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E1816. Imaging in Glenohumeral Instability
Authors
  1. Nicholas Barnthouse; Department of Radiology and Imaging Sciences, University of Utah
  2. Brian Chan; Department of Radiology and Imaging Sciences, University of Utah
  3. Megan Mills; Department of Radiology and Imaging Sciences, University of Utah
  4. Richard Leake; Department of Radiology and Imaging Sciences, University of Utah
  5. Pegah Khoshpouri; Department of Radiology and Imaging Sciences, University of Utah
  6. Majid Chalian; Department of Radiology, University of Washington
  7. Maryam Soltanolkotabi; Department of Radiology and Imaging Sciences, University of Utah
Background
The glenohumeral joint is the most commonly dislocated joint in the body. The high range of motion at the shoulder comes at the cost of mechanical stability, which is largely provided by soft tissue rather than osseous structures. Glenohumeral instability encompasses injury to a variety of structures including bones, labrum, ligaments, and the rotator cuff. Surgical intervention can be necessary to augment biomechanical stability at the shoulder, and radiologists should be familiar with both pre-operative considerations and post-operative imaging in order to provide value to the orthopedic surgeon.

Educational Goals / Teaching Points
The aim of this educational exhibit is to 1) review various types of glenohumeral instability (anterior, posterior, multidirectional, and flail shoulder), 2) describe relevant anatomy in the assessment of glenohumeral instability, 3) introduce operative techniques for correcting instability, and 4) present pre- and post-operative shoulder imaging as well as common imaging pitfalls through clinical cases.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Osseous, tendinous, and capsulolabroligamentous structures of the glenohumeral joint will be reviewed with attention to pathologic insults such as tears and capsular laxity that predispose to instability. Covered procedures will include soft tissue Bankart and reverse Bankart repair, open reduction and internal fixation of osseous Bankart lesions, Latarjet and Bristow, remplissage, Eden-Hybinette, Mclaughlin, capsulorraphy, and Saha procedures. Multimodality imaging manifestations of pathology, expected post-operative appearance, and common post-operative complications will be reviewed, with an emphasis on MR arthrography for evaluation of intra-articular stabilizing structures.

Conclusion
Glenohumeral instability is a debilitating condition that disproportionately affects young, active individuals. Operative techniques for increasing stability can restore normal biomechanical function and greatly increase quality of life. Understanding pre-operative imaging of glenohumeral instability is crucial in order for radiologists to guide appropriate patient selection for surgical intervention. In addition, the radiologist must be familiar with a growing number of evolving and increasingly complex procedures in order to assess for technical success and maximize sensitivity for postoperative complications.