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Shoulder Dislocations/Shoulder Instability
Shoulder Dislocations /Shoulder Instability
The shoulder joint is stabilized by the shoulder labrum and capsule. The labrum is a cartilage-like ring surrounding the glenoid The capsule is a series of ligaments that connects the humerus to the glenoid. When the labrum and/or ligaments stretch or tear, the shoulder has a greater tendency to dislocate. This is known as instability, which can lead to greater and more painful shoulder conditions, especially dislocation and subluxation.
Immobilization of arm after first dislocation
The usual period of immobilization is about 3 to 4 weeks in young patients.In old age sling is enough. Earlier the immobilization was very rigidly followed for fear of recurrent dislocation. However, studies have shown that the possibility of recurrence is dependent on the age of the patient and not on the period of immobilization. In the age group 20-40 years the possibility of recurrent dislocation is about 60%.
Recurrent dislocations
Head (ball) of the joint repeatedly comes out of joint at some particular movements of the shoulder eg. on ladder, when swimming, during traveling in the bus in standing.Patient need surgery to stabilize the shoulder joint ( arthroscopic bankart's repair)
Special X rays and MRI with the contrast needed most of the time to confirm the diagnosis.
A contrast MRI is performed by injecting a fluid called gadolinium into the shoulder; the gadolinium helps to differentiate tears of normal structures, including SLAP tears.
Surgery for shoulder recurrent shoulder dislocation
The new technique is arthroscopic shoulder stabilization using suture anchors(Arthroscopc bankart repair). This is done with either metallic or biodegradable suture anchors.
Bankart Procedure
The operation involves reattachment and tightening of the torn labrum and ligaments of the shoulder (see pictures below). This is done with either metallic or biodegradable suture anchors with the help of arthroscopy.
Latarjet Procedure
The Latarjet operation, also known as the Latarjet-Bristow procedure, is a surgical procedure used to treat recurrent shoulder dislocations and shoulder instability, typically caused by bone loss or a fracture of the glenoid.
The surgery involves removal of a portion of coracoids process from the scapula along with the muscles attached to it, and fixing the coracoid process in front of glenoid. This placement of the coracoid acts as a bone block, and combined with the transferred muscles acting as a strut, prevents further dislocation of the joint. In other words, removing a piece of bone from one part of the shoulder, and transferring it to the front of shoulder socket. The transferred bone acts as a physical barrier preventing the shoulder joint from dislocation and the transferred muscles gives additional stability to the joint.
The latarjet surgery is ideal treatment suited for patients with shoulder instability, recurrent shoulder dislocations, shoulder subluxations and patients with bone defects in the glenoid cavity.