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Education · shoulder

Latarjet Procedure Info In-depth Evidence Consent

Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed

Related shoulder topics. Shoulder instability , Anterior stabilisation and SLAP & biceps pathology .

Also on YouTube.

Video transcript

Your shoulder may keep slipping out of place during everyday movements, making simple tasks feel unpredictable and uncomfortable. This recurring instability often disrupts normal routines, whether you are reaching for a shelf or trying to rest through the night. The condition is medically known as anterior instability, where the joint repeatedly loses its secure position. It can cause a sense of uncertainty when lifting objects or turning your arm. Many people find that these episodes gradually limit their confidence in using the affected side. This operation is usually recommended when you have bone loss from repeated dislocations, or if you dislocate after having had a shoulder stabilisation surgery. The primary aim is to create a more secure foundation than standard soft tissue repairs, which significantly reduces the likelihood of future slipping. Your surgeon focuses on restoring reliable function so you can safely return to your regular daily activities. While most individuals experience strong improvements, outcomes can vary slightly based on personal health factors rather than the severity of the instability. The procedure is designed to provide lasting stability when other approaches fall short. The surgery is performed using a keyhole approach, which involves making several small incisions near the front of your shoulder. A tiny camera is passed through these openings so the surgeon can view the inside of the joint clearly. Special instruments are then used to repair cut the coracoid and move it into position, where it is fixed with screws. Once the repair is finished, the small cuts are closed with sutures or medical glue, and a protective dressing is applied. You will wake up in a recovery area where your discomfort is managed and your shoulder is supported in a sling. Most patients are well enough to go home the same day, though someone must stay with you for the first twenty four hours. Gentle arm movements can begin soon after surgery, while a sling is worn for the first few weeks to protect the healing tissues. A physiotherapist will guide you through safe exercises to gradually restore your range of motion. You will slowly progress to more complex daily tasks as your strength returns and the swelling settles. While most people recover smoothly, occasional problems can arise and require careful monitoring. Spreading redness around the small cuts or a persistent fever may signal an infection that needs prompt attention. You might experience deep pain that simple painkillers cannot ease, or notice a new clicking sensation in the joint. In rare instances, the shoulder could slip out of place again, or wear and tear arthritis may develop over time. Any sudden swelling or severe discomfort should be reported to your surgeon immediately for further assessment.

Why this operation has been suggested

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At your first visit we take a history, examine your shoulder and arrange imaging if it is needed. For a shoulder that keeps dislocating or slipping out of place, we usually try non-operative care first, such as physiotherapy and changes to your activities. Surgery comes into the conversation when those options have not given you enough improvement.

The operation suggested for you is called a Latarjet procedure. It moves a small piece of bone from another part of your shoulder blade to the front of your shoulder socket, where it helps hold the joint in place. We offer it when your shoulder has come out of joint more than once, or when there is bone damage around the socket. The main aim is lasting stability, so your shoulder stays put and you can use your arm with confidence. With careful selection of who has the operation, it prevents repeat dislocation in about 99% of cases.

Before the operation

In the weeks before surgery we arrange the scans needed to plan your operation. This usually includes X-rays, and sometimes an MRI (a scan that shows soft tissues) or an ultrasound. On the day, you will need to stop eating and drinking seven hours beforehand. We ask for seven hours so we can bring you forward if the theatre list runs early; your surgeon will confirm your exact time. You may be asked to stop some of your usual medications, and we will give you clear instructions about which ones. Bring a list of everything you take. Arrange for someone to drive you home afterwards, and wear loose, comfortable clothing. If you have other medical conditions, you may need blood tests or a review with the anaesthetist (the specialist who keeps you safe and pain-free during the operation).

On the day

You arrive at the hospital's surgical admissions unit, where we check you in and prepare you for theatre. This operation is done under general anaesthetic combined with a regional nerve block. The anaesthetist will meet you before the operation and talk you through both parts. You are then taken into the operating theatre, where the operation is performed.

When the operation is finished, you wake up in the recovery area. Nurses stay with you and keep an eye on you while the anaesthetic wears off. Once you are stable, you go to the ward. When you go home, someone must drive you, as you will not be able to drive yourself.

