Glenoid avulsion of glenohumeral ligament: Surgical Mx
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A 56-year-old right-hand-dominant woman sustained two dislocations to her right shoulder, the first of which occurred about 18 days prior to presentation when she slipped and fell onto her bent arm. The fall resulted in an anterior shoulder dislocation that was reduced at the local ED. Post-reduction radiography was normal, and the patient was discharged in a simple sling (Figure 2).

Fourteen days later, when lying in bed, she reached across her body and caused a subsequent dislocation. This dislocation also required a reduction performed at the ED and placement into an abduction sling. Again, post-reduction radiographs were negative for fracture. The patient was initially referred to a nonoperative sports medicine specialist for rehabilitation.

The patient’s past medical history was notable for systemic lupus erythematosus and Sjogren’s syndrome for which she chronically takes Prednisone 5 mg twice daily.

At 2 months after her initial dislocation, she dislocated a third time while reaching in an abducted and externally rotated position while lying down. She required a third reduction with sedation in the ED. A repeat non-arthrogram right shoulder MRI and CT with 3-D reconstruction was performed.

The CT scan and 3-D reconstruction revealed no acute bony abnormality. Non-arthrogram shoulder MRI revealed a globular appearance of the labrum with degeneration. Additionally, extensive capsular edema was present which may have been due to glenoid avulsion of the glenohumeral ligament or possible midsubstance anterior-inferior glenohumeral ligament tear. The rotator cuff was otherwise intact.

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