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Scientific Articles   |    
Pathoanatomy of First-Time, Traumatic, Anterior Glenohumeral Subluxation Events
Brett D. Owens, MD1; Bradley J. Nelson, MD2; Michele L. Duffey, MS3; Sally B. Mountcastle, PhD4; Dean C. Taylor, MD5; Kenneth L. Cameron, PhD, ATC1; Scot Campbell, MD6; Thomas M. DeBerardino, MD7
1 Keller Army Hospital, 900 Washington Road, West Point, NY 10996. E-mail address for B.D. Owens: b.owens@us.army.mil
2 Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55454
3 Department of Kinesiology, Pennsylvania State University, 271A Recreation Building, University Park, PA 16802
4 University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1008, Kansas City, KS 66160
5 Duke Sports Medicine, Finch-Yeager Building, 300 Frank Bassett Drive, Box 3615, Durham, NC 27710
6 Department of Radiology, Wilford Hall Medical Center, 2200 Bergquist Drive, San Antonio, TX 78236
7 New England Musculoskeletal Institute, UConn Health Center, 263 Farmington Avenue, Farmington, CT 06030
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from commercial entities (Genzyme and HealthSport).

A commentary by Jeffrey S. Abrams, MD, is available at www.jbjs.org/commentary and as supplemental material to the online version of this article.
Investigation performed at Keller Army Hospital, United States Military Academy, West Point, New York
Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or the United States government. The authors are employees of the U.S. government.

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Jul 07;92(7):1605-1611. doi: 10.2106/JBJS.I.00851
A commentary by Jeffrey S. Abrams, MD, is available here
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Abstract

Background: 

Relative to dislocations, glenohumeral subluxation events have received little attention in the literature, despite a high incidence in young athletes. The pathoanatomy of first-time, traumatic, anterior subluxation events has not been defined, to our knowledge.

Methods: 

As part of a prospective evaluation of all cases of shoulder instability sustained during one academic year in a closed cohort of military academy cadets, a total of thirty-eight first-time, traumatic, anterior glenohumeral subluxation events were documented. Clinical subluxation events were defined as incomplete instability events that did not require a manual reduction maneuver. Twenty-seven of those events were evaluated with plain radiographs and magnetic resonance imaging within two weeks after the injury and constitute the cohort studied. Magnetic resonance imaging studies were independently evaluated by a musculoskeletal radiologist blinded to the clinical history. Arthroscopic findings were available for the fourteen patients who underwent arthroscopic surgery.

Results: 

Of the twenty-seven patients who sustained a first-time, traumatic, anterior subluxation, twenty-two were male and five were female, and their mean age was twenty years. Plain radiographs revealed three osseous Bankart lesions and two Hill-Sachs lesions. Magnetic resonance imaging revealed a Bankart lesion in twenty-six of the twenty-seven patients and a Hill-Sachs lesion in twenty-five of the twenty-seven patients. Of the fourteen patients who underwent surgery, thirteen had a Bankart lesion noted during the procedure. Of the thirteen patients who chose nonoperative management, four experienced recurrent instability. Two of the thirteen patients left the academy for nonmedical reasons and were lost to follow-up. The remaining seven patients continued on active-duty service and had not sought care for a recurrent instability event at the time of writing.

Conclusions: 

First-time, traumatic, anterior subluxation events result in a high rate of labral and Hill-Sachs lesions. These findings suggest that clinical subluxation events encompass a broad spectrum of incomplete events, including complete separations of the articular surfaces with spontaneous reduction. A high index of suspicion for this injury in young athletes is warranted, and magnetic resonance imaging may reveal a high rate of pathologic changes, suggesting that a complete, transient luxation of the glenohumeral joint has occurred.

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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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