How to Diagnosis Boney Injuries

In this video, Dr. Grant H. Garcia explains how orthopedic surgeons diagnose and evaluate bony injuries caused by recurring shoulder dislocations.

Here is a summary of the core concepts discussed:

• Understanding Bony Abnormalities: When a shoulder frequently dislocates, it can cause structural bone loss. Dr. Garcia uses the analogy of a shortened "golf tee" to describe bone loss on the shoulder socket, which can occur alongside a "dent" (Hill-Sachs lesion) on the ball of the joint. Clinical studies show that if either of these defects is too large, the joint becomes highly unstable and will continue to dislocate more frequently.
• The Impact of Recurrent Dislocations: While patients who have only dislocated their shoulder one to three times are less likely to have severe structural bone issues, those who have suffered five, six, or seven dislocations have a significantly higher risk of experiencing notable bone loss or deeper dents.
• How Diagnosis Dictates Treatment: Dr. Garcia emphasizes that identifying the exact nature of the injury is the most crucial first step because treatment paths vary drastically based on the findings:
  • Simple Labral Tears: If advanced imaging shows a straightforward tear to the cartilage padding without structural bone damage, standard arthroscopic treatment options are typically sufficient.
  • Severe Bone Loss or Large Dents: If the MRI or a follow-up CT scan reveals that a large portion of the socket bone is missing or that there is a deep Hill-Sachs lesion on the ball of the joint, more complex structural bone reconstructions are required.