Disruptions of lateral capsule are seldom observed in recurrent anterior dislocation of the shoulder joint, and complications by rotator cuff tears in young adulthood are extremely rare.
The patient was a 30-year-old-male who at 25 years of age fell while snowboarding and suffered a severe blow to the anterolateral aspect of his left shoulder. ROM was limited by pain for a month. After this, subluxations occurred 12 times. Preoperatively, there was a 35 degree limitation of motion in both elevation and external rotations. The drop arm sign and the initial abduction test were negative. An air-contrast CT and A/G revealed flow of air and contrast medium in the subacromial and subcoracid bursa. Intaroperatively, the anterior joint capsule-labrum junction area was found to be normal, but the joint capsule was torn on the head side, and it was displaced to ward the axilla and retracted. Because of the retraction of the capsule, it was repaired with an homologous lyophilized dura mater. A complete tear of the supraspinatus tendon was observed, and it was reattached. Two years after, ROM slightly restricted, but there have been no problems in terms of activities of daily living, and a dislocation has not recurred.
Very careful preoperative exploration is required because, even in young persons, recurrent anterior dislocation caused by a powerful external force is sometimes associated with rotator cuff tears or joint capsule tears on the head side. Since retraction of joint capsule tears on the head side can occur, plans for surgery must be devised with a means of dealing with this in mind.
