Shoulder Dislocation


Dislocation of the shoulder usually almost always recurs. Each episode of dislocation brings with it additional damage to the cartilage of the socket (Glenoid) and the ball (head of the humerus). This damage is not reversible. The anterior labrum is a crucial stabilising structure which tears leading to the dislocation. In modern day orthopaedics, the treatment of this condition has revolutionised the outcome of the patients. Arthroscopic repair enables the patient to go home the same day or next day of surgery and helps restore the range of motion fully with a early return to pre injury level.

Shoulder is the most common joint in the body to dislocate. Due to its inherent design we have a great deal of mobility within the shoulder, which is directly at the cost of stability. Shoulder instability may present as repeated dislocation where in, patient has to go to a hospital to relocate the shoulder – often under sedation. Some times patients are able to relocate their shoulder themselves. Shoulder dislocation is a recurrent phenomenon. Commonly after the first dislocation there is a risk of 60%-80% recurrence. If the shoulder dislocates again there is more than 90% chance that it will re-dislocate. Each time the shoulder dislocates it peels off the attached ligament (Labrum) worsening the damage. Along with the ligament the cartilage of the joint on both sides (Glenoid & humerus) is damaged permanently. Cartilage damage cannot be repaired.

 

 

It is prudent to get treated early to avoid long-term problems. Repeated shoulder dislocations can lead to nerve injury, which may not heal completely. Repeated peeling off cartilage will eventually lead to early arthritis which can be disabling and compromise daily essential activities.

Symptoms

  • Common symptoms of chronic shoulder instability include:
  • Pain caused by shoulder injury
  • Repeated shoulder dislocations
  • Repeated instances of the shoulder giving out
  • A persistent sensation of the shoulder feeling loose, slipping in and out of the joint, or just “hanging there”

Physical Examination and Patient History

After discussing your symptoms and medical history, your doctor will examine your shoulder. Specific tests help your doctor assess instability in your shoulder. Your doctor may also test for general looseness in your ligaments. For example, you may be asked to try to touch your thumb to the underside of your forearm.

Imaging Tests

Doctor may order imaging tests to help confirm your diagnosis and identify any other problems. X-rays. These pictures will show any injuries to the bones that make up your shoulder joint.

Magnetic resonance imaging (MRI).

This provides detailed images of soft tissues. It may help your doctor identify injuries to the ligaments and tendons surrounding your shoulder joint. The Bankart’s Lesion is the standard lesion associated with this condition. Some or other variant of this lesion may also be found if not standard lesion. The voluminous capsule is the other commonly associated finding with this condition.

3D CT Reconstruction

This provides details of the bony structure of the shoulder. We are particularly interested in the Socket (Glenoid) shape and bone loss due to injury itself or the effect of rubbing (Erosions) in case of very frequent episode of the dislocation of shoulder. Bone loss on socket (Glenoid) side is important to decide about the possibility of the open bone augmentation procedures. The 3D CT also gives details of the depth of bone depression on the back side of the ball (Humerus Head) of shoulder in the form of Hill Sach’s lesions.

Treatment

In the past the surgery for recurrent dislocation was open surgery with long scar & mixed results. In modern era few hospitals are geared to treat this condition with Arthroscopic repair by name of Bankart repair.). The Bankart repair involves re-attaching the detached capsulo-labral complex to the glenoid using suture anchors. It is also possible to do a capsular shift (tightening of the lax capsule) at the same time. The advantage of the arthroscopic technique is its minimally invasive nature which minimizes morbidity of surgery and hospital stay. Further it allows excellent visualization of the entire shoulder joint and is very useful in detecting and treating other causes of dislocation like an ALPSA lesion as well as associated pathology like a SLAP lesion.

The keyhole surgery leaves three small scars. Patients go home on the same day or on the next day of surgery and usually resume light work in few days. Patients must avoid driving for 2 months after surgery. By three months most patients have achieved their full range of movement & strength.