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Inestabilidad de Hombro

Instability and Degenerative Arthritis of the Sternoclavicular Joint

Injuries to the sternoclavicular (SC) joint are uncommon, and typically occur from high intensity impact. The SC joint is located between the proximal end of the clavicle and the clavicular notch of the sternum. Injuries to the SC joint can be treated non-operatively. However, surgical treatment may be indicated for locked posterior dislocations; symptomatic, chronic instability; or persistent, painful osteoarthritis that fails non-operative therapy.

Through the PubMed database this study analyzed all anatomic and biomechanical studies, review articles, case reports, case series, and technique papers that were relevant to the topic of SC joint. Research found that there was not adequate concept reviews of the diagnosis and management of SC joint instability and degenerative arthritis. This article provides an updated review on the current diagnosis and management of instability and degenerative arthritis of the SC joint.

   

The “Bony Bankart Bridge” Procedure: A New Arthroscopic Technique for Reduction and Internal Fixation of a Bony Bankart Lesion

Bony Bankart lesions are avulsion fractures of the anterior glenoid rim, and are associated with anteroinferior glenohumeral instability. Avulsion fratures occur when the glenohumeral joint dislocates, which is typically more common in men than women. Arthroscopic treatment of bony Bankart lesions can be challenging. This study presents a new innovative, and reproducible technique for an arthroscopic procedure to treat bony Bankart fragments.

   

The ‘‘Bony Bankart Bridge’’ Technique for Restoration of Anterior Shoulder Stability

Bony deficiency of the anteroinferior glenoid rim can cause recurrent glenohumeral instability. To address this problem, bony reconstruction is recommended in patients with glenoid bone loss more than 20% to 25%. Recent advances in shoulder surgery techniques allow for the arthroscopic reconstruction of glenoid bone defects to restore stability. The study tested the all-arthroscopic ‘‘bony Bankart bridge’’ (BBB) technique for bony anterior glenohumeral instability to restore shoulder stability and provide good shoulder function as well as improve patient satisfaction for these difficult-to-treat cases.

   

Arthroscopic Management of Anterior Shoulder Instability with Glenoid Bone Defects

Bony deficiency of the anterior glenoid rim may significantly contribute to recurrent shoulder instability. Today, based on clinical and biomechanical data, a bony reconstruction procedure is recommended in patients with bone loss of greater than 20–25% of the glenoid surface area. Recent advances in arthroscopic instruments and techniques presently allow minimally invasive and arthroscopic reconstruction of glenoid bone defects and osteosynthesis of glenoid fractures. This article underlines the role of glenoid bone deficiency in recurrent shoulder instability, provides an update on the current management regarding this pathology and highlights the modern techniques for surgical treatment.
   

Los Resultados de Dos Años de la Reconstrucción Capsular Anterior del Hombro Abierto Para la Inestabilidad de la Deficiencia de Capsular Grave

This study, titled, “Two-Year Outcomes of Open Shoulder Anterior Capsular Reconstruction for Instability from Severe Capsular Deficiency”, documents outcomes after anterior capsulolabral reconstruction for recurrent shoulder instability in 15 patients (20 shoulders) who have had multiple failed stabilizations or collagen disorders.
   

El Intervalo de los Rotadores: Patología y Gestión

The rotator interval describes the anatomic space bounded by the subscapularis, supraspinatus, and coracoid. This space contains the coracohumeral and superior glenohumeral ligament, the biceps tendon, and anterior joint capsule. Although a definitive role of the rotator interval structures has not been established, it is apparent that they contribute to shoulder dysfunction. In this article, “The Rotator Interval: Pathology and Management”, a review of the anatomy and function of the rotator interval is analyzed. The presentation, physical examination, imaging characteristics, and management strategies are discussed for various diagnoses attributable to the rotator interval. Preferred methods for treatment of each lesion are also discussed.
   

Reparación De Flotantes Posteriores Lesiones Inferiores Ligamento Glenohumeral: Técnica Quirúrgica

Posterior glenohumeral joint instability makes up approximately 2% to 10% of all shoulder instability reports in the literature and pathologic findings in patients, which often involve a spectrum of pathology rather than a single pathoanatomic finding. A combined posterior Bankart lesion and posterior humeral avulsion of the glenohumeral ligament has been defined as the floating posterior inferior glenohumeral ligament. This combination of pathology may result in severe posterior-inferior instability and the need to address both lesions during attempted surgical repair has therefore been stressed. In this study, “Repair of Floating Posterior Inferior Glenohumeral Ligament Lesions: Surgical Technique”, suggested techniques for repairing the various subtypes of floating posterior inferior glenohumeral ligament lesions is discussed. Repair of both the humeral and glenoid-sided injuries are addressed.
   

Reconstrucción Abierta de la Anterior Estructuras Glenohumerales Capsulolabral con Aloinjerto de Tendón en la Inestabilidad Crónica de Hombro

In the world of orthopedic medicine, no other joint is as prone and susceptible to dislocations as the shoulder joint with more than one third of all shoulder injuries being shoulder dislocations. Trauma is the primary cause of a shoulder dislocation. Multiple etiologic aspects need to be considered when determining the best approach to treating recurrent shoulder instability. This article, “Open Reconstruction of the Anterior Glenohumeral Capsulolabral Structures with Tendon Allograft in Chronic Shoulder instability”, offers insight on the open reconstruction technique using a tendon allograft. Other approaches are discussed in the article and advantages to the technique highlighted.
   

Gestión de la Inestabilidad Multidireccional del Hombro

Multidirectional shoulder instability is defined as symptomatic instability in two or more directions. Instability occurs when static and dynamic shoulder stabilizers become incompetent due to congenital or acquired means. Nonspecific activity-related pain and decreased athletic performance are common complaints.  This article study discusses “Management of Multidirectional Instability of the Shoulder”. Clinical suspicion for instability is essential for timely diagnosis. Several examination techniques can be used to identify increased glenohumeral translation and are offered in this article. It is critical to distinguish increased laxity from instability. Initial management begins with therapeutic rehabilitation. If surgical management is required, advanced arthroscopic techniques offer several advantages over traditional open approaches and may have similar outcomes. The role of rotator interval capsular plication is controversial, but it may be used to augment capsular plication in patients with specific patterns of instability. Despite encouraging results, outcomes remain inferior to those associated with traumatic unidirectional instability.
   

Combinado Lesión Posterior de Bankart Ósea y la Avulsión Humeral Posterior de los Ligamentos Glenohumerales

This article: “Combined Posterior Osseous Bankart Lesion and Posterior Humeral Avulsion of the Glenohumeral Ligaments”, highlights a case study of “floating” posterior inferior glenohumeral ligament lesions.  The pathoanatomy of anterior shoulder dislocations has been well documented. Until recently, little was discussed regarding posterior shoulder instability. This report offers a study on a 23-year old male who fell while snowboarding.  Three years prior to the report, the young male dislocated his left shoulder, was able to relocate the shoulder on the mountain, and was managed non-operatively.  The instability worsened over the years with occasional subluxation.  A thorough examination was conducted, pathology discussed, and the diagnostic and treatment recommendations are highlighted in this article.Download a copy of “Combined Posterior Osseous Bankart Lesion and Posterior Humeral Avulsion of the Glenohumeral Ligaments” below.

   

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