01Approach to the Critical Patient/attcp35

Immediate Priorities

›Neurovascular compromise recognition

›Absent or diminished distal pulses (radial, ulnar)

›Cool or pale extremity distal to dislocation

›Expanding hematoma suggesting axillary vessel injury

›Axillary artery injury: rare but limb-threatening, occurs in elderly with atherosclerotic vessels

›Axillary nerve injury assessment

›Loss of sensation over lateral deltoid (regimental badge area)

›Inability to contract deltoid muscle

›Most commonly injured nerve in anterior shoulder dislocation

›Fracture-dislocation identification

›Greater tuberosity fracture on pre-reduction films

›Surgical neck fracture with dislocation

›Urgent orthopedic consultation for fracture-dislocation

›Do not attempt blind closed reduction for complex fracture-dislocation without orthopedic involvement

›Early reduction imperative

›Attempt reduction before muscular spasm develops

›Prolonged dislocation increases risk of vascular and neurologic injury

›Increasing time to reduction correlates with greater force required

Key Pearls and Pitfalls

›Diagnostic pitfalls

›Posterior dislocation missed in up to 50% of cases on AP radiograph alone

›Obtain axillary or Velpeau view to exclude posterior dislocation

›Bilateral dislocations suggest seizure or electrocution as cause

›Older patients (>40 years): high suspicion for concomitant rotator cuff tear

›Reduction approach priorities

›Intra-articular lidocaine preferred first-line analgesia: equivalent to IV sedation with fewer adverse events

›Many biomechanical techniques succeed without any sedation or analgesia

02History/hx40

Mechanism and Onset

›Mechanism of injury

›Forced abduction, external rotation, and hyperextension of the arm

›Fall on outstretched hand (FOOSH)

›Direct blow or tackle in contact sport

›Overhead sport activity

›Timing and field events

›Time elapsed since injury

›Reduction attempted in the field (may complicate assessment)

›Number of prior dislocations or subluxations on same side

›Prior surgical stabilization (Bankart repair, Latarjet procedure)

Symptom Profile

›Presenting symptoms

›Sensation of shoulder "popping out"

›Dead arm feeling at time of injury

›Inability to move arm since injury

›Numbness over lateral deltoid (axillary nerve territory)

›Weakness, tingling, or paresthesias in hand

›Important negatives to screen

›Seizure preceding dislocation (suggests posterior mechanism)

›Electrocution as mechanism (suggests posterior dislocation)

›Direct posterior force mechanism

›Syncope or loss of consciousness preceding fall

Risk Factors for Recurrence

›High-risk recurrence factors

›Age less than 25 years: strongest predictor of recurrence

›Male sex: 3x more likely to have recurrent instability

›Contact or collision sport participation (football, rugby, hockey, wrestling)

03Physical Exam/exam29

Inspection and Palpation

›Shoulder contour assessment

›Loss of normal deltoid contour (squared-off shoulder appearance)

›Arm held in slight abduction and external rotation

›Prominent acromion with anterior fullness

›Humeral head palpable anteriorly (subcoracoid or subclavicular)

›Empty glenoid fossa posteriorly

›Skin and soft tissue

›Skin tenting or open dislocation

›Expanding hematoma (axillary vessel injury)

›Ecchymosis distribution

Neurovascular Examination

›Pre-reduction neurovascular exam (mandatory)

›Axillary nerve: sensation over lateral deltoid (regimental badge area)

›Axillary nerve: deltoid muscle contraction

›Radial pulse strength and symmetry

›Ulnar pulse strength

›Capillary refill time distal digits

›Musculocutaneous nerve: lateral forearm sensation and biceps strength

›Post-reduction neurovascular exam (mandatory repeat)

›All components repeated after reduction confirmed

›New deficits after reduction require urgent imaging

Range of Motion and Stability

›Acute range of motion assessment

›Passive range of motion after reduction

›Apprehension testing deferred in acute setting

›Active elevation and rotation symmetry compared to contralateral side

›Provocative tests (defer to follow-up in office)

04Differential Diagnosis/ddx37

Shoulder Dislocations

›Posterior shoulder dislocation (ICD-10: S43.025)

›Mechanism: seizure, electrocution, direct anterior force

›AP radiograph often appears deceptively normal

›Light-bulb sign on AP or trough sign

›Missed in up to 50% on AP alone — requires axillary or Scapular Y view

›Inferior dislocation — luxatio erecta (ICD-10: S43.035)

