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Reverse Hill Sach Lesion

- Discussion:
    - defect in anteromedial portion resulting from posterior shoulder dislocation;
    - management of this injury is determined by both the size of impression defect & time locked posterior dislocation has been present;

- Non Operative Treatment:
    - if < 20% of joint surface is involved, joint usually remains stable after reduction;
    - impression defects or head spliting frxs may result when the humeral head is severely impacted against the glenoid rim;
         - esp w/, posterior dislocations which go unrecognized;

- Operative Treatment:
    - defects involving 20-50% of joint surface, subscapularis tendon can be transferred into the defect, which should fill defect;
    - w/ a defect of > 45% or > 6 month dislocation, consider arthroplasty;
    - w/ involvement of glenoid consider total shoulder arthroplasty