The treatment of chronic anterior and posterior dislocations of the glenohumeral joint and associated articular surface defects

The treatment of chronic dislocations of the glenohumeral joint remains difficult. The patients often are debilitated, with poor bone quality and limited rehabilitation potentials. Prompt recognition of the dislocation through a complete history, physical examination, and radiologic examination is critical. Skillful neglect should be considered in the patient with limited disability and functional expectations. Surgical interventions should be undertaken in a systematic manner beginning with a reduction and full assessment of the stable range of motion. Reconstructive procedures are undertaken as appropriate. Lesser tuberosity advancement remains the operation of choice for chronic posterior dislocations with humeral head lesions between 20% and 45% of the articular surface. Proximal humeral head replacement or total shoulder arthroplasty is indicated in patients with dislocations of longer than 6 months' duration or with humeral head defects greater than 45%. As in posterior dislocations, chronic anterior dislocations require careful attention to soft tissue reconstruction and balancing. In addition to proximal humerus replacement for large Hill-Sachs lesions, the anterior capsule and subscapularis tendon must be repaired to prevent further instability. Careful concern for soft tissue balance and restoration of the articular congruity, in most cases, lead to significant pain relief and marked improvements in functional ranges of motion.