shoulder instability pre-webinar cases

These cases are are to get you to start thinking and questioning your knowledge ahead of the webinar on shoulder dislocation / instability.

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Let’s get straight into it

Case 1 – First time shoulder dislocation – Lennard Funk

A 22 year old male student and amateur weekend rugby player sustained an anterior dislocation tackling another player 1 week ago. His shoulder was relocated off pitch and he was placed in a sling. He comes to see you in fracture clinic. He is desperate to return to rugby. No previous shoulder problems.

X-rays were done after relocation:

What do you see on the x-rays? (you can select more than one option)

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What would next steps be? (you can select more than one option)

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He had an MR Arthrogram:

What do you see on the MRA? (you can select more than one option)

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How would you definitively manage this injury now?

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What would be your indications for surgery? (you can select more than one option)

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When would you consider a bony reconstruction (eg. Latarjet / Eden-Hybinette)? (you can select more than one option)

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See takeaway video below next cast

Case 2 – First time shoulder dislocation – Lennard Funk

A 22 year old male student and amateur weekend rugby player sustained an anterior dislocation tackling another player 1 week ago. His shoulder was relocated off pitch and he was placed in a sling. He comes to see you in fracture clinic. He is desperate to return to rugby. No previous shoulder problems.

X-rays were done after relocation:

What do you see on the x-rays? (you can select more than one option)

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The patient had a CT scan:

What do you see on the CT scan? (you can select more than one option)

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How would you definitively manage this injury?

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When would you allow him to return to rugby? (you can select more than one option)

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Case 3 – recurrent instability – Graham Tytherleigh-Strong

This is a 25-year old female who underwent an arthroscopic Bankart repair for recurrent anterior instability 3 years ago. She had considered her shoulder stable until 1 year ago, when she sustained a documented anterior dislocation whilst playing hockey. She returned to all sports but presents to the clinic having had a further ‘dislocation’ of her shoulder in her sleep. Her shoulder ‘re-located’ in the ambulance.

Does this patient need any further imaging?

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The patient goes on to have a CT scan.

What is the likely cause of the patient’s on-going instability?

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How would you definitively manage this patient?

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Are the metal anchors likely to be of any concern if a revision procedure is considered?

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Case 4 – Gaelic football injury – Hannan Mullett

22 year old sports science masters student who plays Gaelic football (which involves collisions +++!!)

He has had several subluxations following an arthroscopic shoulder stabilisation 2 years ago for presumed anterior instability only.

He reports that it has never been 100% since then and feels that the shoulder is stiff.

On examination there is restricted external rotation to 40 degrees Vs 80 on the good side. Rotator cuff has good strength. There is mid range apprehension, with positive relocation sign. O’briens and modified O’Briends are positive.

what would you do now?

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His buddy is a MRI technician and gets him scanned to see what’s going on:

MRA scans

what do you think is going on?

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You decide to do an EUA and a shoulder arthroscopy. On EUA he is stiff (external rotation to 40 degrees), with grade II anterior and posterior instability. Pictures below:

what would you do now?

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Webinar

Please post your thoughts about these cases in the comments section below.

For the answers to these questions and much more join our webinar this week, Wednesday 24th October at 8pm BST.

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