Lennard Funk presented on the clinical and radiological assessment of shoulder instability in athletes. He discussed evaluating anterior and posterior instability through physical examination tests in different positions and assessing glenoid and humeral bone loss on imaging studies like MRI arthrograms. Funk also covered management strategies and decision making, which involves considering factors related to the patient, their profession, the type and extent of pathology, and the treating physician.

1. Lennard Funk
Shoulder Instability
in the Athlete
Clinical &
Radiological
Assessment
lenfunk@shoulderdoc.co.uk

2. www.wrightington.com
My brief (10-15min):
Clinical assessment of complex anterior and
posterior instability. - with Video
Radiological assessment of glenoid
and humeral bone loss.
Management strategies
and decision making
!2

3. www.wrightington.com !3
1 Sports Injuries
of the Shoulder
Lennard Funk
Mike Walton
Adam C. Watts
Mike Hayton
Chye Yew Ng
Editors
1239 783030 230289
ISBN 978-3-030-23028-9
SportsInjuriesoftheShoulder
This book provides a practical guide detailing the aetiology,
diagnosis, relevant pathology, management principles, and out-
comes of a variety of injuries to the shoulder including rotator
cuff disorders, glenoid bone loss, and pectoralis major ruptures
in both elite and non-elite athletes. Each chapter features clinical
pearls and a question and answer section to emphasize key points.
Sports Injuries of the Shoulder is an essential book for those
seeking an up-to-date resource. It is aimed at sports doctors and
musculoskeletal doctors; senior orthopedic trainees with an
interest in upper limb and those preparing for the FRCSOrth
exam and similar international exams, as well as surgeons with
a particular interest in shoulder conditions.
Lennard Funk · Mike Walton · Adam C. Watts · Mike Hayton
Chye Yew Ng Editors
Sports Injuries of the Shoulder
Funk·Walton·Watts
Hayton·YewNgEds.

4. www.wrightington.com
Factors affecting RTP & Recurrence
Age
Type of Sport
Level of Sport
Laxity
Pathology:
Bone Loss
ALPSA / HAGL
!4

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Clinical Assessment
History:
1. Age; Level of sport; Position
2. Mechanism of Injury
3. Dislocation / Subluxation
4. Return to play?
5. Able to play?
6. Time of Season
7. Goals & Targets

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Generalised Hypermobility
Beighton Score
Normal for young adult = 4-6.
> 6 = hypermobility
1+2
3+4
5+6
7+8
9

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Anterior
Instability
1. Apprehension
• Position
2. Ant-Inf.
Apprehension
Sulcus

8. www.wrightington.com !8
Posterior Instability

9. www.wrightington.com !9
Posterior Instability

10. www.wrightington.com !10
Posterior Instability - Modifications

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1. Posterior Drawer
• Position
2. WPIT / Modified O’Brein’s
• Position
3. Kim’s Test
• Position
4. Modifications
Posterior Instability

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Investigations
X-Rays
Bony Lesions- Bony Bankart, Hill-Sachs
MR Arthrogram
All lesions
CT Scan
Accurate assessment of:
Bony deficiency
Hill Sachs size
CT Arthrogram
Previous Surgery

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MR Arthrogram
Bone enhancing
ABER in selected patients
Radial Sequences
!13

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Radial Sequences
!14
Cartesian (Rectilinear)
Radial Sampling

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How much glenoid loss
for Bony Reconstruction?
1. 10%
2. 15%
3. 20%
4. 25%

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What is a significant Hill-Sachs
Lesion?
1. 4cm long
2. 20% humeral head surface
3. 40% humeral head surface
4. Engaging at Arthroscopy

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Balance Stability Angle - Matsen
Effective Glenoid Arc = the area of the glenoid’s
articular surface available for humeral head
compression
Balance Stability Angle = the angle between the centre
of the glenoid and the end of the effective glenoid arc
in any direction (18 degrees anterior)
!17

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Largest Track (contact)
found in full ABER
= 84% of glenoid width
!18
‘Glenoid Track’

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Glenoid:
Best fit circle (Huysmans)
!19
Humerus:
Hill-Sachs on coronal
GT = 0.84xD-d HS
D
d
1.If HS > GT, the HS is ‘off track’, or engaging.
2.If HS < GT, the HS is ‘on track’, or non-engaging.
Simplified: Not validatedTokish et al. 2015

20. www.wrightington.com
Two year period of 57 Bankart repairs
On-track (49) - recurrence 4%
Off-track (8) - recurrence 75%
PPV for Glenoid Track = 75%
PPV for Glenoid loss >20% = 43%
!20

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My Approach - Glenoid
!21

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My Approach - Humerus
Funky Pizza Method
!22

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!23

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MR Arthrogram
Six-series: Bone enhancing T1 + FS (Axial & coronal)
!24
GLENOID HILL-SACHS
No bony lesion < 12.5% Arthroscopic repair
No bony lesion > 12.5% Arth repair & Remplissage
Any bony lesion < 25% Latarjet
Any bony lesion > 25 - 40% Latarjet & Remplissage
Any bony lesion > 40% Latarjet & Allograft

25. Physician
Experience
Facilities
Evidence
Preference
www.wrightington.com
Decision Making
!25
Profession
Time of Season
Career Targets
Economics
Social Factors
Pathology
Glenoid Loss
Hill-Sachs
HAGL
Cuff Tear
Player
Position
Preference
Previous Injuries
Age

26. www.wrightington.com
My brief:
Clinical assessment of complex anterior and posterior
instability. - with Video
History; Exam (positions)
Radiological assessment of glenoid and humeral bone loss.
MRA vs CTA: Radials
Assessing Bone Loss
Management strategies and decision making
1. Patient
2. Profession
3. Pathology
4. Physician
!26

27. www.wrightington.com !27
“Soap and water
and common sense are the
best disinfectants”
William Osler