›Arm locked in full abduction

›Rare, high-energy mechanism

›High rate of neurovascular injury

›Multidirectional instability

›Atraumatic, often bilateral

›Generalized ligamentous laxity present

›No discrete dislocation event

Fractures and Bony Injuries

›Proximal humerus fracture (ICD-10: S42.209)

›Greater tuberosity fracture: associated in up to 14-35% of anterior dislocations

›Surgical neck fracture: do not attempt blind reduction

›Distinguish on pre-reduction radiograph

›Glenoid fracture — bony Bankart (ICD-10: S42.109)

›Anterior glenoid rim fracture

›Prevalence increases with each recurrent dislocation

›CT required to quantify bone loss

›Acromioclavicular joint separation (ICD-10: S43.109)

›Mechanism typically direct blow to top of shoulder

›Normal glenohumeral relationship on X-ray

›AC joint tenderness and deformity

05Laboratory Tests/lt17

Routine Labs

›Standard uncomplicated dislocation

›Routine laboratory testing not required for isolated anterior shoulder dislocation

›No pre-procedural labs needed in healthy patients for intra-articular lidocaine

›No pre-procedural labs required for procedural sedation in healthy young adults

›Selective lab indications

›Glucose in diabetic patients if sedation planned

›Coagulation studies in patients on anticoagulation

›CBC and type and screen if vascular injury suspected

›Metabolic panel if rhabdomyolysis suspected (electrocution mechanism)

Point-of-Care Testing

›POC testing indications

›Blood glucose: if diabetic or prolonged NPO status prior to sedation

›Bedside urine myoglobin if electrocution mechanism (rhabdomyolysis screen)

›Pregnancy test (urine hCG) in women of childbearing age before procedural sedation

Neurophysiology Studies

›Nerve conduction studies

›Indicated at follow-up for persistent neurologic deficit not resolving within 3-6 weeks

›Axillary nerve EMG/NCS if deltoid weakness or numbness persists after reduction

›Electromyography useful to characterize brachial plexus injury pattern

06Diagnostic Tests/dt60

Scoring Systems

›Instability Severity Index Score (ISIS)

›Validated risk stratification tool for recurrence and surgical planning

›Scores risk factors: age, sport type, ligamentous laxity, Hill-Sachs, glenoid contour

›ISIS score >6 associated with high recurrence — surgical stabilization recommended

›Used in outpatient orthopedic setting, not acute ED

›WOSI Score (Western Ontario Shoulder Instability Index)

›Patient-reported outcome measure for glenohumeral instability

›21-item questionnaire across physical, sport, work, and lifestyle domains

›Scores 0-2100, lower score = better shoulder function

›Used to monitor treatment outcomes and surgical decision-making

›Beighton Score

›Assesses generalized ligamentous laxity (0-9 scale)

›Score >=4 indicates hypermobility

›Important prognostic factor for recurrent instability

›Bilateral pinky hyperextension, thumb to forearm, elbow/knee hyperextension, forward flexion palms flat

MRI

›MRI indications for shoulder dislocation

›Not routinely indicated after first-time dislocation

›Indicated in patients >40 years with suspected rotator cuff tear

›Recurrent dislocations requiring surgical planning

›Persistent pain or functional deficit after adequate conservative trial

›MRI protocol considerations

›Non-contrast MRI adequate in acute setting: joint effusion provides natural arthrographic effect

›MR arthrography (gadolinium intra-articular) preferred for chronic instability evaluation

›ACR Appropriateness Criteria 2024: MRI without contrast usually appropriate for first dislocation in selected cases

›MRI findings in anterior dislocation

›Bankart lesion: anterior-inferior labral tear (59-66% prevalence)

07Disposition/dispo31

Discharge Criteria

›Standard discharge criteria

›Successful closed reduction confirmed on post-reduction radiograph

›Intact neurovascular exam post-reduction

›Pain adequately controlled on oral analgesics

›Patient able to ambulate and perform self-care

›Reliable outpatient follow-up arranged within 1-2 weeks

›Discharge instructions and follow-up

›Orthopedic follow-up within 1-2 weeks for all first-time dislocations

›Sling instructions and duration (2-4 weeks for comfort)

