PATHOLOGICAL-CHANGES ASSOCIATED WITH SHOULDER DISLOCATIONS - ARTHROSCOPIC AND PHYSICAL-EXAMINATION FINDINGS IN FIRST-TIME, TRAUMATIC ANTERIOR DISLOCATIONS

This prospective observational study was performed on young patients, less than 24 years old, with first-time, traumatic anterior shoulder d islocations. These patients were offered either arthroscopic or nonope rative treatment. Fifty-three patients chose nonoperative treatment. S ixty-three patients elected to have arthroscopic procedures. The avera ge patient age was 19.6 years. There were 59 men and 4 women. All proc edures were performed within 10 days of dislocation. All 63 patients h ad hemarthrosis. Sixty-one of 63 (97%) patients treated surgically had complete detachment of the capsuloligamentous complex from the glenoi d rim and neck (Perthes-Bankart lesion), with no gross evidence of int racapsular injury. Of the other two patients, one had an avulsion of t he inferior glenohumeral ligament from the neck of the humerus, and on e had an interstitial capsular tear adjacent to the intact glenoid lab rum. Fifty-seven patients had Hill-Sachs lesions; none were large. The re were six superior labral anterior posterior lesions, two with detac hment of the biceps tendon. There were no rotator cuff tears. Of the 5 3 nonoperatively treated patients, 48 (90%) have developed recurrent i nstability. In this population, the capsulolabral avulsion appeared to be the primary gross pathologic lesion after a first-time dislocation . These findings, associated with the 90% nonoperative recurrence rate , suggest a strong association between recurrent instability and the P erthes-Bankart lesion in this population.