Shoulder Dislocation Associated Lesions - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describing lesions associated with anterior shoulder dislocation.

Shoulder dislocation may occur in association with different presentation and pathology. We need to identify the different lesions that can be seen during shoulder dislocations, specifically the anterior shoulder dislocation. Anterior shoulder dislocation is more common than posterior shoulder dislocation. There is a high incidence of recurrence in the young. There is a high incidence of rotator cuff tear in the elderly. Some percentage of patients may have axillary nerve palsy.
Two lesions that may be present with an anterior shoulder dislocation are bankart lesion (labrum) and the hill-sachs lesion (humeral head).
Different scenarios association with an anterior shoulder dislocation:
Bankart Lesion:
• Avulsion of the anterior inferior labrum
• Present in about 90% of traumatic shoulder dislocations
Rotator cuff tears may occur in 80% of individuals older than 60 years old with anterior shoulder dislocation.
Axillary Nerve Injury:
• The patient may not be able to raise the arm after shoulder dislocation which may occur in about 5% of the time
• This may also cause inability to raise the may due to rotator cuff tear, especially in older patients
• Check the sensation over the shoulder area (axillary nerve injury)
HAGL Lesion:
• Humeral avulsion of the glenohumeral ligament
• The ligament becomes avulsed at the insertion at the humerus, and not at the mid substance or glenoid area
• It may be hard to diagnose this lesion and some believe that an open surgical procedure is better
Hill-Sachs Lesion:
• Humeral compression fracture in the posterolateral aspect of the humeral head which is present in about80% of anterior shoulder dislocations
• May also be seen as edema in the posterolateral aspect of the humeral head
ALPSA:
• Medial displacement of the glenohumeral ligament (medialized Bankart lesion)
Recurrence of anterior shoulder dislocation after surgery:
• Occurs in over 65% of patients because the lesion is not addressed
• What is the lesion? Bony defect of the scapula
Glad lesion is a tear of the anterior inferior labrum (nondisplaced) with avulsion of the adjacent glenoid cartilage. In case of a GLAD lesion, you will find the anterior inferior labrum is detached with an associated glenoid chondral defect. This lesion results from impaction of the humeral head against the glenoid. The patient will complain of persistent shoulder pain but no instability. In the GLAD lesion, the labrum is not detached and there is no capsular stripping.

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