Abstract
Inferior and multidirectional instability of bilateral shoulders developing in a patient with autosomal recessive distal muscular dystrophy (ARDMD) was reconstructed surgically, which has not been reported yet.
(A Case Report) A 41-year-old-man was diagnosed as having ARDMD at age 27. He started to use a wheel-chair at age 30 which bore weight on bilateral his shoulders, which gradually made them unstable. Finally, at age 36, inferior subluxation of the left shoulder occurred frequently during his daily living activies.
(Course) At the initial examination, bilateral shoulders shoulders showed inferior subluxation at reat, which was reduced by shrugging. Inferior and anterior instabilities were recognized, which resulted in positive inferior and anterior apprehension signs. Preoperatively, the JOA scores of the left and right shoulders were 26.0 and 35.5 point out of 100, respectively. At age 38, an inferior capsular shift and glenoid osteotomy were performed on his left shoulder, and 1.5 years later, on his right. Both of the operated shoulder were immobilized in a spica for 6 weeks and obtained 71 points at 3.5-year-and 2year-follow-ups. The purpose of this surgical reconstruction was to get three-dimensional tightness of the joint capsule and prevent inferior translation of the humeral head due to muscle dystrophy. He has never complained of pain in ADL or recurrence of shoulder instability. (Conclusion) Inferior capsular shift accompanied by glenoi d osteotomy could prevent inferior and multidirectional instability effectively in a patient suffering from incurable muscle weakness.