›Return precautions clearly communicated

›Avoid provocative positions (abduction + external rotation) during healing

Admission Criteria

›Hospital admission indications

›Irreducible dislocation requiring operative reduction

›Associated fracture requiring orthopedic surgical management

›Vascular injury (axillary artery) requiring vascular surgery

›Open dislocation

›Prolonged procedural sedation recovery with hemodynamic instability

›Significant comorbidities complicating sedation recovery

Specialist Consultation

›Urgent orthopedic consultation (same encounter)

›Irreducible dislocation after two technique attempts

›Fracture-dislocation

›Open dislocation or skin tenting

›Vascular injury suspected

›Significant glenoid bone loss or complex associated fracture

›Outpatient orthopedic referral (all cases)

08Treatment/t90

Analgesia and Procedural Preparation

›Intra-articular lidocaine (first-line for most patients)

›20 mL of 1% lidocaine injected into glenohumeral joint

›Posterior approach: 2 cm inferior and medial to posterolateral corner of acromion

›Landmark injection or ultrasound-guided

›Wait 15-20 minutes before reduction attempt

›Equivalent efficacy to IV sedation for successful reduction

›Fewer adverse events than procedural sedation

›Shorter ED length of stay

›No NPO requirements

›Cochrane systematic review 2022 supports intra-articular lidocaine as preferred

›Procedural sedation (when intra-articular approach fails or contraindicated)

›Ketofol (ketamine + propofol combination)

›Ketamine 0.5-1 mg/kg IV plus propofol 0.5-1 mg/kg IV titrated

›Reduces individual agent adverse effects

›Maintains airway reflexes better than propofol alone

›Midazolam plus fentanyl

›Midazolam 1-2 mg IV plus fentanyl 1-2 mcg/kg IV titrated

›Longer duration, greater respiratory depression risk

›Propofol alone

›1-2 mg/kg IV initial dose with titration

›Rapid onset and short duration

›Monitor for hypotension and apnea

›Monitoring requirements during procedural sedation

›Continuous pulse oximetry and capnography

›IV access, supplemental oxygen, airway equipment at bedside

›Physician skilled in airway management present

›No-analgesia techniques (select patients)

›Many biomechanical techniques achieve reduction without sedation or analgesia

›External rotation (ERWOSA): effective especially in male patients

›Cunningham technique: traction-countertraction variant with muscle relaxation focus

›Patient cooperation and positioning are key

Reduction Techniques

›Scapular manipulation

›Operator rotates inferior scapular tip medially while assistant maintains traction

›Superior success rate in systematic comparisons

›Low force required, well tolerated

›Can be performed in sitting or prone position

›FARES method (Functional Assessment, Reduction, Evaluation)

›Arm abducted at side with gentle traction, oscillated while slowly abducting to 90 degrees, then externally rotated

›Superior pain management versus other techniques

›No sedation required in most cases

›External rotation method

›Arm at side, elbow at 90 degrees, gentle slow external rotation to 70-80 degrees

›Patient in supine or sitting position

›Effective without sedation or analgesia (ERWOSA)

›Especially effective in male patients

›Cunningham technique

›Patient seated, operator massages bicipital groove and periscapular muscles

›Elbow at side, no traction applied

›Least painful, requires muscle relaxation

›Requires patient cooperation and no spasm

›Stimson technique

›Patient prone, arm hanging over table with 4-5 kg weight attached

›Gravity-assisted reduction over 15-20 minutes

›Low force, good for elderly or fragile patients

›Traction-countertraction (Hippocratic method)

›Sheet around thorax for countertraction, in-line traction on arm

›Effective but more painful than biomechanical techniques

›Requires two operators

Post-Reduction Management

›Immobilization

›Sling immobilization for 2-4 weeks for comfort

›External rotation immobilization may be superior to internal rotation in preventing redislocation

›Evidence evolving; not yet standard of care

›External rotation brace: arm at side, shoulder externally rotated 10-15 degrees

›Early mobilization preferred after age 40 to prevent stiffness

›Analgesia post-reduction

›Acetaminophen 500-1000 mg orally every 6-8 hours as needed

›Ibuprofen 400-600 mg orally every 6-8 hours with food

›Short course NSAIDs: no detrimental effect on tissue healing

›Opioids used sparingly if at all

›Ice packs to shoulder 20 minutes on, 20 minutes off for 48-72 hours

›Rehabilitation pathway

›Phase 1: passive range of motion (weeks 1-3)

›Phase 2: active range of motion (weeks 3-6)

