Complex Posterior Glenohumeral Instability Case Management

Abstract

A 21-year-old male patient suffering from insidious shoulder instability from neurogenic and structural attenuation of shoulder stabilizer, due to old minor cerebrovascular accident, presented with a two-year history of repetitive shoulder dislocation, operated by fixing the biceps tendon to its insertion on the superior labrum, correction of the glenoid version and reattaching the subscapular tendon along with a new technique for stabilization of the shoulder replicating the coracohumeral ligament with a ligament advanced reinforcement system (LARS) transplant. Following structured physical therapy, our patient returned to normal daily activities at 15 months.

Keywords: coracohumeral ligament; glenohumeral joint; labrum; posterior shoulder instability; surgical technique.

Figure 1. Standard X-ray showing an absence of congruence of the glenohumeral joint upon abduction of the arm

Figure 2. MRI scan showing a significant reverse Bankart lesion with a loose subscapularis tendon

Figure 3. CT scan showing glenoid dysplasia with a loss of posteroinferior concavity with 28 degrees of retroversion

Figure 4. X-rays showing posterior dislocation of the right shoulder 15 days after the intervention.

Figure 5. CT scan showing the tunnel drilled in the humeral head to pass the transplant

Figure 6. Image showing the LARS transplant passing through the humeral head drilled tunnel

A) LARS transplant, B) humeral head LARS - ligament advanced reinforcement system

Figure 7. Image showing the LARS transplant tied around the conjoint tendon

A) detached subscapularis tendon, B) conjoint tendon LARS - ligament advanced reinforcement system

Figure 8. X-ray showing a congruent shoulder joint