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Review
. 2023 May;16(5):201-210.
doi: 10.1007/s12178-023-09833-3. Epub 2023 Apr 17.

Management of Shoulder Instability in Patients with Seizure Disorders

Yousif Atwan  1 , Allen Wang  1 , Joseph T Labrum 4th  1 , Joaquin Sanchez-Sotelo  1 , Jonathan D Barlow  1 , Joshua S Dines  2 , Christopher L Camp  3
Affiliations
Review

Management of Shoulder Instability in Patients with Seizure Disorders

Yousif Atwan et al. Curr Rev Musculoskelet Med. 2023 May.

Abstract

Purpose of review: Patients with seizure disorders commonly suffer shoulder dislocations and subsequent instability. Due to high rates of recurrence and bone loss, management of this instability and associated pathology has proven to be more complex than that of patients without seizure disorders. The ultimate goal of this review is to outline the various treatment modalities and their respective outcomes in this complex patient population.

Recent findings: Optimization of medical management of seizure disorders is imperative. However, despite these efforts, the incidence of post-operative seizure activity continues to be a concern. These subsequent episodes increase the risk of further instability and failure of surgical procedures. Overall, the use of soft tissue procedures has proven to result in increased recurrence of instability compared to bone-block augmenting and grafting procedures. There are a variety of bone-block procedures that have been described for anterior and posterior instability. Despite their success in decreasing further instability, they are associated with several complications that patients should be informed of. There is no consensus regarding the optimal surgical management of shoulder instability in patients with seizure activity. A multidisciplinary approach to the management of the seizure activity is paramount to the success of their treatment. Further studies are required to evaluate the optimal timing and type of surgical intervention for individualized cases.

Keywords: Bone graft; Epilepsy; Seizure; Shoulder; Shoulder dislocation; Shoulder instability.

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Conflict of interest statement

No author has any financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

Figures

Fig. 1
Fig. 1
3D reconstruction of CT scan (two different shoulders) of A isolated scapular view depicting posterior glenoid bone loss. B Isolated humeral reconstruction depicting a Hill-Sachs lesion
Fig. 2
Fig. 2
Steps for preparation of distal tibial allograft. A DTA cut to appropriate dimension per size of glenoid defect. B Glenoid aspirate using a commercially provided device. C After the allograft is cleaned of any marrow remnants, it is soaked with the glenoid aspirate. D Final position and fixation of the DTA to the anterior glenoid defect
Fig. 3
Fig. 3
A Case example of posterior instability with associated posterior glenoid bone deficiency. B Intraoperative image depicting use of DTA that is fixed with fully threaded cortical screws. Postoperative C anteroposterior and D lateral radiographs demonstrating fixation of posteriorly based DTA
Fig. 4
Fig. 4
A Case example of humeral head defect in the setting of recurrent instability. B Intraoperative image depicting extent of humeral defect. C Proximal humeral allograft was utilized, D and the native defect was templated and outlined prior to preparing the graft for fixation to fill the void
See this image and copyright information in PMC

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