Abstract
Traumatic anterior instability is the most common instability of the shoulder. Although Bankart and Hill-Sachs lesions are the most common pathology, capsulolabral tear can develop in other areas of the joint. While controversy remains regarding the initial first-time instability, early surgical stabilization is strongly recommended in active young patients who have a substantial high risk of recurrence. Currently, arthroscopic repair is a popular procedure and provides successful results. Suture anchors, especially bioabsorbable suture anchors, are most commonly used for capsulolabral repairs. A large bone loss at the glenoid or humeral head can be replaced with a bone graft. Distinct from multidirectional hyperlaxity, which is characterized by asymptomatic translation, multidirectional instability has symptoms related to increased translations. In asymptomatic multidirectional hyperlaxity, the increased capsular ligamentous laxity is the underlying initial pathology. However, repetitive subluxation overloads the posteroinferior glenoid labrum by excessive rim-loading of the humeral head. This excessive rim-loading eventually develops a posteroinferior labral lesion, which is an essential lesion that develops shoulder symptoms. During this stage, the shoulder pain originates from the labral lesion when the humeral head glides over the pathologic labrum. Four types of labral lesion have been reported. Kim’s lesion is a concealed and incomplete tear of the posteroinferior labrum characterized by loss of labral height and retroversion, marginal crack, and looseness of the deep portion of the labrum. The retroversion of the glenoid labrum decreases the containment function of the glenohumeral joint, which further increases the instability.
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Kim, SH. (2015). Shoulder Instability. In: Doral, M., Karlsson, J. (eds) Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36801-1_21-1
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DOI: https://doi.org/10.1007/978-3-642-36801-1_21-1
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