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Patient Info

Instability / Dislocation

Shoulder dislocation is a common injury, mainly occurring in younger active patients and during sport. It usually caused by a forward force on the ball of the shoulder joint when the arm is abducted and externally rotated. The ligaments and labrum at the front of the shoulder joint tear. Sometimes this is associated with a small fragment of bone also. These are called ‘Bankart Lesions’.

As the humeral head scuffs over the front of the glenoid it can also sustain an impaction fracture at the back. This is known as a “Hill-Sachs lesion”

In some cases, the shoulder may be unstable posteriorly, which is usually due to aposterior labrum tear at the back of the glenoid. Some patients may also have “loose joints”. This is known as ligament hyperlaxity. This is a risk factor for instability in one direction and is a common finding in multi-directional instability.

Treatment

Contact athletes and younger active people are likely to develop problems relating to ongoing shoulder instability after a first shoulder dislocation episode, and will require a surgical stabilisation procedure. Studies have shown that patients under 30 years of age presenting with a shoulder instability episode are most likely to develop recurrent dislocations.

Arthroscopic stabilisation

Most cases of shoulder instability can be dealt with very well with this key holetechnique. The aim is to restore the soft tissue “bumper” at the front of the glenoid to prevent the shoulder from dislocating in a forwards direction. Small bone anchors are inserted into the rim of the glenoid and the torn labrum and capsule are brought back to their normal position so that they may heal to the bone. The capsule can be also tightened appropriately if necessary. This technique deals with posterior instability much more easily and effectively than with previous open techniques.

Open stabilisation

For many years this was the gold standard treatment until the emergence of newer arthroscopic techniques but it still has a role – particularly in the contact athlete, in revision surgery scenarios, and where there is a large glenoid fracture.

"Laterjet" open stabilisation

This open procedure is necessary in the situation where there is a large defect in the anterior glenoid, a large “engaging Hill-Sachs lesion”, or both. The surgery involves screwing a bone block on to the front of the glenoid to stop the humerus from dislocating. I use the nearby coracoid process as a local bone graft with it`s muscle attachments preserved. The net result is a “triple effect” with a bony, ligamentous, and muscular restraint to shoulder dislocation. This technique was pioneered in France and has a good track record.

Shoulder Knee
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