig. 2
Fig. 2
Radiography: shoulder in AP view (a) and axial view (b), white arrow – displaced osseous fragment.
Fig. 3
Fig. 3
(a) 2D-CT with multiplanar reconstruction (2D-CT–MPR); (b) quasi-3D-CT; (c) true-3D-CT.
Fig. 4
Fig. 4
Best-fit circle method presented by Sugaya et al (b/A x100%); (a) A – area of best-fit circle; b –area of displaced osseous fragment; (b) A – diameter of best-fit circle; b – bone defect width.
Fig. 5
Fig. 5
Pico method developed by Baudi et al (b/Ax100%; b – area of defect; A –area of best-fit circle (of the contralateral glenoid) on 2D-CT with multiplanar reconstruction (MPR) (a) and quasi-3D-CT (5b).
Fig. 6
Fig. 6
Gerber’s index; A – diameter of best-fit circle; B – anterior glenoid bone defect length.
Fig. 7
Fig. 7
Glenoid index (A/Bx100%) A – diameter of injured glenoid; B –diameter of intact (contralateral) glenoid; (2D-CT–MPR).
Fig. 8
Fig. 8
Barchillon et al.; d/R d – depth from the centre of the best-fit circle to the edge of the glenoid; R – radius of best-fit circle on 2D-CT–MPR (a) and quasi-3D-CT (b).
Fig. 9
Fig. 9
Humeral head measurements of Hill–Sachs lesion (HSL); (a) a – best-fit circle, d – HSL depth, b – HSL width; (b) HSL orientation, the clock face, e, e’ – medial and lateral margins of HSL; (c) HSL location, b – HSL width, b’ – HSL length.
Fig. 10
Fig. 10
Hill–Sachs angle; A – axis of the deepest groove of the Hill–Sachs; B- longitudinal axis of humeral shaft.
Fig. 11
Fig. 11
On-track/off-track measurements; (a) R- line of medial margin of rotator cuff attachments; G2 – line of medial margin of glenoid track of affected shoulder; G1 – line of medial margin of glenoid track of intact shoulder; HIS – Hill–Sachs Interval; BB – bone bridge; d – width of anterior glenoid bone defect; GTaf – width of glenoid track of affected shoulder; GTint – width of glenoid track of intact shoulder; (b) D – width of intact glenoid; d – width of glenoid bone defect.
Fig. 12
Fig. 12
Algorithmic approach to clinical and radiological evaluation of bone deficiency in shoulder instability.
See this image and copyright information in PMC

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