Management of Recurrent Shoulder Dislocations

Diagnostic Approach

• The American College of Radiology recommends standard radiographs as the first imaging study, including anteroposterior (AP) views in internal and external rotation, plus an axillary or scapula-Y view to properly assess glenohumeral alignment 3
• Special radiographic views, such as the Westpoint view for bony Bankart lesions and the Stryker notch view for Hill-Sachs deformities, can help identify specific pathology 4, 5
• MR arthrography is the gold standard for evaluating recurrent shoulder instability, with a rating of 9/9 in appropriateness criteria, and offers superior assessment of labroligamentous injuries, Hill-Sachs lesions, glenohumeral ligament injuries, and glenoid bone loss assessment 1, 2, 4, 6
• Non-contrast MRI is a reasonable alternative (rated 7/9) when MR arthrography is not available 4
• CT arthrography can be considered if MRI is contraindicated (rated 5/9) 2, 4

Common Pathologic Findings

• Glenoid bone loss is found in up to 10% of patients with recurrent instability 2

Treatment Algorithm

• Early surgical intervention is preferred as delayed surgery is associated with progressive labro-ligamentous injury 2

Surgical Options Based on Pathology

• The Latarjet procedure is recommended when significant glenoid bone loss is present (>20%) 2

Pitfalls and Caveats

• Ultrasound has no defined role in the assessment of shoulder instability and should not be used as a primary diagnostic tool 2, 7