›Phase 3: rotator cuff and periscapular strengthening (weeks 6-12)

›Phase 4: sport-specific conditioning and return-to-sport

Surgical Considerations

›Arthroscopic Bankart repair

›Significantly reduces recurrence in patients <40 years (Class I recommendation, multiple RCTs)

›Arthroscopic Bankart repair: recurrence rate 8-13% vs 40-60% conservative

›Early surgical stabilization after first-time dislocation in young athletes shows superior outcomes

›Network meta-analysis 2025: surgery superior to conservative options in adults <40

›Indications for surgical referral

›Recurrent dislocations (any age)

›Glenoid bone loss >13.5-20%

›Off-track Hill-Sachs lesion

›Bony Bankart lesion

›Young high-risk athletes in contact sports after first dislocation

›Latarjet procedure

›Indicated for significant glenoid bone loss or failed Bankart repair

›Coracoid transfer to anterior glenoid provides bone augmentation and sling effect

›Lower recurrence rate than Bankart repair when bone loss present

09Special Populations/sp59

Pregnancy

›Procedural sedation in pregnancy

›Avoid benzodiazepines and propofol (teratogenic potential, especially first trimester)

›Ketamine relatively contraindicated due to uterine stimulation effects in first trimester

›Intra-articular lidocaine 1% is preferred analgesia in pregnancy

›Lidocaine category B safety profile

›Minimal systemic absorption with intra-articular injection

›Fetal monitoring post-procedure if >20 weeks gestation

›Obstetric consultation if procedural sedation considered

›Positioning modifications

›Left lateral tilt positioning if >20 weeks gestation to relieve aortocaval compression

›Avoid prolonged supine positioning

›Imaging considerations

›Pre-reduction radiograph: 2 views with abdominal shielding

›MRI preferred over CT for soft tissue evaluation (no ionizing radiation)

›Ultrasound-guided reduction confirmation where possible to reduce radiation

›Post-reduction care

›Acetaminophen preferred for analgesia in pregnancy

›NSAIDs: caution after 32 weeks (premature ductus arteriosus closure risk)

›Orthopedic follow-up within 1 week given limited sedation options if recurrence

Geriatric

›Age-related anatomic considerations

›Rotator cuff tear most common associated injury in patients >40 years

›Prevalence 14% isolated, up to 28% combined injuries

›MRI referral at orthopedic follow-up for all patients >40 years

›Greater tuberosity fracture risk increased with age and osteoporosis

›Axillary artery injury more common in elderly due to atherosclerosis and vessel friability

›Procedural sedation modifications

›Reduced doses of sedatives required: decreased hepatic metabolism and body composition changes

›Higher risk of respiratory depression: propofol 0.5-1 mg/kg initial dose (50% reduction)

›Intra-articular lidocaine strongly preferred to avoid sedation risks

›Prolonged monitoring period post-sedation required

›Fracture threshold

›Lower threshold for pre-reduction radiograph in elderly (osteoporotic bone)

›Do not proceed with closed reduction without imaging in elderly patients

›Stimson gravity technique well tolerated in frail elderly patients

›Immobilization consideration

›Shorter immobilization period (1-2 weeks): adhesive capsulitis risk with prolonged immobilization

›Early physiotherapy referral within 1-2 weeks post-reduction

›Fall risk assessment and prevention counseling

Pediatrics

›Age-specific epidemiology

›True glenohumeral dislocations rare below age 12 (growth plate fractures more common)

›Peak incidence in adolescents ages 15-20 years

›Recurrence rate 51% in ages 15-20: highest of any age group

›Male adolescents in contact sports: highest risk group for recurrence

›Physeal injury considerations

›Proximal humeral physeal fracture (Salter-Harris) must be excluded in skeletally immature

›Apparent dislocation in child <12: consider physeal injury first

›Pre-reduction radiograph mandatory in all pediatric patients

›Orthopedic consultation for physeal fractures

›Procedural sedation in pediatrics

›Weight-based ketamine IV: 1-2 mg/kg IV or 4-6 mg/kg IM for dissociative sedation

›Midazolam 0.05-0.1 mg/kg IV (max 2 mg per dose) for anxiolysis

›Intra-articular lidocaine effective in cooperative older adolescents

›10-15 mL of 1% lidocaine (weight-adjusted, max 4 mg/kg)

›Pediatric anesthesia consultation for age <8 or complex airways

›Surgical counseling

›Early surgical stabilization: strongly recommended for adolescent athletes in contact sports

