Recurrent instability management

Principles of treatment



 structural instability - traumatic or atraumatic

                   operative management

  non-structural instability - muscles patterning

                 non -operative management


Structural abnormality

  Anatomical repair

         Bankart repair

             reattachment of bankart lesion to margin of glenoid by open or arhtroscopic technique



          if Hill-sach lesion , transfer infraspinatus to fill defect to prevent redislocation


 Non anatomical repairs

           Laterjet procedure

                coracoid transfer to anterior glenoid rim with conjoined tendon

            Magnuson -stock - advancement of subscsapularis

           Putti - Platt - imbrication and shortening of subscapularis

            Glenoid or humeral osteotomies - if there's excessive anteversion of GH joint.


Strucutral posterior instability

            Reverse Bankart procedure and capsular shift

            Reverse Putti-platt

           
            Boyd-sisk -transfer of long head of biceps to posterior glenoid

             
            Reverse Hill  Sachs - transfer of subscapularis to lesser tuberosity


Non structural instability and muscle patterning

            multidisciplinary approach

             EMG

            muscle patterning , exercises ,endurance , co-ordination



 
       













 












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