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| Mechanical Shoulder Pain in a Seventeen-Year-Old Girl Nine Months Following Arthroscopic Bankart Repair | ||
| By Dominick Tuason, MD, Kristofer Jones, BA, and Lawrence Wells, MD*, Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania | ||
| A seventeen-year-old girl suffered a traumatic anterior-inferior dislocation of the left shoulder while playing lacrosse. After having recurrent episodes of instability and a failed trial of physiotherapy, the patient underwent arthroscopic anterior capsulolabral reconstruction for instability of the left shoulder. Preoperative physical examination with the patient under anesthesia demonstrated anterior and inferior shoulder instability; arthroscopic evaluation revealed a glenoid labral tear at the 9 o'clock position (Fig. 1) and anteroinferior laxity of the glenohumeral ligaments as well as laxity of the axillary pouch. | ||
 Fig. 1 |
Fig. 1 Arthroscopic view of the left shoulder, showing the anterior capsulolabral tissue detached and mobilized from the anteroinferior glenoid rim. For larger view, click on image |
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| The capsular volume of the anteroinferior aspect of the axillary pouch was reduced by mobilizing the lax capsulolabral complex and reattaching the tissue with use of two bioabsorbable knotless suture anchors (DePuy Mitek, Westwood, Massachusetts). Two drill-holes were made at the 7:30 and 9 o'clock positions on the glenoid. A Caspari suture punch (Linvatec, Largo, Florida) was used to shift the anterior-inferior glenohumeral ligament capsular complex superiorly to the glenoid rim, where it was then reattached (Fig. 2). | ||
 Fig. 2 |
Fig. 2 Arthroscopic view demonstrating final Bankart repair, with the capsulolabral complex reattached to the glenoid rim. For larger view, click on image |
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| At the completion of the procedure, the shoulder was found to be stable, and the so-called "drive-through sign," or the ability to pass the arthroscope between the humeral head and glenoid at the level of the anterior band of the inferior glenohumeral ligament, was eliminated. (The "drive-through" sign is diagnostic of shoulder instability and has been associated with shoulder laxity and superior labrum anterior posterior (SLAP) lesions1.) | ||
| The postoperative course was uneventful. Initially, the patient wore a shoulder immobilizer for four weeks, after which she performed gentle range-of-motion exercises for four weeks and then began a formal physical therapy program. She received physical therapy two to three times a week for eight weeks, with a specific focus on restoring range of motion and strength in the shoulder. Three months postoperatively, she was able to return to playing competitive lacrosse. | ||
| Nine months postoperatively, the patient returned for evaluation of a mechanical popping sensation in the left shoulder associated with activity. In addition, she reported radicular symptoms in the left shoulder, extending downward to the elbow and occasionally to the long finger. Physical examination revealed that the shoulder was stable. The neurovascular examination was normal in both upper extremities. Magnetic resonance imaging of the cervical spine was performed to evaluate the radicular symptoms and demonstrated a small left paracentral-foraminal disc herniation at the level of C7 without any signs of central canal or neural foramen encroachment. A magnetic resonance imaging-arthrogram of the left shoulder was acquired (Figs. 3-A and 3-B). | ||
 Fig. 3-A |
 Fig. 3-B |
For larger view, click on image |
| What is the diagnosis? | ||
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