›Arthroscopic Bankart repair after first-time dislocation in high-risk adolescents: recurrence 8% vs 51% conservative

›Shared decision-making with patient, family, and orthopedic surgeon

›Growth plate closure status informs surgical approach selection

10Background/b63

Epidemiology

›Incidence and prevalence

›Glenohumeral joint is the most commonly dislocated joint in the body

›Up to 96% of shoulder dislocations occur anteriorly

›Incidence 11-29 per 100,000 persons per year

›Bimodal age distribution: peak in late teens and early twenties, second peak in elderly

›Male predominance: 3x more common than in females for recurrent instability

›Recurrence rates by age

›Ages 15-20 years: recurrence rate up to 51%

›Ages 21-40 years: recurrence rate approximately 36%

›Ages >40 years: recurrence rate 10-11%

›Each additional dislocation causes progressive bone and soft tissue loss

›Associated injury prevalence

›Bankart lesion (anterior-inferior labral tear): 59-66% of cases

›Hill-Sachs lesion (posterolateral humeral head): 71-85% of cases

›Greater tuberosity fracture: 14-35% of cases

›Rotator cuff tear: 14-28% in patients >40 years

›Axillary nerve injury: 5-18% of cases (most common neurologic complication)

›ICD-10 coding

›S43.015: Anterior dislocation of right glenohumeral joint

›S43.016: Anterior dislocation of left glenohumeral joint

›S43.019: Anterior dislocation of unspecified glenohumeral joint

Pathophysiology

›Glenohumeral joint anatomy and stability

›Inherently unstable ball-and-socket joint: glenoid surface covers only 25-30% of humeral head

›Static stabilizers: glenoid labrum, capsule, glenohumeral ligaments (inferior most important)

›Dynamic stabilizers: rotator cuff muscles, deltoid, biceps long head

›Negative intra-articular pressure contributes to joint stability

›Mechanism of anterior dislocation

›Forced abduction, external rotation, and extension levers the humeral head anteriorly

›Inferior glenohumeral ligament (anterior band) fails under tensile load

›Bankart lesion: anterior-inferior labrum avulses from glenoid rim

›Hill-Sachs impaction: posterolateral humeral head impacts anterior glenoid rim on dislocation

›Progressive bone loss mechanism

›Each dislocation episode causes incremental glenoid and humeral bone loss

›Off-track Hill-Sachs lesion: defect engages glenoid during arm elevation and external rotation

›Bipolar bone loss (glenoid + humeral) compounds instability

›Glenoid track concept: defines safe vs engaging Hill-Sachs lesions

›Bone loss >13.5-20% of glenoid width: critical threshold for instability

›Neurovascular injury mechanism

›Axillary nerve: wraps around posterior humeral head; stretched during anterior dislocation

›Axillary artery: susceptible in elderly with atherosclerosis and decreased vessel compliance

›Brachial plexus: traction injury possible with forceful or prolonged dislocation

Therapeutic Considerations

›Evidence base for reduction techniques

›No single technique clearly superior in success rate (AJEM umbrella review 2025)

›Scapular manipulation shows superior success in systematic comparisons

›FARES method: superior pain management vs other techniques

›Biomechanical techniques (without sedation) achieve high success rates in cooperative patients

›External rotation technique (ERWOSA): high success in males, minimal resources required

›Intra-articular lidocaine evidence

›Cochrane review 2011 and meta-analysis 2022 support equivalence to IV sedation

›Fewer adverse events than procedural sedation

›Shorter ED length of stay with intra-articular approach

›ACEP supports intra-articular lidocaine as appropriate first-line analgesic (Level B)

›Conservative versus surgical management

›Surgery superior to conservative options for preventing recurrence in adults <40 years

›Network meta-analysis 2025 (Arthroscopy): surgical treatment significantly reduces recurrence

›Arthroscopic Bankart repair: recurrence 8-13% vs 40-60% with conservative management

›Immediate surgical stabilization after first-time dislocation endorsed for young athletes (Level B)

›Conservative management reasonable in patients >40 (lower recurrence rate, higher surgical risk)

›Immobilization controversies

›Traditional internal rotation immobilization: standard of care for decades

›External rotation immobilization hypothesis: better labral apposition on glenoid rim

›Current evidence: external rotation may reduce recurrence but evidence remains evolving

