Treatment of glenohumeral instability in rugby players

Rugby is a high-impact collision sport, with impact forces. Shoulder injuries are common and result in the longest time off sport for any joint injury in rugby. The most common injuries are to the glenohumeral joint with varying degrees of instability. The degree of instability can guide management. The three main types of instability presentations are: (1) frank dislocation, (2) subluxations and (3) subclinical instability with pain and clicking. Understanding the exact mechanism of injury can guide diagnosis with classical patterns of structural injuries. The standard clinical examination in a large, muscular athlete may be normal, so specific tests and techniques are needed to unearth signs of pathology. Taking these factors into consideration, along with the imaging, allows a treatment strategy. However, patient and sport factors need to be also considered, particularly the time of the season and stage of sporting career. Surgery to repair the structural damage should include all lesions found. In chronic, recurrent dislocations with major structural lesions, reconstruction procedures such as the Latarjet procedure yields better outcomes. Rehabilitation should be safe, goal-driven and athlete- specific. Return to sport is dependent on a number of factors, driven by the healing process, sport requirements and extrinsic pressures

Intra-observer and interobserver reliability of the 'Pico' computed tomography method for quantification of glenoid bone defect in anterior shoulder instability

Objective To evaluate the intra-observer and interobserver reliability of the \u2018Pico\u2019 computed tomography (CT) method of quantifying glenoid bone defects in anterior glenohumeral instability. Materials and methods Forty patients with unilateral anterior shoulder instability underwent CT scanning of both shoulders. Images were processed in multiplanar reconstruction (MPR) to provide an en face view of the glenoid. In accordance with the Pico method, a circle was drawn on the inferior part of the healthy glenoid and transferred to the injured glenoid. The surface of the missing part of the circle was measured, and the size of the glenoid bone defect was expressed as a percentage of the entire circle. Each measurement was performed three times by one observer and once by a second observer. Intra-observer and interobserver reliability were analyzed using intraclass correlation coefficients (ICCs), 95% confidence intervals (CIs), and standard errors of measurement (SEMs). Results Analysis of intra-observer reliability showed ICC values of 0.94 (95% CI=0.89\u20130.96; SEM=1.1%) for single measurement, and 0.98 (95% CI=0.96\u20130.99; SEM=1.0%) for average measurement. Analysis of interobserver reliability showed ICC values of 0.90 (95% CI=0.82\u20130.95; SEM=1.0%) for single measurement, and 0.95 (95% CI= 0.90\u20130.97; SEM=1.0%) for average measurement. Conclusion Measurement of glenoid bone defect in anterior shoulder instability can be assessed with the Pico method, based on en face images of the glenoid processed in MPR, with a very good intra-observer and interobserver reliability