Instability/Recurrent Shoulder Dislocation

Normal Shoulder Xray
Dislocated Shoulder Xray

Recurrent shoulder dislocation is a common out-patient diagnosis. The patient compliants of inability to take the shoulder in a throwing position and painful range of motion at involved shoulder. The apprehension in taking the shoulder ino throwing position is main sign on examination. Young patients with high demand or athletic activity have highest chances of redislocation (upto 90%). The patients reporting of recurrent dislocations regularly, while sleeping and habitual relocators are the ones who have clear cut indications for surgical treatment.

The soft tissue envelope around the bony cup of the shoulder is called the capsulolabral complex which tears off while the humeral head (ball) dislocates. This barrier is a bone to soft tissue connection and once broken, does not heal by itself. The cases who once dislocate, have a high chance of re-dislocating it again even with slightest trauma or jerk. The painful shoulder leads to inactivity and lack of exercises. This leads to atrophy of the muscular cover over the humeral head and increases chances of dislocation further.

MRI showing a Bankart lesion in shoulder dislocation patient

The surgical treatment essentially involves stitching of the soft tissue envelope (Capsule-labral complex) over the bony cup (glenoid rim). This tear is called a BANKART lesion and surgery called BANKART Repair surgery. Sometimes when there is a bony defect on the cup (glenoid loss) or an indentation on the ball (humeral head) due to a traumatic force causing dislocation, the procedure may change. Bony procedure followed (in cases of cup fractures) is called the latarjet procedure and the soft tissue procedure (in cases of humeral head damage) is called bankart with remplissage.

Video illustrates another technical points in a Arthroscopic Bankart repair using PEEK anchors

The results are good to excellent in trained hands. The patient is immobilised for about 6 weeks post which range of motion is started followed by strength training and proprioceptive exercises. Rehabilitation exercises in cases of repair consists of phases which focus on :

1. Range of motion;

2. Strengthening;

3. Rehabilitation to sports.

The video illustrates phase 1 or establishment of range of motion in the operated or injured shoulder. This goes on from 6th week to 12th week post surgery. For more information please feel free to consult Us !

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