The bare area of the humeral head is limited in front by the cartilage and backwards by the insertion of the Infra Spinatus tendon. There are few references in the current literature. The aim of this work was to precise the anatomic description of the bare area and to compare the size of this area in patients with anterior shoulder instability and patients without anterior shoulder instability. Material and method. We have proceeded first to an anatomic study to precise the limit of the bare area. The second part of this study was a retrospective and prospective comparative arthro CT-scan study in two groups of patients. The first group (group 1) had 48 patients, going to have anterior instability surgery. The second group (group 2) had 38 patients, without shoulder instability. Mean age was respectively 28.2 years (range: 19–48) in group 1; and 39.3 years (16–69) in group 2. The size of the bare area was measured on the axial injected CT cut passing by the larger diameter of the humeral head, The size of the bare area was definite by the angle between the line connecting the centre of the head to the posterior limit of the cartilage and the line connecting the centre of the head to the anterior point of the Infra Spinatus tendon. The reproducibility of the measure has been evaluated by a Bland and Altman test and an intra class correlation test. The measures were realised by two independent surgeons in a blind manner. The results where compared by a Student test with a threshold at 5%. Results. In the anatomic part of this study, the average angle of the bare area was 32.7° equal to 13.7mm wide. Mean intraobserver variability was 4° (range: 0 to 20°) (NS) and mean interobserver variability was 4° also (range: 0 to 20°) (NS). Mean size of the bare area was 49.6° eaqual to 19.8mm wide [range 25° to 70°] in group 1 and 33.2° equal to 13.5mm wide [range 21° to 60°] in group 2 (p< 0,05). Discussion. Our measures were reproducible. This study confirms our hypothesis: the bare area is significantly larger in shoulders suffering of anterior instability, but we cannot yet tell if this result is a consequence or a risk factor of anterior shoulder instability

Background. The functional outcome and risk of recurrence following arthroscopic stabilisation for recurrent anterior shoulder instability is poorly defined in large prospective outcome studies. This is the first study to prospectively evaluate these outcomes in patients who have been treated using this technique. Methods. We performed a prospective study of a consecutive series of 302 patients (265 men and 37 women, mean age 26.4 years) who underwent 311 (9 bilateral) arthroscopic Bankart repairs for recurrent anterior instability. Patients were evaluated preoperatively and postoperatively at 6 months, and annually thereafter. The chief outcome measures were risk of recurrence and the two-year functional outcomes (assessed using the WOSI and DASH scores). Results. On survival analysis, the overall re-dislocation rate after surgery was 13.5% (42/311 shoulders). The median time to recurrence was 12 months (range 3 to 110 months) and 55% of these developed recurrent instability within 1 year of their surgery. The median follow-up in those patients who did not re-dislocate was 70 months. There was a significant improvement in the WOSI and DASH scores at 2 years postoperatively of 21.4 and 9.9 points respectively (both p<0.001). The risk of redislocation was significantly increased by the presence of glenoid bone loss associated with or without a Hill-Sachs lesion, and the type and engagement of a Hill-Sachs lesion on arthroscopic examination (all p<0.001). However, the risk in these sub-groups was lower than that reported in previous studies. A multivariate model was produced from these parameters to estimate the risk of recurrence at the time of primary surgery. Conclusions. The majority of patients have successful functional outcomes and relatively low risk of recurrence following arthroscopic stabilisation. The identification of preoperative factors which increase the risk of instability has enabled us to better counsel patients of their risk of failure following arthroscopic repair

The generally-accepted treatment for large, displaced fractures of the glenoid associated with traumatic anterior dislocation of the shoulder is operative repair. In this study, 14 consecutive patients with large (> 5 mm), displaced (> 2 mm) anteroinferior glenoid rim fractures were treated non-operatively if post-reduction radiographs showed a centred glenohumeral joint.

After a mean follow-up of 5.6 years (2.8 to 8.4), the mean Constant score and subjective shoulder value were 98% (90% to 100%) and 97% (90% to 100%), respectively. There were no redislocations or subluxations, and the apprehension test was negative. All fragments healed with an average intra-articular step of 3.0 mm (0.5 to 11). No patient had symptoms of osteoarthritis, which was mild in two shoulders and moderate in one.

Traumatic anterior dislocation of the shoulder, associated with a large displaced glenoid rim fracture can be successfully treated non-operatively, providing the glenohumeral joint is concentrically reduced on the anteroposterior radiograph.