Shoulder dislocation and instability

What is shoulder dislocation?
The slipping of the humeral head out of the glenoid.

How it happens?
Usually by a violence trauma or during sports.



When a shoulder is considered unstable after the 1rst dislocation?
A shoulder is considered “unstable” when it dislocates frequently or slips partially out of the joint. The 2nd conditionis known as subluxation. This could be caused by injuries to a number of structures including the labrum, glenohumeral ligaments, joint capsule or rotator cuff.In such cases the apprehension test is positive.


The apprehension test

What happens after recurrent dislocations? What can we do for prevention?
When a shoulder re-dislocates, there can be additional damage to the ligaments and the joint surfaces which may increase the risk of arthritis later in life. New arthroscopic, surgical techniques can be used to repair and stabilize shoulders after they dislocate. In some high risk individuals, surgery may be the best option, even after only a single dislocation. Arthroscopic repair minimizes pain, allows the surgery to be performed on an outpatient basis, and decreases the overall risk of complications.



Hill Sachs Lesion



Bone graft in order to treat an engaging lesion

What’s the role of arthroscopy in shoulder dislocation?
Arthroscoping stabilization surgery (surgical shoulder stabilization) can be performed through an arthroscopic procedure involving the reattachment of loose or torn ligaments to the joint with the use of special implants called suture anchors. These anchors are used to fix, hold in place and tighten injured parts of the joint.



What about the duration of arthroscopic surgery?
Usually its about 1hour but, it depends on the surgeon’s skills and the pathologic lesions.


The arthroscopic Anatomy. Note the cannulae with green colour.


Drilling the glenoid to anchor implantation.


Anchors


Suture pass tools


Retrieving sutures through tissues


Knot fixation after suture retrieval


Knot configuration and fixation


Fixation with 2 anchors implantation


Recommendations after surgery?
After arthroscopic stabilization surgery, it is crucial that the arm remain in a sling for a period of time. This helps to decrease the chance for a new injury to the repaired joint. The patient is asked notto lift any heavy objects and to rest the arm in the sling. There will be a 3-6 week period of a rehabilitation program that the joints heals. Usually pendulum exercisesstart on 2ndposo-op day while the patient is encouraged to pump the hand and move the wrist and elbow to keep the blood circulating and prevent stiffness.

Rehabilitation Following Shoulder Stabilization Surgery
There are specific guidelines for patients who have undergone arthroscopic surgery. These guidelines are broken down into various shoulder rehabilitation phases. Depending on the extent of the injury and surgery, the rehab guidelines may vary. There are simply protocols for all patients who have had arthroscopic shoulder surgery. The surgeon decides the acceleration or not of the program, according to the extent of the lesions.

 

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