Mount Si High School Student Forum

 A senior at Mount Si High School, Donny suffered from chronic dislocations of his left shoulder.  All throughout his junior and senior football seasons he played with the injury and suffered from dislocations and immense pain.

 Mechanism of Injury: The first injury occurred in June during his junior year of football at a Washington State University football camp. He was grabbed by the arm while running to complete a pass. He states that he felt his arm being torn and was shortly after hit by another player. He thought he cracked his shoulder. He had suffered an anterior dislocation. As a result he had recurrent instability and eventually he learned to reduce his shoulder himself.

 After visiting his doctor, a MRI showed an anterior-inferior labral tear, as well as a posterior-superior Hill-Sachs lesion.  Assessment:He had a left shoulder Bankart lesion.

 Hill-Sachs lesion- This is an injury that causes damage to the head of the humerus. A Hill-Sachs lesion is a complication of a shoulder dislocation. When a shoulder dislocates the smooth cartilage surface of the humerus hits against the rim of the scapula.  Bankart lesion- Is when the labrum of the shoulder joint is torn. The stability of the shoulder joint is therefore compensated. This lesion often occurs when an individual sustains a shoulder dislocation. The tear is to part of the labrum called the inferior glenohumeral ligament. Symptoms: a sense of instability, repeat dislocations, catching sensations, and aching of the shoulder.

 Plan: To proceed with a left shoulder arthroscopic Bankart repair and posterior inferior capsular plication.

 Preoperative Diagnoses: There is left shoulder chronic anteroinferior instability.  Postoperative Diagnoses: There is left shoulder chronic anteroinferior instability with a bony Bankark lesion. Also present is a superior labral flap tear.  Procedure to be performed: A left shoulder arthroscopic repair of the bony Bankart lesion was done. He also needed a left shoulder posteroinferior capsular plication and a left shoulder superior labral flap tear debridement.

 December 5 th - Forward flexion went from 170° to 90°, external rotation changed from 60° to 0°  December 15 th - Forward flexion rose to 140°, external rotation to 50°. At this point he is doing gentle range of motion exercises and some isometrics.  January 14 th forward flexion 175°, external rotation 60°. He can now do cuff strengthening exercises.  February 25 th - No change in flexion.  April 22 nd - Forward flexion 180° no change in external rotation. Will continue progress in all of his activities and there are no longer any restrictions.

 On August 26 th, 2009, Donny reinjured his left shoulder. He was tackling a player and there was a posterior force placed on the left glenohumeral joint and he felt a shifting sensation. Following this he felt discomfort.  After visiting his doctor, his shoulder demonstrated discomfort with impingement maneuvers. His sulcus testing was negative and his cuff strength is good. Neurovascular is intact to the left upper extremity. There is a slight click with anterior and posterior translation. His apprehension tests are decreased with relocation maneuvers.

 Assessment: Donny’s left shoulder has a possible recurrent Bankart lesion.  He underwent a contrast MRI -Where gadolinium was used along with a MRI to highlight any injuries  Findings: There was no rotator cuff tear. MRI shows the disrupted anteroinferior labrum having a moderately macerated appearance with localized synovitis. Also found a linear band of intralabral contrast extension involving the superior labrum, highly suspicious of a TYPE II SLAP tear. A chronic Hill-Sachs lesion is present. A chronic articular cartilage injury at the anteroinferior glenoid articular surface is also present. Appearances suggest fibrocartilaginous healing of a chronic chondral injury.

 SLAP tear- It is a specific type of labral tear that stands for Superior Labral tear from Anterior to Posterior. The SLAP tear occurs at the point where the tendon of the biceps muscle inserts on the labrum. Symptoms: a catching sensation and pain with shoulder movements

 Played his senior season as running back and experienced multiple dislocations following his repeated injury. He will require a revision Bankart repair with capsular plication. There is also a need to plicate the posterior inferior capsule and then they needed to take a closer look at the superior labrum to see if there is a need to repair the SLAP lesion.