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Glenoid Bone Loss in Athletes

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Sports Injuries of the Shoulder

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Abstract

Anterior shoulder instability in athletes is a complex problem and necessitates accurate pre- and intra-operative assessment of soft-tissue and bony pathology. Significant bone loss on the glenoid or humeral head predisposes to failure of soft-tissue repair, and bone grafting procedures are necessary to stabilise the shoulder. Recent research has focussed on radiological and arthroscopic assessment of glenoid bone loss, and treatment algorithms have evolved to incorporate newer techniques for optimal outcomes. This chapter describes key concepts that guide diagnosis and management of this complex condition. Essential surgical procedures, and their recent significant modifications are outlined, and the outcomes of various procedures are highlighted.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seth GS Medical College, and King Edward VII Memorial Hospital, Mumbai, India

    Deepak N. Bhatia

  2. SPORTSMED, Mumbai, India

    Deepak N. Bhatia

  3. Cape Shoulder Institute, Cape Town, South Africa

    Joe F. De Beer

Authors
  1. Deepak N. Bhatia
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  2. Joe F. De Beer
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Editor information

Editors and Affiliations

  1. Wrightington Hospital, Wigan, UK

    Lennard Funk

  2. Wrightington Hospital, Wigan, UK

    Mike Walton

  3. Wrightington Hospital, Materials, University of Manchester, Wigan, UK

    Adam Watts

  4. Upper Limb Unit, Wrightington Hospital, Wigan, UK

    Michael Hayton

  5. Upper Limb Unit, Wrightington Hospital, Wigan, UK

    Chye Yew Ng

Q&A

Q&A

  1. (1)

    What is the incidence of bone loss on the glenoid and humeral head?

    Glenoid bone loss of varying severity occurs in 90% of the glenoids. Humeral head defects (Hill–Sachs lesions) occur in 65–93% of anterior instability cases

  2. (2)

    Which sports are associated with bony instability in athletes?

    Aggressive, full-contact and overhead sports (rugby, wrestling, judo, mixed martial arts, bodybuilding, weightlifting) result in high-energy traumatic dislocations, and usually have a high incidence of significant bone defects. Other conditions that are associated with significant glenoid defects include post-concussion seizures, vehicular sports (motocross and downhill mountain biking), and recreational gym injuries.

  3. (3)

    Name five clinical “warning signs” of significant bone loss in instability.

    (1) Frequent and easy dislocations, (2) Dislocations in sleep, (3) High energy traumatic dislocation, (4) Failed previous stabilization procedure, and (5) a positive “bony apprehension” test

  4. (4)

    Name 4 radiographic views used to evaluate bony instability.

    (1) Grashey view, (2) Garth view, (3) Bernageau view, (4) True AP external rotation view.

  5. (5)

    What is the indication for a soft tissue repair procedure?

    On-track Hill–Sachs (nonengaging) or Off-track Hill–Sachs (engaging) + <25% glenoid bone loss

  6. (6)

    What is the indication for a bone reconstruction procedure?

    Off-track Hill–Sachs (engaging) + >25% glenoid bone loss

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Bhatia, D.N., De Beer, J.F. (2020). Glenoid Bone Loss in Athletes. In: Funk, L., Walton, M., Watts, A., Hayton, M., Ng, C. (eds) Sports Injuries of the Shoulder. Springer, Cham. https://doi.org/10.1007/978-3-030-23029-6_7

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  • DOI: https://doi.org/10.1007/978-3-030-23029-6_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23028-9

  • Online ISBN: 978-3-030-23029-6

  • eBook Packages: MedicineMedicine (R0)

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