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Recurrent Atraumatic Anterior Instability

- See: anterior instability

- Discussion:
    - characterized by dislocation occuring after minor trauma, relative ease of relocation, and evidence of multidirectional instability;
    - this condition is often present in overhead throwing athletes;
    - it may lead to thoracic outlet syndrome (dead arm syndrome);
    - causes: 
             - fracture of both the glenoid rim and the greater tuberosity 
             - fracture of the glenoid rim
             - concomitant rotator cuff tear
             - patients w/ a neurological deficit 
             - abnormal glenoid version
             - abnormal humeral version
             - Hill-Sachs lesion 

- Physical Exam:
    - sulcus sign is often seen in pts with multidirectional instability;
          - look for prominent depression below acromion when inferior traction is applied to wrist; 
          - integrity of the rotator interval capsule can be confirmed by a lessening of the sign on external rotation of the shoulder

- Surgical Treatment:
    - arthroscopic reconstruction 

    - remplissage
                   - The Effect of the Remplissage Procedure on Shoulder Stability and Range of MotionAn in Vitro Biomechanical Assessment
                   - Arthroscopic Bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging Hill-Sachs lesion: a report of 49 cases with a minimum 2-year follow-up.
                   - Anatomical and functional results after arthroscopic Hill-Sachs remplissage
                   - A prospective, comparative, radiological, and clinical study of the influence of the "remplissage" procedure on shoulder range of motion after stabilization by arthroscopic Bankart repair
                   - Arthroscopic remplissage with Bankart repair for the treatment of glenohumeral instability with Hill-Sachs defects
                   - Outcomes of arthroscopic "remplissage": capsulotenodesis of the engaging large Hill-Sachs lesion.

Redislocation of the shoulder during the first six weeks after a primary anterior dislocation: risk factors and results of treatment.

Radiographic views in recurrent anterior shoulder dislocation. Comparison of six methods for identification of typical lesions.

Failed surgery for recurrent anterior dislocation of the shoulder. Causes and management.

Release of the subscapularis for internal rotation contracture and pain after anterior repair for recurrent anterior dislocation of the shoulder.

The coracoid transfer for recurrent anterior instability of the shoulder in adolescents.

Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability.