Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct;15(5):369-376.
doi: 10.1007/s12178-022-09773-4. Epub 2022 Jul 5.

Assessing Bone Loss in the Unstable Shoulder: a Scoping Review

Kyle Gouveia  1 , Syed Fayyaz H Rizvi  2 , Danielle Dagher  3 , Timothy Leroux  4 , Asheesh Bedi  5 , Moin Khan  6
Affiliations

Assessing Bone Loss in the Unstable Shoulder: a Scoping Review

Kyle Gouveia et al. Curr Rev Musculoskelet Med. 2022 Oct.

Abstract

Purpose of review: The aim of this scoping review is to identify and summarize findings published in the literature over the past 5 years related to methods for assessment of bone loss in anterior shoulder instability.

Recent findings: Of the 113 clinical studies included in this review, 76 reported a cutoff for glenoid bone loss when determining the patients indicated for one of the many stabilization procedures investigated. Bone loss on the glenoid side was evaluated most commonly with three-dimensional computed tomography (3D CT), and either linear or surface area-based methods were employed with the use of a best-fit circle. When combined with plain CT, the two methods comprise up to 70% of the reported measurement techniques for glenoid bone loss (79 of 113 studies). On the humeral side, Hill-Sachs lesions were assessed more heterogeneously, though plain CT or 3D CT remained the methods of choice in the majority of studies (43 of 68, 63.2%). Lastly, the glenoid track was assessed by 27 of 113 studies (23.9%), again most commonly with 3D CT (13 studies) and plain CT (seven studies). The assessment of glenoid and humeral bone loss is essential to treatment decisions for patient with recurrent anterior shoulder instability. Glenoid bone loss is most commonly assessed using cross-sectional imaging, most often 3D CT, and some variation of a best-fit circle applied to the inferior portion of the glenoid. Hill-Sachs lesion assessment was also commonly done using three-dimensional imaging; however, there was more variability in assessment methods across studies and there is an obvious need to unify the approach to humeral bone loss assessment for the purposes of improving treatment decisions and to better assess on-track and off-track lesions.

Keywords: Bipolar bone loss; Glenoid bone loss; Glenoid track; Hill-Sachs lesion; Shoulder instability.

PubMed Disclaimer

Conflict of interest statement

The authors declare no existing conflicts of interest.

Figures

Fig. 1
Fig. 1
Included studies by year of publication. *2022 up to search date (Feb 2022)
Fig. 2
Fig. 2
Included studies by location. Modalities used for the assessment of glenoid bone loss in clinical studies
See this image and copyright information in PMC

References

    1. Cutts S, Prempeh M, Drew S. Anterior shoulder disloctation. Ann R Coll Surg Engl. 2009;91:2–7. doi: 10.1308/003588409X359123. - DOI - PMC - PubMed
    1. Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Jt Surg - Ser A. 2010;92:542–549. doi: 10.2106/JBJS.I.00450. - DOI - PubMed
    1. Pougès C, Hardy A, Vervoort T, Amouyel T, Duriez P, Lalanne C, Szymanski C, Deken V, Chantelot C, Upex P, Maynou C. Arthroscopic Bankart repair versus immobilization for first episode of anterior shoulder dislocation before the age of 25: a randomized controlled trial. Am J Sports Med. 2021;49:1166–1174. doi: 10.1177/0363546521996381. - DOI - PubMed
    1. Leroux T, Wasserstein D, Veillette C, Khoshbin A, Henry P, Chahal J, Austin P, Mahomed N, Ogilvie-Harris D (2014) Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario, Canada. Am J Sports Med 42:442–450. Describes the epidemiology of anterior shoulder instability in a Canadian population. - PubMed
    1. Vermeiren J, Handelberg F, Casteleyn PP, Opdecam P. The rate of recurrence of traumatic anterior dislocation of the shoulder - a study of 154 cases and a review of the literature. Int Orthop. 1993;17:337–341. doi: 10.1007/BF00180449. - DOI - PubMed

Publication types