Background
Indications
RA
OA
AVN
Contra-indications
Infection
Charcot
Paralysis of deltoid
Torn rotator cuff
Insufficient glenoid bone stock
RA
OA
AVN
Infection
Charcot
Paralysis of deltoid
Torn rotator cuff
Insufficient glenoid bone stock
Usually after 50-60 years of age
Primary 90% of cases
Secondary
- AVN
- trauma
- instability
Engaging Hill Sachs
Anterior
Anterolateral
Posterior
Indications
- shoulder stabilization
- arthroplasty
- fracture fixation
Approach
Position
- beach chair
- upper body elevated 30- 40o / reduces venous pressure and bleeding
Wind-up
- cocking
- ER up to 180o in pitcher
Acceleration
- large scapular muscles
- acceleration - 7000o/sec
- rotatory acceleration similar to car tyre at 130 kph
Control and deceleration
- fragile cuff & glenohumeral ligament complex
Chondroid Metaplasia of synovium affecting large joints
Nodules of hyaline cartilage
- formed in the subsynovial layer of joint capsules
Rare lesion
Most common in 20's and 30's
Sex: M > F (2:1)
Monoarticular
Fewer complications than TSR
Simpler procedure
Posterior Portal
- make slightly inferior and lateral compare to normal
- inspect joint
Compare both shoulders
- ROM
- anterior and posterior draw
- load and shift
- sulcus sign
1. Patient factors
A. Recurrent Trauma
- contact athletes higher risk
B. MDI / Ligamentous Laxity / Voluntary dislocaters
C. Poor rehabilitation
- poor motivation
- too rapid
- patients rarely get stiff, better to go very slow
2. Surgeon Factors
A. Unrecognised bony defect