Anterior Shoulder Instability Management: Indications, Techniques, and Outcomes - Matthew Provencher, MD | Orthopedic Knee & Shoulder Surgeon

Authors:

Justin W Arner, Liam A Peebles, James P Bradley, Matthew T Provencher

Abstract:

Anterior shoulder instability is common in young athletes. Male individuals younger than 20 years who are involved in contact sports are at particular risk of injury and recurrence. Essential imaging includes radiography and magnetic resonance imaging in all patients, with 3-dimensional computed tomography being helpful to evaluate glenoid bone loss and Hill-Sachs lesions. Evaluation of the glenoid track is essential to help determine appropriate treatment because off-track scenarios in which the Hill-Sachs width is greater than the glenoid width impart a risk of failure with isolated arthroscopic treatment. Associated injuries also must be evaluated, including bone loss, Hill-Sachs lesions, humeral avulsion of the glenohumeral ligament (HAGL), glenolabral articular disruption (GLAD), anterior labroligamentous periosteal sleeve avulsion (ALPSA), rotator cuff injury, other fractures, and axillary nerve injury. Optimal treatment continues to be debated. Conservative management with physical therapy for rotator cuff and periscapular strengthening can be attempted, with the addition of bracing if continued play is desired until the season’s conclusion. Surgical intervention is considered in patients with recurrent dislocations, glenoid bone loss, or large Hill-Sachs lesions or in young athletes involved in contact or high-risk sports. Treatment options include arthroscopic capsulolabral repair with at least 4 anchors if good tissue quality and no bone loss exist. Remplissage has been recommended by some surgeons if a large Hill-Sachs exists. Open repair is suggested in patients with a high number of recurrent dislocations without bone loss or in those who participate in high-risk sports. Coracoid transfer or the Latarjet procedure is suggested in patients with bone loss greater than 20%. Bone grafting for glenoid bone loss using autograft or allograft, such as distal tibial allograft, is recommended in patients with a failed Latarjet procedure or those with significant bone loss. Hill-Sachs lesion grafting may also be beneficial in those with large lesions that engage.

For the complete study: Anterior Shoulder Instability Management: Indications, Techniques, and Outcomes

Matthew Provencher, MD

Average rating:

66 reviews

James Wilson

Oct 11, 2024

by James Wilson on Matthew Provencher, MD

Senior Electronics development engineer

Wow the Steadman clinic and Doctor Matthew Provencher now that;s a super combination of expertise, experience, empathy, skill and a cherry picked staff with truly outstanding nurses and professional support staff. I was scared of shoulder surgery until I read Dr. Provencher BIO and talked to him. If your considering shoulder replacement surgery this is the place. In three weeks out now and people are amazed at my ability of movement and flexibility I have now. I love the Steadman Clinic and Dr. Matthew Provencher, He's Superman

Anne Miller

Jun 18, 2024

by Anne Miller on Matthew Provencher, MD

Grateful to Dr Provencher and his team

I am a 75-year old, active, athletic woman. Over the last few years, both of my shoulders reached a point where severe arthritis was affecting even day to day tasks. It started with one shoulder in 2021 and recently the second reverse shoulder replacement – both with Dr Provencher. Before my first one, I had received various recommendations including adjusting my lifestyle. Dr Provencher looked at my MRI and x-ray and asked what I enjoy doing and was quick to let me know I could be back to my active lifestyle soon – and he was right. He reads images faster and more accurately than any doctor I have consulted. He has many options available and if you need surgery he is the one to do it. Surgery is quick and the recovery is much easier than I anticipated. I am 10 days out from my second reverse shoulder and have no pain and gaining mobility already! My case for both shoulders was a bit more complicated due to bone integrity, severe arthritis and bicep tears. Dr Provencher has dealt innovatively with both complications and makes it seem straightforward although I know it was not. He is not only one an extraordinary surgeon, but also, a caring human being who takes the time with his patients and makes himself available if questions arise. His team is second to none – Maddy, Madison, Sam, Scott, Jasmin and in pre-op, Layla and Kevin – in terms of commitment, competence, compassion and responsiveness. Both times I have felt cared for and that resolving my situation mattered to him. Wherever you live, Dr Provencher and his team are the ones to trust. There is no need to live a compromised life!

Gene reiling

Jul 21, 2023

by Gene reiling on Matthew Provencher, MD

Success

If you are planning to see Dr Provencher ,do not hesitate ,do it. In 2018 Dr Provencher replaced my LCL. I had no complications and very little pain. I did my physical therapy as prescribed. I was able to ski 30 plus days the winter of 2019-2020. Before seeing dr Provencher I had spent a years time trying to solve my problem locally. I saw a pain specialist, orthopedic urgent care and a orthopedic surgeon. All had access to an mri done locally. It was also read by local radiologist. Pain dr gave injections as did orthopedic urgent care. No relief from pain. Orthopedic surgeon told me about arthritis, meniscus needing cleaning up and general deterioration from age. Told me to take ibuprofen for pain. At that time I reached out to Steadman Clinic. By luck of the draw I was assigned Dr Provencher. I took with me the mri that had been done locally and viewed by 3 local Drs and 1 PA. It took Dr Provencher less than a minute to tell me my problem was my LCL after viewing my mri. He told me my options . I selected surgery as I wanted to continue an active life style. It was a complete success!!

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