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How is a dislocation and traumatic shoulder instability treated?
The initial reduction of a dislocation can be quite difficult. Contractions
of the shoulder muscles can trap the humeral head against the glenoid.
Gentle traction, and at times, medication may be needed to accomplish
the reduction. Once the shoulder is reduced, a sling is used for
a few days to protect it, and relieve discomfort. Physical therapy
may help the patient regain motion in the joint.
Non-Operative Treatment
Initial treatment for recurrent instability of the shoulder centers
on physical therapy. Strengthening the rotator cuff
muscles and periscapular muscles (those around
the scapula) gives stability to the joint. The goal of physical
therapy is to help the muscles provide stability to the shoulder
that the torn ligaments can no longer supply. The therapy for recurrent
instability should be carefully designed for each patient since
this condition often causes apprehension about certain arm positions
or exercise maneuvers. Very often, physical therapy can help regain
lost motion, reduce apprehension, and restore shoulder function.
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External Rotation
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Pendulums
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Standing parallel
to an elastic resistance cord, the elbow should be bent 90
degrees at the side. The hand should slowly rotate away from
the body, using the elbow as a hinge. Rotation should continue
until the arm is in a neutral position.
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While bending
at the waist the affected arm should hang relaxed.
The arm should be moved in all directions using momentum.
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Operative Treatment
Surgery is usually recommended if recurrent instability cannot be
controlled with physical therapy and activity modification. The goal
of surgery is to return stability to the shoulder with the least loss
of motion. All shoulder procedures designed to stabilize the shoulder
involve some loss of motion. The current procedures for anterior
shoulder instability attempt to restore the normal anatomy without
over tightening the ligaments. In certain instances, such as in young
persons who have a higher risk of re-dislocation and in contact athletes
who plan on continuing to participate in sports that put their shoulders
at risk, surgery may be performed after the first dislocation.
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Use the bottons above to see the different steps.
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Open Labral Repair
Currently, the preferred procedure for anterior instability is an
open labral repair with an anterior capsular shift.
This procedure is performed through a two to three inch incision
on the front of the shoulder. The torn labrum is repaired and the
stretched-out anterior shoulder capsule is imbricated
(overlapped) to make it smaller. This procedure is successful approximately
95% of the time in eliminating recurrent dislocations.
Arthroscopic Techniques
Recently, arthroscopic procedures such as
Bankart repair have been used to repair the torn labrum
and reduce capsular laxity. Arthroscopic techniques are approximately
80% successful. These procedures are performed with visualization
through a small fiberoptic scope. Instruments are inserted into
the joint through two or three small incisions to repair the labrum.
The surgical technique is similar to the one used in an open repair.
A loose capsule is more difficult to address arthroscopically. Procedures
using thermal energy to shrink the loose capsule have been developed,
and are still being evaluated.
What types of complications may occur?
The major complications of anterior stabilization techniques are
recurrent instability and/or loss of motion. The rate of recurrent
instability depends largely on the technique used for the repair.
The loss of motion can be severe, and is a function of over tightening
the anterior capsule. In general, the operative shoulder should
lose no more than ten degrees of external rotation. Other small
risks (less than 1%) include infection, post-operative stiffness,
nerve damage, or blood vessel injury.
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© 2001 by LeadingMD, Inc. All rights reserved
Disclaimer
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What should I bring with me on my first visit to your office? |
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Get answers to this question and others in the Frequently Asked Questions Section
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