What the operation involves

Your surgeon does this operation as keyhole surgery, also called arthroscopic surgery. A small camera is placed inside your shoulder joint through small cuts around the shoulder, including one at the back. The camera sends a picture of the inside of your joint to a screen, so your surgeon can see and work inside the shoulder without opening it up.

The operation moves a small piece of bone from your shoulder blade, called the coracoid, to the front of your shoulder socket. This piece of bone is held in its new position with screws. It acts as a support that stops your shoulder from slipping out of joint towards the front. Because the transferred bone brings a piece of attached tendon with it, it also adds a brace across the front of the joint.

At the end of the operation, your surgeon closes the small cuts with stitches and covers them with a dressing. You will wake up in the recovery area with your arm supported in a sling.

After the operation

When you wake up, you will be moved to the recovery ward. Nurses will check on you regularly and give you pain relief as you need it. Your arm will rest in a simple sling for comfort, which comes off for exercises and washing. Most patients stay one or two nights in hospital after this operation. Because you will still be feeling the effects of the anaesthetic, someone should stay with you for the first 24 hours. We leave the dressing on for about 10 days; please do not take it off before then unless we tell you to. We change or remove it when we see you. You will be able to walk around on the day of surgery, with help at first.

Recovery

Your shoulder will be sore and swollen for the first few days. This settles gradually over the following weeks. Regular pain relief, rest and ice packs help ease the discomfort. The small cuts around your shoulder heal under the dressing we leave in place for about 10 days.

You will go home with your arm resting in a simple sling for comfort. It comes off for your exercises and for washing. Your physiotherapist will guide you through gentle movements at first, then more active exercises as your shoulder settles. You will be able to walk around from the day of surgery, with help at first. Sleep can be awkward with a sore shoulder; many people find resting propped up more comfortable in the early weeks. Around the house, you will need help with tasks that need both hands, such as dressing and cooking, until your arm is ready.

Progress comes in stages rather than all at once. Once the worst of the swelling settles, everyday movements feel easier. As your range of motion returns, your physiotherapist will add gentle strengthening. Once your surgeon clears you to drive, typically at the six-week review, you can find more detail in our guide on Driving after upper-limb surgery. Returning to work and sport happens in steps, guided by how your shoulder feels and what your surgeon and physio advise.

Recovery varies between individuals. Your timeline may differ, and your surgeon and physiotherapist will guide you along the way.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

Sometimes the shoulder can slip or feel loose again after surgery. You might notice the same sense of the joint shifting that led you here. Tell your surgeon at your next review, or call the clinic sooner if it feels like a full dislocation.

The bone graft and the screws holding it can occasionally cause problems. You might feel a click, a catch or a grating deep in the shoulder, or a pain that does not settle the way you expected. Mention this at your review so it can be checked with imaging.

Nerves near the shoulder can be irritated during surgery. This might show as numbness, tingling, weakness or a burning feeling in the shoulder, arm or hand. Most of these settle with time. If you notice new numbness or weakness, let the clinic know so it can be watched closely.

Infection is uncommon but needs quick attention. Watch for a deep, throbbing pain that does not ease with simple painkillers, redness spreading out from the wounds, swelling that keeps growing, or a fever. Some infections stay close to the skin and settle with antibiotic tablets. Others go deeper and need a return to theatre to wash the area out, along with antibiotics through a drip. If you see any of these signs, call the clinic straight away or go to the emergency department.

Pain and stiffness that do not improve can occasionally persist. If your shoulder is not easing as the weeks pass, bring it up at your review so your recovery plan can be adjusted.

Arthritis can develop or worsen in the shoulder many years after this operation, though it is usually mild when it happens. You might notice aching, stiffness or grinding that builds slowly over time. Mention any of these changes at a later review.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Most problems after this operation show up in ways you can see or feel. Call us if you have a fever, if the skin around your wounds becomes more red or starts leaking fluid, or if pain suddenly gets much worse. Go to emergency if you have swelling in your calf, shortness of breath, new numbness in your arm or hand, or if you cannot move the arm at all. These signs need checking straight away. If you are unsure, call the clinic and we will guide you.

In more depth

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. The Latarjet is worth the extra reading because it is the clearest trade-off in shoulder surgery: it is the more reliable operation for keeping the shoulder in, and it is the one with more that can go wrong. Deciding between it and a soft-tissue repair means deciding which of those you weight more heavily.

What it buys

Compared directly with arthroscopic Bankart repair, the Latarjet procedure produced a lower recurrence rate, better patient-reported outcomes, and a faster return to sport, while carrying a higher incidence of complications [1]. A long-term comparison of 3,088 patients found the same directional result: lower recurrent instability and lower revision rates after open Latarjet than after arthroscopic Bankart, with comparable rates of moderate-to-severe arthritis between the two [2].

That last detail matters, because the standard worry about the Latarjet is that moving bone and tendon across the front of the joint must accelerate arthritis. On this evidence, at long-term follow-up, it did not, the arthritis rates were similar.

What it costs

Pooling 7,175 patients, the overall complication rate after the Latarjet was 6–7%, with graft-related problems the most common category [3]. There was no significant difference in complication rate between the open and arthroscopic versions of the operation [3].

Six to seven percent is neither trivial nor alarming, and the composition is the useful part: the complications cluster around the transferred bone, its fixation, its healing, its resorption, rather than around the joint itself. That is intrinsic to what the operation does.

Why it is not simply the better operation

If the Latarjet has lower recurrence, an obvious question is why anyone has a Bankart repair.

Part of the answer is the complication rate above. The other part is that the soft-tissue options have improved. Across 2,100 patients, adding a remplissage to a Bankart repair reduced instability recurrence compared with isolated Bankart repair without a significant external rotation deficit, and may reduce the risk of reoperation compared with Latarjet [4].

So the real decision is three-way rather than two-way, and it turns on your glenoid bone loss, your Hill-Sachs lesion, your sport and your age, not on which operation has the best headline recurrence figure.

Do it first, if you are going to do it

One finding deserves emphasis because it affects sequencing rather than technique. Pooling 1,571 patients, salvage Latarjet, performed after a failed previous stabilisation — produced inferior outcomes to primary Latarjet in terms of recurrent instability and return to pre-injury sport [5].

The Latarjet is often described as the fallback if a Bankart repair fails. This is evidence that it works less well in that role than when chosen first. For a patient with substantial bone loss and high demands, "try the smaller operation and we can always do the Latarjet later" is a plan with a measurable cost attached.

Reviewed by Dr Kieran Hirpara · 7 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

References for the advanced reading
  1. Hossein Zadeh R, Daliri M, Sadeghi M, Hossein Zadeh R, Sahebi M, Moradi A, et al. Arthroscopic Bankart repair vs. Latarjet procedure for recurrent shoulder instability: a meta-analysis. J Shoulder Elbow Surg. 2024;33(12):e652-e674.
  2. Meyer AM, Lorentz SG, Klifto CS, Bradley KE, Lau BC, Dickens JF, et al. Open Latarjet results in lower recurrent instability and revision rates than arthroscopic Bankart repair at long-term follow-up. Arthroscopy. 2025;41(9):3693-705.
  3. Hurley ET, Schwartz LB, Mojica ES, Campbell KA, Matache BA, Meislin RJ, et al. Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elbow Surg. 2021;30(7):1693-9.
  4. Gonzalez-Morgado D, Ardebol J, Noble MB, Galasso LA, Menendez ME, Denard PJ. No difference in external rotation loss after isolated Bankart repair, remplissage, or Latarjet: a systematic review and meta-analysis. Am J Sports Med. 2025;53(2):493-500.
  5. Zhang C, Yang S, Pang L, Li T, Li Y, Wang H, et al. Salvage Latarjet may provide worse outcomes in terms of recurrent instability and return to sport compared with primary Latarjet: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024;25(1).
Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology

Bony Anatomy

  • The glenoid is a convex structure of shallow depth shaped like an inverted pear [3].
  • The glenoid cavity is a shallow socket, approximately one third the size of the humeral head [4].
  • The subchondral bone of the glenoid is relatively flat, and the articular concavity is augmented by cartilage and a circumferential labrum [6].
  • The glenoid averages 5° of retroversion in relation to the axis of the scapular body [6].
  • The humeral head is spherical and has a diameter of 37 to 57 mm [3].
  • The most superior portion of the articular surface of the humeral head averages 8 mm above the greater tuberosity [3].
  • Humeral version averages 29.8 degrees, with a range of 10 to 55 degrees [3].
  • The humeral head is inclined approximately 130 degrees with respect to the humeral shaft [3].
  • The neck-shaft angle measures an average of 135 degrees [4].
  • The humeral head is retroverted an average of 30 degrees [4].
  • The humeral head averages 19° of retroversion and 41° of inclination (neck-shaft angle) [6].
  • The bicipital groove lies between the greater tuberosity and lesser tuberosity and serves as a pathway for the long head of the biceps [3].
  • The distal aspect of the bicipital groove is internally rotated with respect to the proximal portion [3].
  • The anatomic neck of the proximal humerus is located at the junction of the articular surface and the tuberosities [3].
  • The surgical neck represents an indistinct region (metadiaphyseal junction) below the tuberosities but above the humeral shaft [3].
  • The greater tuberosity is located in a posterior-superior location with respect to the humeral shaft [3].
  • The lesser tuberosity is located on the anterior aspect of the proximal humerus [3].
  • The scapula is triangular when viewed anteroposteriorly, with its base situated superiorly and its apex inferiorly [5].
  • The glenoid is connected with the flat body of the scapula by the scapular neck [5].
  • The coracoid process curves forwards from the superior surface of the scapular neck [5].
  • The scapular spine ends in a flattened bony process, the acromion, which curves forwards [5].
  • The highest concentration of bony mass in the scapula is found in the glenoid, the scapular neck (including the base of the coracoid process), and the lateral border of the scapular body [5].
  • Two bony pillars transmit compressive forces from the glenoid fossa: the lateral pillar and the spinal pillar [5].
  • The lateral pillar connects the inferior border of the glenoid with the inferior angle [5].
  • The spinal pillar arises from the central part of the glenoid and continues medially to become part of the base of the scapular spine [5].
  • The weakest bone in the scapula is located primarily in the central part of the biomechanical body, specifically in the infraspinous fossa [5].
  • The weakest area of the circumference of the biomechanical body of the scapula is the spinomedial angle, which is the connection of the scapular spine and the medial border of the scapula [5].
  • The acromion has three ossification centers: the metacromion (base), the mesoacromion (middle), and the preacromion (tip) [6].
  • The proximal humerus has three centers of ossification: the humeral head (4 to 6 months), the greater tuberosity (1 to 3 years), and the lesser tuberosity (3 to 5 years) [6].
  • The ossification centers of the proximal humerus fuse to the shaft at age 17 to 20 years [6].

Soft Tissue & Ligaments

  • The greater tuberosity serves as the attachment site for the supraspinatus, infraspinatus, and teres minor tendons of the rotator cuff [3].
  • The lesser tuberosity serves as the attachment site for the subscapularis tendon [3].
  • The rotator cuff consists of four muscles: the subscapularis, supraspinatus, infraspinatus, and teres minor [4].
  • The teres major is not a rotator cuff muscle [4].
  • The rotator cuff muscles serve as depressors of the humeral head to allow the deltoid to efficiently abduct the humerus [4].
  • The infraspinatus and teres minor are external rotators, while the subscapularis is an internal rotator of the humerus [4].
  • The acromion, the coracoacromial ligament, and the coracoid process form the coracoacromial arch [3].
  • The coracoacromial arch is a rigid bony-ligamentous structure that imparts stability to the shoulder girdle [3].
  • The rotator cuff, subacromial bursa, and subdeltoid bursa pass underneath the coracoacromial arch [3].
  • The glenoid labrum provides concavity and up to 50% of marginal glenoid socket depth [6].
  • The rotator interval is defined medially by the base of the coracoid, superiorly by the supraspinatus tendon, and inferiorly by the subscapularis tendon [6].
  • The rotator interval contains the coracohumeral ligament, the superior glenohumeral ligament, and the intra-articular portion of the long head of the biceps tendon [6].
  • The coracohumeral ligament restricts external rotation in adduction and is a static restraint to inferior and posterior translation in adduction and external rotation [6].
  • The superior glenohumeral ligament is a primary static restraint against anterior translation with the arm at the side [6].
  • The superior glenohumeral ligament, along with the coracohumeral ligament, forms a pulley that provides restraint against medial subluxation of the long head of the biceps tendon [6].
  • The middle glenohumeral ligament is a primary static restraint against anterior translation with the arm in external rotation and 45° of abduction [6].
  • The anterior band of the inferior glenohumeral ligament is a primary static restraint against anterior-inferior dislocation of the glenohumeral joint in 90° of abduction and external rotation [6].
  • The posterior band of the inferior glenohumeral ligament is a primary static restraint against posterior-inferior translation in internal rotation and adduction [6].
  • The superior transverse scapular ligament arises from the medial base of the coracoid overlying the suprascapular notch [6].
  • The suprascapular artery runs superior to the superior transverse scapular ligament, while the nerve runs deep to it [6].
  • Entrapment of the suprascapular nerve at the superior transverse scapular ligament causes denervation of both the supraspinatus and the infraspinatus [6].
  • The spinoglenoid ligament overlies the suprascapular nerve at the spinoglenoid notch [6].
  • Entrapment, traction, or compression of the suprascapular nerve at the spinoglenoid notch causes denervation of the infraspinatus [6].
  • The subscapular bursa lies between the subscapularis tendon and the neck of the scapula [7].
  • The subscapular bursa communicates with the joint cavity between the superior and middle glenohumeral ligaments [7].
  • The subscapular bursa protects the tendon of the subscapularis at the point where it passes under the base of the coracoid process and over the neck of the scapula [7].
  • The subscapular bursa is linked to the coracoid process by a suspensory ligament [7].
  • In 28% of specimens dissected by Colas and colleagues, the subscapular bursae merged with the subcoracoid bursae, forming a unique wide bursa [7].
  • The subscapular bursa often houses loose bodies in the shoulder [7].
  • The subscapular bursa is a region in which synovitis of the shoulder may be most intense [7].
  • A soft tissue sheath consistently covers the long head of the biceps tendon to the level of the proximal margin of the pectoralis major tendon [7].
  • The fibro-osseous bicipital tunnel consists of three distinct anatomic zones: Zone 1 (bony groove), Zone 2 ("no man's land"), and Zone 3 (subpectoral region) [7].
  • Zone 1 of the bicipital tunnel represents the traditional bony bicipital groove beginning at the articular margin and ending at the distal margin of the subscapularis tendon [7].
  • Zone 2 of the bicipital tunnel extends from the distal margin of the subscapularis tendon to the proximal margin of the pectoralis major tendon [7].
  • Zone 3 of the bicipital tunnel is distal to the proximal margin of the pectoralis major tendon and represents the subpectoral region [7].

Vascular Supply

  • The proximal humerus receives its blood supply from the anterior and posterior humeral circumflex branches from the third division of the axillary artery [3].
  • The posterior humeral circumflex artery travels with the axillary nerve, enters the quadrilateral space posteriorly, and anastomoses with a branch of the anterior circumflex to supply the posterior cuff [3].
  • The anterior humeral circumflex artery arises from the axillary artery at the inferior border of the subscapularis [3].
  • The anterior humeral circumflex artery provides vascular inflow to the humeral head by way of its terminal anterolateral branch known as the artery of Laing (also known as the arcuate artery) [3].
  • The ascending branch of the anterior humeral circumflex artery courses parallel to the lateral aspect of the long head biceps tendon and enters the humeral head at the interface of the bicipital groove and greater tuberosity [3].
  • Injury to the arcuate artery may result in osteonecrosis of the humeral head [3].
  • Additional extraosseous collateral branches can permit humeral head perfusion despite complete ligation of the arcuate artery [3].
  • The major blood supply to the humeral head is through the ascending branch of the anterior humeral circumflex artery, which penetrates the head at the bicipital groove and becomes the arcuate artery [4].
  • The anterolateral ascending branch of the anterior humeral circumflex artery provides the primary blood supply to the humeral head [6].
  • The anterolateral ascending branch of the anterior humeral circumflex artery travels proximally in the lateral aspect of the intertubercular groove [6].
  • The terminal intraosseous portion of the anterior humeral circumflex artery enters at the proximal aspect of the intertubercular groove as the arcuate artery [6].
  • Fractures of the anatomic neck have a poor prognosis because of complete disruption of the blood supply to the head [4].
  • Surgical neck fractures are common, and with these, the blood supply to the head is preserved [4].

Biomechanics & Pathophysiology

  • Stability and function of the glenohumeral joint is provided by the interaction of the glenohumeral joint that promote a near global range of motion and purposeful function [3].
  • External loads transferred to the shoulder girdle are initially offset by joint surface anatomy, joint volume, atmospheric pressure, and joint fluid cohesion and adhesion [3].
  • Moderate and large loads are counterbalanced by the deltoid and rotator cuff and by the capsulolabral and bone structures, respectively [3].
  • Normal shoulder motion is approximately two-thirds glenohumeral and one third scapulothoracic [6].
  • The superior shoulder suspensory complex provides a stable connection between the scapula and the axial skeleton [6].
  • The superior shoulder suspensory complex is composed of the glenoid, the coracoid process, the coracoclavicular ligaments, the distal clavicle, the acromioclavicular joint, and the acromion [6].
  • The superior strut of the superior shoulder suspensory complex comprises the middle clavicle [6].
  • The inferior strut of the superior shoulder suspensory complex comprises the lateral scapular border/spine of the scapula [6].
  • The sternoclavicular joint is the only true diarthrodial articulation between the upper appendicular and axial skeletons [6].
  • The posterior sternoclavicular joint capsule and ligaments are the primary stabilizers to anterior and posterior translation of the medial clavicle [6].
  • The acromioclavicular joint is a small diarthrodial joint with an interposed fibrocartilaginous disk [6].
  • The superior and posterior acromioclavicular ligaments are the primary stabilizers to anterior and posterior (horizontal) translation of the clavicle [6].
  • The coracoclavicular ligaments (conoid: medial; trapezoid: lateral) are the primary stabilizers to superior (vertical) translation of the distal clavicle [6].
  • Dynamic stabilizers of the glenohumeral joint include the rotator cuff, which stabilizes the joint via joint compression [6].
  • Static stabilizers of the glenohumeral joint include articular congruity, the glenoid labrum, concavity-compression, negative intra-articular pressure, and the glenohumeral capsule and ligaments [6].
  • Laxity of the rotator interval results in inferior laxity (the sulcus sign) [6].
  • Contracture of the rotator interval is seen with adhesive capsulitis [6].
  • The malcentering of the joint reaction force on the glenoid leads to posterior instability, posterior glenoid wear, and "rocking horse" loosening of prosthetic glenoid components [2].

