Anterior Instability of the Shoulder

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- Discussion:  
    - ON THE ARTICULATIONS. by Hippocrates.
    - pathoanatomy:
            - bankart lesion
            - hill sachs lesion
            - stabilizers of the shoulder:
                   - dynamic / muscular stabilizers:
                   - static stabilizers
                   - anteroinferior glenohumeral ligament: 
            - references:
                   - Pathoanatomy of first-time, traumatic, anterior glenohumeral subluxation events. 
    - mechanism of anterior dislocations:
            - combination of abduction, extension, and a posteriorly directed force applied to the arm;
            - humeral head is driven anteriorly, tearing shoulder capsule, detaching labrum from glenoid, and
               producing a compression frx of humeral head;
            - arm position during the traumatic episode leads to variations of anterior dislocation:
            - associated injuries:
            - references:
                  - Mechanisms of glenohumeral joint stability.
                  - Lesions in different types of anterior glenohumeral joint dislocation. An experimental study.
    - classification of anterior dislocation:
            - chronic unreduced dislocations:
            - fracture dislocation:
            - multidirectional instability:
            - recurrent anterior instability: 
    - natural history: 

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- Physical Exam: 
    - associated injuries; 

- Radiographic Studies:
    - Apical Oblique View
    - Axillary View
    - Hill Sachs Lesion
    - True AP - (35 deg oblique to the body)
    - Transscapular View 
    - Stryker Notch view for picking up a Hill Sachs;
    - West Point Axillary View: 
         - osseous bankart defect on anteroinferior glenoid rim;  
    - discussion:
              - common radiographic changes seen following anterior dislocations, include Hill Sachs lesion                 calcification along the antero-inferior aspect of the glenoid rim (or fracture of the glenoid rim);
              - additional findings include fracture, erosion, blunting of the anterior glenoid rim;

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- Initial Treatment of Dislocation:
    - work up for shoulder dislocation:
    - reduction methods: 



- Non Operative Treatment: 
    - natural history: 
    - may be indicated for patients w/ multidirectional instability       for voluntary instability, for posterior glenohumeral instability,
      & for those who need a supranormal ROM - such as base ball pitchers;
    - references: ;
            - Immobilization after primary dislocation of the shoulder. 
            - Treatment of instability of the shoulder with an exercise program. 
            - Conservative treatment of fractures and fracture-dislocations of the upper end of the humerus. 
            - Treatment of primary anterior shoulder dislocation in patients older than 40 years of age. 
            - Immobilization in External Rotation After Shoulder Dislocation Reduces the Risk of Recurrenc.
              A Randomized Controlled Trial
            - Redislocation of the Shoulder During the First Six Weeks After a Primary Anterior Dislocation:
              Risk Factors and Results of Treatment 
            - Conservative therapy of antero-inferior glenoid fractures
            - Position and Duration of Immobilization After Primary Anterior Shoulder Dislocation

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- Surgical Treatment:
    - Open Anterior Shoulder Reconstruction: (anterior approach to shoulder):
    - Arthroscopic Shoulder Reconstruction: