Surgical treatment by changcheng2


									 Surgical treatment of posterior instability of the shoulder by
 anteversion osteotomy of the scapular neck associated with
                  posterior capsulorraphia.
    Traitement chirurgical des instabilites posterieures d' epaule par
     osteotomie d' anteversion du col de l' omoplate associee a une
                        capsulorraphie posterieure
          Djian,-P; Christel,-P; Herman,-S; Demarais,-Y; Roger,-B
    Journal-de-traumatologie-du-sport-(Paris) 14(3), sept 1997, 137-146

From 1987 to 1996, we operated 10 patients (mean age at operation 25
years) including 6 who were victims of indirect trauma to the shoulder during
sports activities. There were seven high-level athletes who practiced judo (n =
2), rugby (n = 2), basketball (n = 2), gymnastics (n = 2) and boxing (n =1).
Trauma usually caused medial rotation and retropulsion. The main signs were
painful clicking, and apprehension for certain movements requiring
antepulsion and medial rotation. All of the signs led to interrupting sports
activities. Physical examination demonstrated normal muscle force and
mobility. The most important sign was apprehension at medial rotation
associated with anteroposterior displacement of the elbow. Among the
exploratory tests, arthroscan of the shoulder reliably evidenced distension of
the posterior capsule and possible bone damage and allowed comparative
measurement of glenoid version. Retroversion of the glenoid cavity was 13
degrees (6-20 degrees) prior to surgery. Posterior access was used for
posterior osteotomy of the scapular neck and grafting with the scapular spine
together with posterior capsulorraphia. The shoulder was then immobilized in
lateral rotation for 21 days followed by rehabilitation exercises. Sports
activities could be resumed at best six months after surgery. All patients were
seen again for examination at 33 months. Standard radiograms and CT-scans
were obtained to evaluate corrections obtained. We used the constant
classification. Results were excellent in 6 patients, good in 3 and poor in 1 at
33 months mean follow-up. This technique allows rapid return to sports
activities with good stability and nearly normal mobility.

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