Investigations

Radiographic Evaluation

  • The purpose of shoulder imaging is to help establish the diagnosis, determine the severity of pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [2].
  • Unless a specific research protocol is in place, the temptation to “overimage” should be resisted by obtaining only the scans or reconstructions necessary for patient care [2].
  • CT scans may offer increased precision in measuring glenoid version, but this precision does not necessarily improve the quality of surgery or clinical outcome [2].
  • Standardized plain films are almost always sufficient to garner the information needed for care [2].
  • Proper radiographic technique is as important as proper surgical technique to achieve the desired outcome [2].
  • The first key radiographic view is the anteroposterior (AP) view in the plane of the scapula, taken so that the x-ray beam passes through the glenohumeral joint [2].
  • The AP view in the plane of the scapula shows the superoinferior position of the humeral head relative to the glenoid, presence of osteophytes, narrowing of the joint space, degree of medial displacement of the humerus, quality of bone, presence of loose bodies, and humeral head collapse or deformity [2].
  • The second key radiographic view is the axillary view taken with the arm in the functional position of elevation in the plane of the scapula [2].
  • The axillary view is oriented so that both the spinoglenoid notch and the scapular neck are visible [2].
  • The axillary view demonstrates glenohumeral relationships in the functional position of elevation, referred to as the “truth view” [2].
  • CT scans have the disadvantage of being taken with the arm in the adducted position, whereas the axillary truth view is taken in elevation [2].
  • Many “axillary views” sent for consultation are taken without standardization, making it impossible to determine important features of the glenohumeral joint [2].
  • When taken properly, standardized anteroposterior and axillary views indicate cartilage space thickness, relative positions of the humeral head and glenoid, presence of osteophytes, degree of osteopenia, and extent of bony deformity and erosion [2].
  • Joint space narrowing is most evident on the axillary truth view as opposed to images made with the arm at the side [2].
  • The standardized axillary view can show posterior subluxation or “functional decentering” that is not evident in images taken with the arm at the side [2].
  • The degree of posterior subluxation can be measured by the position of the center of the humeral head in relation to the plane of the scapula [2].
  • The degree of posterior subluxation can be measured by the position of the center of the humeral head in relation to the glenoid face [2].
  • The degree of posterior subluxation can be measured by the point of contact of the humeral articular surface on the glenoid articular surface [2].
  • The point of contact of the humeral articular surface on the glenoid articular surface reflects the degree of centering of the net humeral joint reaction force on the glenoid [2].
  • Malcentering of the joint reaction force leads to posterior instability, posterior glenoid wear, and “rocking horse” loosening of prosthetic glenoid components [2].
  • At least two X-ray views should be obtained: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction [11].
  • The axillary projection with the arm in abduction shows the relationship of the humeral head to the glenoid [11].
  • Three-dimensional reconstructions can reveal fine details of shoulder anatomy, but this additional information rarely changes the planning or conduct of arthroplasty [2].

Magnetic Resonance Imaging

  • Magnetic resonance imaging (MRI) is useful to identify osteonecrosis of the humeral head or a bone tumour [11].
  • MRI can identify labral tears and rotator cuff tears [11].
  • The accuracy of MRI for identifying labral tears and rotator cuff tears is enhanced by combining the scan with arthrography [11].

Computed Tomography

  • Computed tomography (CT) is helpful for planning fracture surgery and shoulder joint replacement [11].

Ultrasonography

  • Ultrasonography is a simple and accurate test for identifying rotator cuff tears and calcific tendinitis [11].
  • Ultrasonography can be useful in guiding injections or barbotage (aspirating calcific deposits in the rotator cuff) [11].
  • The most commonly performed joint examination using ultrasonography is the shoulder examination [9].
  • The accuracy of rotator cuff ultrasonography depends on the skill of the scanner operator and an awareness of pitfalls encountered [9].

General Imaging Principles

  • The shoulder is a three-dimensional structure that cannot be represented by a single planar view [13].
  • Critical relationships, such as the degree of centering of the humeral head, change with the position of the arm [13].
  • Shoulder pathology may be found in a large number of different bones and soft tissues [13].
  • Overlying and superimposed structures as well as metallic implants may complicate imaging the structures of interest [13].
  • Surgeons need to develop a judicious approach to imaging that yields necessary information while avoiding the tendency to "over-image" [13].

References

[2] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Radiographic Evaluation.

[3] Rockwood And Matsen S The Shoulder. Shoulder and Elbow Specialty Clinic Workers’ Survey > ANATOMY.

[4] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 2Musculoskeletal Trauma Surgery > SHOULDER AND ARM INJURIES.

[5] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Applied Anatomy Related to Scapular Fractures.

[6] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Shoulder, Arm, and Elbow > I. Shoulder.

[7] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Bursae.

[9] Orthopaedic Knowledge Update Sports Medicine 6. Diagnostic Ultrasonography and Ultrasonography-­Guided Procedures > Annotated References.

[11] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INVESTIGATION.

[13] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > SENIOR EDITOR COMMENTARY.

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