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Figure A
3%
38/1353
Figure B
2%
33/1353
Figure C
22/1353
Figure D
85%
1149/1353
Figure E
7%
97/1353
Select Answer to see Preferred Response
This patient is presenting with anterior and posterior instability. Of the images provided, Figure D (270-degree labral tear) is most likely to benefit from anterior and posterior stabilization. Glenohumeral instability is a common condition in young, active athletes. The anatomy of the glenohumeral joint, which consists of a shallow glenoid, allows for improved motion but makes the shoulder susceptible to instability events. Traumatic labral tears involving the anterior, inferior, and posterior aspects of the glenoid fossa represent a unique subpopulation of shoulder instability. These pan-labral tears consist of 270-degree to 360-degree injuries to the labrum. The patients may complain of both anterior and posterior instability or simply instability in one direction alone. Physical examination and advanced imaging is critical in the diagnosis of these patients. With improving arthroscopic techniques, these pan-labral tears may successfully be managed with arthroscopic stabilization. Mazzocca et al. prospectively evaluated the clinical results of patients who underwent arthroscopic repair of 270° labral tears. They reported improvements in functional outcomes scores, with a 15% failure rate for patients who experienced subsequent episodes of instability. They concluded that arthroscopic repair of these extensive labral injuries involving 270° of the glenoid fossa was an effective surgical treatment and restored mechanical stability of the shoulder. Van Blarcum et al. reviewed shoulder conditions that are also associated with shoulder instability, including superior labrum anterior/posterior (SLAP) tears, pan-labral tears, and multidirectional instability. They report that patients may present with anterior or posterior instability alone in the presence of a pan-labral tear. They conclude that arthroscopic labral repair remains a good initial option for surgical treatment of these conditions. Tjoumakaris et al. reviews glenohumeral instability an its arthroscopic management. They report that with evolving arthroscopic techniques, complex instability patterns which were previously managed open, may now be successfully managed by means of arthroscopic stabilization. They conclude that these patient with complex tears, in the absence of significant bony lesions or deformity, can expect equivalent rates of recurrence, better functional outcomes, and less morbidity. Figure A is the axial MRI image demonstrating an anterior bony Bankart injury. Figure B is the axial MRI image demonstrating a subscapularis tear. Figure C is the axial MRI image demonstrating of an anterior Bankart injury. Figure D is the axial MRI image demonstrating a 270 degree labral tear. Figure E the axial MRI image demonstrating a Kim lesion. Incorrect Answers: Answer A: An anterior bony Bankart would not likely require posterior labral stabilization Answer B: A subscapularis tear would require rotator cuff repair, not labral stabilization Answer C: An anterior Bankart would not likely require posterior labral stabilization Answer E: A Kim lesion would not likely require anterior labral stabilization
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