Shoulder Dislocation

WHAT IT IS ?

A dislocated shoulder occurs when the humerus separates from the scapula at the glenohumeral joint. The shoulder joint has the greatest range of motion of any joint in the body and as a result is particularly susceptible to subluxation and dislocation.[1] Approximately half of major joint dislocations seen in emergency departments involve the shoulder. Partial dislocation of the shoulder is referred to as subluxation.

CAUSE OF RECURRENT DISLOCATION :

Once dislocated , shoulder joint is prone for repeated , recurrent dislocations . basic pathology in shoulder dislocation is tearing of labrum (protective soft tissue ) from glenoid (shoulder cup) OR bony defect ( hill sach’s lesion) in head of humerus . with each dislocation chances of subsequent dislocation increase .

SIGNS AND SYMPTOMS :

Significant pain, sometimes felt along the arm past the shoulder.

  • Inability to move the arm from its current position, particularly in positions with the arm reaching away from the body and with the top of the arm twisted toward the back.
  • Numbness of the arm.
  • Visibly displaced shoulder. Some dislocations result in the shoulder appearing unusually square.
  • No palpable bone on the side of the shoulder.
INVESTIGATIONS REQUIRED :

Usually a MRI is enough to confirm the labral tear for recurrent dislocations . but in case of multiple dislocaiotns a CT scan might be required to look for and quantify the bony defect

TREATMENT POSSIBLE :

No amount of physiotherapy or medicine can correct a recurrent shoulder dislocation . but it is totally curable with surgery

  • ARTHROSCOPIC (KEY HOLE SURGERY ) : also called as arthroscopic bankart repair. It is done when there is isolated labral tear (bankart lesion). The labrum is sewd back to the socket with special anchors . A small defect can be filled with a concomitant filling with soft tissue (remplissage )
  • LATARJET PROCEDURE : it is the bony procedure for large bony defects. It is done when there is significant defect in ball or socket. this procedure involves removing a piece of bone from another part of the shoulder, and attaching it to the front of your shoulder socket. The bone will then act as a barrier which will physically block the shoulder from slipping out of the socket, while the muscles which are transferred with the bone will give additional stability to the joint.
REHABILITATION AND RECOVERY :
  • Arthrosocopic surgery : patient is allowed to move and lift shoulder by himself the very next day of surgery . there is minimal pain after surgery and most patient don’t require any analgesics(pain killers ) after 2-3 days . by 1.5- 2 months patient is able to do all functions
  • LATARJET PROCEDURE :patient is instructed to keep arm in pouch arm sling till the defect is covered by bone. Usually the patient is able to do full movements by end of 2 months
REHABILITATION AND RECOVERY :
  • Arthrosocopic surgery : patient is allowed to move and lift shoulder by himself the very next day of surgery . there is minimal pain after surgery and most patient don’t require any analgesics(pain killers ) after 2-3 days . by 1.5- 2 months patient is able to do all functions
  • LATARJET PROCEDURE :patient is instructed to keep arm in pouch arm sling till the defect is covered by bone. Usually the patient is able to do full movements by end of 2 months