2001 Volume 25 Issue 3 Pages 427-430
We present a case of recurrent anterior shoulder dislocation which requiring reconstruction of the ruptured, retracted capsule.
A 23-year-old man had injured his right shoulder at 13 years of age while playing volleyball, resulting in the shoulder being abducted and externally rotated. Dislocation occurred 10 times after the first dislocation, eventually even during sleep.
Muscle atrophy was not apparent. The apprehension sign was positive both anteriorly and posteriorly. Range of motion was slightly restricted in elevation. Plain radiograms showed Hill-Sachs lesion, but no apparent bony Bankart lesion. Pneumo-arthro CT revealed extraarticular anteromedial bulging of the capsule below lesser tuberosity. On exploration, we found that the subscapularis muscle had been replaced by fibrous membrane that covered the humeral head directly. The MGHL was intact. The anterior capsule was torn obliquely, and the course of the tear, starting from 3 o'clock along with the IGHL, reached the anatomical neck. The ruptured capsule was displaced toward the scapular neck and retracted. To add to the Bankart repair, we reconstructed the ruptured thin capsule with Teflon felt and the Latarjet method.
Conclusion
Many cases of recurrent shoulder dislocation owing to capsule rupture have been reported. Most are successfully repaired by primary suturing. Due to capsule retraction in our case, the capsule required supplementation. We consider such remarkable capsule retraction to have resulted from the absence of traction force concomitant with joint motion from the attached subscapularis muscle. Pneumoarthro CT was useful in preoperatively diagnosing irreparable capsule rupture.
