Locked Glenohumeral Dislocation



A GH dislocation which has been missed for a significant period of time

- time period is arbitary

- > 3-6 weeks




Humerus soft and osteoporotic

Significant soft tissue contractures


1.  Anterior / subcoracoid dislocation



- scarring to NV structures

- RC tears including SSC, especially > 40

- anterior glenoid wear / can have significant bone loss

- large engaging Hill Sachs / humeral head defects


2.  Posterior dislocation

- posterior glenoid wear

- reverse Hill Sach's / large anteromedial defects




Anterior 41%


Posterior 59%




Multi trauma


Poor patient mental function




Limitation ROM

History multi trauma / seizures

Previous treatment

- often have had inadequate X-rays

- extensive physiotherapy / injections




Usually some asymmetry


Some reduction ROM


Palpate humeral head anteriorly / posteriorly




Scapular AP view

Scapular lateral

Axillary lateral




Aids diagnosis and preoperative planning




Non Operative



- elderly 

- minimal functional limitation

- significant medical issues


Only operate if significant clinical problems

- anterior more difficult than posterior to solve




Closed reduction




1.  Timing 

- has been successful up to 6-8 weeks

- most successful outcomes in literature < 4 weeks


2.  Humeral head impression

- if this is locked on glenoid, closed reduction is contraindicated


3.  May be unstable afterwards

- need further open procedure

- need careful postoperative monitoring

- regular xray surveillance


Chronic Anterior Dislocation


1.  Large Humeral Head Defect


Hill Sach's

- posterolateral defect

- manage according to size


Defect < 40%


A.  Elevate and Bone graft defect

- < 4 weeks in young patient

- adequate bone, salvageable cartilage

- posterior approach

- split deltoid / L shaped Infraspinatous tenotomy


B. Advance Infraspinatous +/- GT

- posterior approach

- < 20% IS alone

- if larger must also take GT


Defect > 40%


A.  Allograft

- young patient

- pre-op CT to estimate humeral head size

- appropriate sized femoral / humeral head


B.  Prosthesis

- often significant OA with long standing dislocation

- anterior glenoid deficiency

- older patient

- increase retroversion of humeral component

- may need to address anterior glenoid deficiency


2.  Glenoid Deficiencies


Indicated when > 20-25% anterior glenoid eroded


Bristow / Latarjet


Glenoid Reconstruction

- humeral head

- iliac crest


Glenoid Reconstruction Humeral HeadGlenoid Reconstruction


3.  Soft tissue deficiencies 


Always combine with anterior labral repair +/- inferior capsular shift


4.  Rotator cuff tears


Significant issue

- if massive cuff tear, may lead to chronic instability

- very difficult to treat




50 year old, missed locked anterior dislocation one year

- head severely mis-shapen

- missing 50% glenoid

- massive rotator cuff tear



- open reduction

- shoulder hemiarthroplasty / humeral head used to bone graft glenoid / rotator cuff repair

- unfortunately rotator cuff repair failed, and developed recurrent instability

- option: Reverse TSR / fusion


Locked Anterior 1Locked anterior 2Locked Anterior 3


Locked anterior MRI 1Locked anterior MRI 2Locked anterior MRI 3


Locked anterior surgery 1Locked anterior surgery 2Locked anterior surgery 3




26 year old female

- ligamentous laxity, but no previous shoulder problems

- traumatic anterior shoulder dislocation

- leading to recurrent anterior subluxation

- had an arthroscopic anterior and posterior capsular plication

- shoulder now permanently dislocated anteriorly

- options: open posterior capsular release and latarjet / or fusion


Chronic anterior dislocation 1Chronic anterior dislocation 2Chronic anterior dislocation 3


Locked anterior 1Locked anterior 2Locked anterior 3


Chronic Posterior Dislocations




Standard DP approach

- manage SSC depending on operative plan for humeral head defect

- open capsule

- remove any fibrous tissue in glenoid

- use lever to reduce humeral head

- usually can ignore posterior capsular detachments


Manage humeral head / glenoid defects


See Posterior Shoulder Instability


1.  Humeral Head defects


Posterior dislocation

- anteromedial


Defects < 40%


A.  Disimpaction and bone graft

- < 4 weeks, young patient

- articular cartilage must be salvageable

- via anterior approach


B.  McLaughlin

- < 20%, SSC only

- < 40% transfer SSC + LT into defect

- secure with 2 x cancellous screws


Defects > 40%


A. Allograft

- young patient


B.  Hemiarthroplasty / TSR


2.  Posterior Glenoid Deficiency


May need posterior bone graft