›Duration: 2-4 weeks for comfort; longer immobilization does not reduce recurrence

11Patient Discharge Instructions/pdi33

copy discharge instructions

›What happened to your shoulder

›Your shoulder dislocated — the ball of your upper arm bone came out of its socket

›The shoulder was put back in place (reduced) in the Emergency Department

›X-rays confirmed the shoulder is back in normal position

›Sling instructions

›Wear the sling for 2-4 weeks for comfort

›Remove the sling for bathing and gentle pendulum exercises as directed

›Do not lift objects with the affected arm until cleared by orthopedics

›Keep the arm in the sling when sleeping initially if comfortable

›Medications

›Acetaminophen 500-1000 mg every 6-8 hours as needed for pain (maximum 3000 mg per day)

›Ibuprofen 400-600 mg every 6-8 hours with food as needed

›Apply ice pack wrapped in towel to shoulder for 20 minutes, 3-4 times per day for 48-72 hours

›Activity restrictions

›No contact sports, overhead activities, or heavy lifting until cleared by your orthopedic surgeon

›Avoid positions that put the arm out to the side and rotate it outward

›Driving: do not drive until cleared by your orthopedic surgeon and pain-free

›Follow-up appointments

›Orthopedic surgeon appointment within 1-2 weeks

›Bring any prior shoulder X-rays or MRI to your follow-up appointment

›Physiotherapy referral likely at your orthopedic appointment

›Return to Emergency Department immediately if

›Increasing numbness, tingling, or weakness in the arm or hand

›Loss of pulse, cold fingers, or blue discoloration of the fingers

›Worsening pain despite taking medications

›Feeling of shoulder slipping out of place again

›Fever greater than 38.5 degrees Celsius

12References/r29

Guidelines and Key Sources

›Simon LM, Nguyen V, Ezinwa NM. Acute Shoulder Injuries in Adults. American Family Physician. 2023

›PMID: 37192075

›Comprehensive clinical review of diagnosis and management

›Gonai S, Miyoshi T, da Silva Lopes K, Gilmour S. An Umbrella Review of Systematic Reviews for Assessment and Treatment of Acute Shoulder Dislocation. American Journal of Emergency Medicine. 2025

›PMID: 39442380

›Umbrella review supporting intra-articular lidocaine and biomechanical techniques

›Braun C, McRobert CJ. Conservative Management Following Closed Reduction of Traumatic Anterior Dislocation of the Shoulder. Cochrane Database of Systematic Reviews. 2019

›Cochrane review: recurrence rates by age, immobilization evidence

›Sithamparapillai A, Grewal K, Thompson C, Walsh C, McLeod S. Intra-Articular Lidocaine Versus Intravenous Sedation for Closed Reduction. CJEM. 2022

›PMID: 36181665

›Meta-analysis supporting intra-articular lidocaine equivalence to IV sedation

›Jin H, Zhang G, Chen S, et al. Surgical Treatment Is Superior to Conservative Options in Preventing Recurrence of First-Time Anterior Shoulder Dislocation in Adolescents and Adults Under 40 Years of Age. Arthroscopy. 2025

›PMID: 40939903

›Network meta-analysis supporting early surgical stabilization in young patients

›Baden DN, Visser MFL, Roetman MH, et al. Effects of Reduction Technique Without Sedation. European Journal of Trauma and Emergency Surgery. 2023

›PMID: 36856781

›Meta-analysis of biomechanical reduction techniques without sedation

Imaging and Bone Loss Guidelines

›Laur O, Ha AS, Bartolotta RJ, et al. ACR Appropriateness Criteria Acute Shoulder Pain: 2024 Update. Journal of the American College of Radiology. 2025

›Imaging algorithm for acute shoulder pain including dislocation

›MRI and CT indications following shoulder dislocation

›Provencher MT, Midtgaard KS, Owens BD, Tokish JM. Diagnosis and Management of Traumatic Anterior Shoulder Instability. Journal of the American Academy of Orthopaedic Surgeons. 2021

›PMID: 33275397

›Bone loss thresholds, off-track Hill-Sachs, surgical indications

›Hettrich CM, Magnuson JA, Baumgarten KM, et al. Predictors of Bone Loss in Anterior Glenohumeral Instability. American Journal of Sports Medicine. 2023

›PMID: 36939180

›Glenoid bone loss predictors and thresholds

Evidence & Review

Evidence & Review