Following a traumatic dislocation of the shoulder, recurrent instability—either dislocation or subluxation—may occur. This happens more frequently in patients younger than 40 years of age, and less frequently in those older than 40. Physical therapy may help to improve the effectiveness of the rotator cuff in dynamically stabilizing the shoulder, but if the torn capsulolabral complex does not heal, and symptoms of instability persist, arthroscopic surgery is feasible and efficacious in the majority of patients. Further, success rates have approached those observed with traditional open approaches, making the less invasive nature of arthroscopic repair all the more attractive. In some cases open repair may be needed, however. If a fracture of the glenoid or humerus has occurred, open techniques may be need in order to provide bony reconstruction. Postoperatively, a sling is used for 4-6 weeks. Usually therapy begins at approximately 3 weeks after surgery, and it may take upwards of 3 months to regain full motion. Return to contact sports is allowed after 4 months.
The inferior glenohumeral ligament is the primary stabilizer when it comes to resisting anterior instability. When torn acutely it is called a “Bankart lesion.” When this capsulolabral complex displaces and scars to the glenoid away from the articular rim, it may be called an ALPSA lesion (anterior labral-ligamentous periosteal sleeve avulsion). Effective surgical repair requires mobilization and repair to the glenoid articular rim. Physical exam will show that the humeral head displaces anterior to the glenoid rim to some degree. If it can be displaced to the rim it is 1+; if it can be displaced over the rim, but it spontaneously comes back, it is 2+; if it stays anterior to the rim, it is 3+ (see video of physical exam).
When a glenoid defect exceeds 20-25%, when the capusuloligamentous tissue is attritional, or when previous surgery has failed, the Latarjet procedure may be advisable--to augment the articular surface of the glenoid, to provide a sling effect from the inferior subscapularis, and to allow capsular repair (to the CA ligament).
1 comment
mtomaino 2/27/11 at 12:10 pm
If you have dislocated your shoulder only once, and are young, you may be advised to have an acute capsulolabral repair. Indeed, there are some advocates who believe that this will diminish a high risk of recurrent instabilty.
I believe that such studies are inherently flawed, and recommend that exam, assessment during recovery, and a number of other factors be considered rather than proceeding directly to surgery.
Please visit this link for more information----
http://www.rearmyourself.com/article/shoulder-dislocation
At the bottom of this page is a PDF article which provides pretty compelling evidence that acute surgery is tantamount to "unecessary" treatment in a sizeable percentage of patients.