This is a 22 year old right-hand dominant male who had a history of recurrent anterior instability of his right shoulder. He had an open anterior stabilization procedure in 2003, and was pain-free and without instability symptoms until 2007. Over the past two years, however, he had several episodes of painful anterior subluxation. He had moderate pain at night and denied any numbness or tingling.
Physical Examination
This is a 6 feet 2 inch, 168 pound male. Cervical spine exam is benign. There is full range of motion with a negative Spurling’s sign. No abnormal swelling is noted. There is a negative sulcus sign. Thumb to forearm index is 2cm.
The right shoulder is well-muscled. There is a well-healed deltopectoral scar. Forward flexion is to 165 degrees with abduction to 165 degrees, external rotation is to 60 degrees with internal rotation to T6. Subscapularis push-off test is negative. Supraspinatus test is negative. Speed test is negative. O’Brien’s test is negative. Palpation reveals no areas of tenderness. Supine there are slightly positive impingement signs present. Supine abduction, external rotation is to 85 degrees with significant anterior apprehension and a positive relocation test. Supine abduction internal rotation is to 85 degrees. Resisted external rotation is negative. Abdominal press test is negative. Biceps 2 test is negative.
Studies
Right shoulder series includes AP, axillary and outlet views and shows a Type IIb acromion and three metal anchors in the glenoid.
Significant MRI series appear below. Click on thumbnails to enlarge.
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Diagnosis
Right shoulder recurrent instability due to capsular shift suture failure from previous open Bankart with capsular shift. Repaired arthroscopically with two #2 Orthocord sutures and 3 Lupine Loop BR anchors using 3 portals and Chia PercPasser.
