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Recurrent Anterior Shoulder Dislocation Caused by a Midsubstance Complete Capsular Tear
Naoko Mizuno, MD1; Minoru Yoneda, MD, PHD1; Kenji Hayashida, MD, PHD2; Shigeto Nakagawa, MD, PHD3; Tatsuo Mae, MD, PHD1; Kazutaka Izawa, MD4
1 Shoulder and Sports Medicine Service, Osaka Kosei-nenkin Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka 530-0003, Japan. E-mail address for N. Mizuno: nao-miz@hcc5.bai.ne.jp
2 Department of Orthopaedic Surgery, Hoshigaoka Kosei-nenkin Hospital, 4-8-1 Hoshigaoka, Hirakata City, Osaka 573-8511, Japan
3 Department of Orthopaedic Surgery, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka City, Osaka 530-0021, Japan
4 Department of Orthopaedic Surgery, Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka City, Osaka 560-0045, Japan
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Shoulder and Sports Medicine Service, Osaka Kosei-nenkin Hospital, Osaka, Japan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Dec 01;87(12):2717-2723. doi: 10.2106/JBJS.E.00027
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Background: A midsubstance complete capsular tear is one of the well-known causes of anterior glenohumeral instability. However, its prevalence and clinical picture have not been well elucidated. The purpose of this study was to examine the prevalence of isolated complete capsular tears and to assess the clinical features as well as the results of surgical treatment of recurrent anterior glenohumeral instability caused by such tears.

Methods: Three hundred and three shoulders underwent surgery to treat recurrent anterior glenohumeral instability at our institution during a five-year period. Twelve (4.0%) of these shoulders had an isolated complete capsular tear as the main pathological condition. Those twelve patients (nine male and three female) were the subjects of the present study. The average age at the time of the operation was twenty-five years. Patient age; the cause of the initial dislocation; the position of the arm at the initial dislocation; and the findings of the preoperative physical examination, of computed tomographic arthrography, and at surgery were assessed. Eleven patients underwent arthroscopic capsular repair, and one was treated with an open capsular repair.

Results: The twelve patients either did not have a Hill-Sachs lesion or had a chondral indentation-type of Hill-Sachs lesion. When assessed with arthrography, the Hill-Sachs lesions were small compared with those in shoulders with an isolated Bankart lesion and, interestingly, they were quite similar in size to those seen with humeral avulsion of the inferior glenohumeral ligament. The average Rowe score for the twelve patients improved from 30.4 points preoperatively to 90.4 points at an average of thirty-one months postoperatively.

Conclusions: The prevalence of isolated complete capsular tears causing recurrent glenohumeral instability was 4.0% (twelve of 303). These tears were associated with either a small or no Hill-Sachs lesion. We believe that a complete capsular tear should be recognized as one of the essential lesions causing recurrent anterior shoulder dislocation. Arthroscopic examination and repair can provide effective treatment.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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