Surgery as treatment for a dislocated shoulder

Shoulder dislocation accounts for 50% of all major joint dislocations seen in clinics and emergency rooms.

The primary shoulder joint has the greatest range of motion than any joint in the body due to its ball-and-socket design. A network of muscles, tendons, and ligaments, in particular the rotator cuff (a ring of tendons that encircles the shoulder joint and the joint capsule), keep this joint, the glenohumeral joint, in place.

The cost of shoulder joint flexibility is the possibility of instability. The humeral head may become displaced because the glenoid, or socket, is shallow and flat, especially at the front (anterior) of the joint.

There are various ways that a shoulder dislocation can happen. The most typical type of shoulder dislocation is an anterior one. Anterior dislocation occurs when the humeral head shifts forward. Almost 90% of dislocated shoulders are anterior dislocations. A fall on an extended arm or participation in contact sports can also result in this injury.

Another dislocation direction is the posterior dislocation, when the humeral head shifts toward the rear of the body (backward). It occurs for 2 to 4% of shoulder dislocations and is typically because of a blow during physical activity. Yet, athletes like offensive linemen and weightlifters frequently suffer from posterior dislocations.

Inferior (downward) dislocation, in which the humeral head moves downward, is the least common, accounting for only 0.5% of shoulder dislocations. This type of dislocation can happen when you apply weight or force to an extended arm that is away from your body.

Knowing the direction of the dislocation, and the potential soft tissue damage help the orthopaedic surgeon develop a diagnosis and treatment plan.

Orthopaedic surgeons usually apply nonsurgical treatment for first-time shoulder dislocations, and surgeons do not consider surgery until the shoulder shows signs of persistent instability. Physical therapy is the first step in the conservative approach since it will help to strengthen the muscles that keep the shoulder’s humeral head firmly in its socket. To compensate for the fact that the labrum, the cartilage that surrounds your shoulder, may not always heal in its natural position, the patient can strengthen the muscles surrounding the shoulder. Using this method, the patient may be able to restore their shoulder’s normal range of motion. Age and participation in contact sports both increase the risk of recurring shoulder dislocation, with young athletes participating in contact sports having a 90% higher risk of a second dislocation. As a result, when an anterior shoulder dislocation due to trauma occurs in a young athlete for the first time, surgeons are increasingly considering doing surgery right away.

 

Surgery for treating a dislocated shoulder can be either open or arthroscopically (meaning with small incisions and devices to guide the surgeon).

The orthopaedic surgeon typically performs a Bankart repair on patients who have anterior dislocations, or dislocations that point toward the front of the body. Anterior dislocations have the potential to tear the labrum, which is the cartilage that surrounds the shoulder joint. A Bankart lesion is the medical term for this type of tear. During a Bankart repair, the orthopaedic surgeon repairs and replaces the torn labrum in the shoulder joint. A shoulder dislocation’s most common type of damage is the Bankart tear. As part of a Bankart procedure, reattaching the labrum to the shoulder joint, tightens the ligament that holds the humeral head in place.

If the shoulder socket has lost bone density, the orthopaedic surgeon may recommend Laterjet surgery. The orthopaedic surgeon inserts a small portion of bone from the coracoid (a part of the shoulder blade) in the front of the shoulder socket during a Latarjet procedure. To replace the lost bone in the socket, the surgeon may use bone grafts from a donor or the patient’s iliac crest (a section of pelvic bone).

The recovery period following shoulder dislocation surgery may vary depending on the procedure type and surgical strategy of the orthopaedic surgeon (open versus arthroscopic). Most patients who have surgery undergo physical therapy while wearing a sling for several weeks. It could take several months to fully recover.

Both open and arthroscopic procedures for treating a dislocated shoulder have a high success rate in restoring function and preventing further dislocations.

Written by Elmari Snoer, BusinessBrainz

Interview with Orthopaedic Surgeon, Dr  Hannes Jonker


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