Definition
A glenohumeral dislocation which has been missed for a significant period of time
- time period is arbitrary
- > 3-6 weeks
Pathology
Anterior glenoid bone deficiency
Large Hill Sachs lesions
Rotator cuff tears
Etiology
Poor historians
- developmental delay
- dementia
Issues
Closed reduction may be unsuccessful / locked
Open reduction - unstable due to bony deficiency / rotator cuff tears
Xray
Signs of chronic shoulder dislocation
CT
Assess bone stock / glenoid bone loss / Hill Sachs lesions
Chronic shoulder dislocation with large Hill Sachs and minimal glenoid deficiency
Chronic shoulder dislocation with large Hill Sachs and significant glenoid deficiency
MRI
Rotator cuff tears
MRI with massive supraspinatus tear, subscapularis tear, and large Hill Sachs lesion
MRI with supraspinatus tear, Hill Sachs lesion and significant glenoid bony deficiency
Nonoperative management
Indications
Elderly with significant medial issues
Operative management
Options
1. Reverse total shoulder arthroplasty +/- glenoid bone graft
2. Open reduction +/- glenoid bone graft +/- Hill Sachs allograft +/- rotator cuff repair
Reverse TSA +/- glenoid bone graft
Open reduction +/- glenoid bone graft +/- Hill Sachs allograft +/- rotator cuff repair
Option 1: Hill Sachs and glenoid allograft + rotator cuff repair
Option 2: Humeral head replacement + glenoid autograft + rotator cuff repair
Post humeral head replacement / glenoid autograft / rotator cuff repair
Rotator cuff failure and development of anterosuperior escape