The management of recurrent shoulder instability in patients with epilepsy: a 15-year experience

BackgroundThe purpose of this study was to review our experience with recurrent shoulder instability in epileptic patients and to discuss factors influencing its management.MethodsA retrospective review was conducted at a single facility. All patients with epilepsy and recurrent shoulder instability were included for study.ResultsA consecutive series of 33 patients with 49 unstable shoulders presented during a 15-year period. Mean age at the time of the index dislocation was 20 years (range, 9-31). There were 24 patients with 36 anteriorly unstable shoulders, 6 patients with 8 posteriorly unstable shoulders, and 3 patients with 5 multidirectionally unstable shoulders. A large Hill-Sachs lesion was present in 21 shoulders. Glenoid bone loss was seen in 11 cases and involved >25% of the anterior-inferior margin in 6 cases and >50% in 2 cases. Thirty-six shoulders in 31 patients underwent surgery. Ongoing postoperative instability was found in 61% (22 of 36 shoulders) of the anterior group, 38% (3 of 8 shoulders) of the posterior group, and 40% (2 of 5 shoulders) of the multidirectional group. Skeletal reconstruction was found to be associated with a significantly lower rate of recurrence compared with an isolated soft tissue repair (P = .004). Glenohumeral arthrosis was found in 17 patients (22 shoulders) a mean of 12 years (range, 5-20) after the index dislocation.ConclusionThe presence of bone loss and degenerative changes are the principal factors affecting the specific surgical strategy employed to treat shoulder instability in patients with epilepsy.