Shoulder instability (or actually the shoulder joint) is a condition in which the head of the humerus is displaced relative to the acetabulum of the scapula. The brachial joint is a spherical joint that connects the humerus with the scapula. The relatively small acetabulum and large head of the humerus in combination with the loose and spacious joint capsule are the main reasons for its low stability. The shoulder joint is the joint with the greatest range of mobility - and thus - very susceptible to various types of injuries and injuries.
One of the most common shoulder injuries is shoulder dislocation. The shoulder joint after such an injury often becomes prone to recurring dislocations. Recurrent slipping of the humerus head out of the acetabulum is called chronic shoulder instability.
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Shoulder dislocation - symptoms
Shoulder dislocations occur most often as a result of a mechanical injury - it may be a fall on the shoulder or an extended arm. Athletes who practice contact sports, horse riding, cycling and skiing, as well as people exercising at the gym, are often exposed to shoulder dislocation. Symptoms of a shoulder dislocation are primarily pain and swelling in the shoulder area. People with a dislocated shoulder have problems with moving the arm, and thin people may notice swelling and deformation of the shoulder area.
Treatment
After a shoulder joint dislocation, the doctor prescribes conservative treatment in most cases. When dislocation is accompanied by severe damage to the labrum and / or the acetabulum, surgery is required.
If the shoulder has been knocked out without damaging the joint structures, it is first adjusted and then rehabilitated. Your doctor may prescribe oral painkillers to reduce the discomfort of the pain you are experiencing. The next stage of treatment is the stabilization and regeneration of damaged tissues. The limb is stabilized for about 2-4 weeks in a special orthosis. This time is needed for the articular capsule to heal. The therapy in this period mainly consists of lymphatic drainage accelerating the evacuation of edema, manual therapy of the soft tissues of the shoulder area, electrostimulation of the muscles of the shoulder girdle, cryotherapy, iontophoresis with an analgesic. These methods are designed to accelerate the healing process of tissues.
The introduction of movement should be as early as possible, but at the same time it should be safe for healing tissues. The aim of the procedure will be to improve the stability of the shoulder joint thanks to the activity of the appropriate muscles, gradually restore the range of motion and increase the strength and endurance of the muscles of the upper limb. The physiotherapist will advise the patient to exercise the muscles stabilizing the head of the humerus in the joint socket and exercises to improve the range of motion. Remember that the exercises should be introduced gradually. The patient should be under the constant care of the attending physician and physiotherapist.
Habitual dislocations of the shoulder joint
During dislocation, the labrum of the acetabulum is often detached in the anteroposterior region - the so-called Bankart injury. If the injury is severe, the acetabular bone and the head of the humerus may be damaged, and the cartilage may be damaged. In older patients, the rotator cuff is often damaged or the greater tubercle of the humerus is fractured. In the vast majority of cases, damage to the acetabular labrum leads to repeated dislocations, which in turn cause further detachment of the acetabulum. We are talking then about instability of the shoulder joint. A consequence of the instability is habitual dislocation of the joint, which occurs during normal abduction and rotation movements. Often, during such dislocations, the head of the humerus spontaneously returns to its place or the patient is able to adjust the joint by himself. However, recurring dislocations are dangerous - in extreme cases they can completely destabilize the joint.
Patients suffering from habitual dislocations of the barium joint develop pain when performing certain movements. Sometimes jumping the joint is accompanied by a characteristic "click". Patients are afraid of performing certain movements and the instability of the joint sometimes prevents them from performing certain activities or playing sports. Untreated habitual dislocations lead to limb weakness and significant discomfort. In the case of damage to the labrum of the acetabulum, surgical treatment is necessary.
Surgical treatment of shoulder instability
The aim of the operation is to reattach the acetabular labrum in its anatomical place. Depending on the type of injury, anatomical conditions and the degree of damage to the labrum, the operation can be performed arthroscopically or with the classic opening of the joint.
Arthroscopic treatment of shoulder instability
Arthroscopic treatment is usually performed under general anesthesia. Two incisions are usually made around the joint, about 1 cm in size, then the shoulder joint is filled with physiological fluid. A probe with a camera and arthroscopic surgical instruments are inserted through the incisions. The doctor who performs the operation uses special anchors to fix the torn off acetabular helix. The number of anchors depends on how extensive the trauma is. During the operation, the doctor also removes the hypertrophied synovium, smoothes the damaged fragments of the articular cartilage, and also - if necessary - plasticizes the capsule. Arthroscopic treatment is a minimally invasive procedure, the incisions are small, so the postoperative scar will also be hardly visible. Usually, the patient is discharged home a few hours after the surgery. Arthroscopic treatment of shoulder instability also allows the patient to recover faster.
Shoulder surgery using the open method
When the injury is extensive, the labrum has been irreversibly damaged, or the patient also has bone damage to the joint, the classical method is performed - open-ended. The most popular, most often performed and giving the best results is the so-called Operation Bristow-Latarjet. This operation requires a larger incision to be made to allow the clinician to better reach the site of the injury. During the operation, the surgeon transfers the coracoid process of the scapula to the defect of the acetabular edge in order to protect the humerus against anterior dislocation. Together with the coracoid process, a fragment of the biceps tendon is transplanted along with blood vessels. This prevents the occurrence of bone necrosis and the tendon additionally stabilizes the head of the humerus. The doctor also performs the plastic of the articular capsule, shortening it, which is aimed at additional stabilization of the joint. Open surgery is performed under general anesthesia.
In both cases - both after arthroscopy and open surgery - the patient receives painkillers. Cold compresses are also used to reduce pain and swelling. The swelling usually resolves 48 hours after the operation. The sutures are removed on the 10-14th day after the procedure.
Rehabilitation after surgery
In order for the patient to regain full fitness, rehabilitation after surgery is necessary. The aim of rehabilitation is to restore the dynamic stability of the shoulder. Immediately after the procedure, the patient's shoulder is immobilized in an orthosis, which will protect the operated shoulder joint and limit the possibility of uncontrolled movements. The patient wears the orthosis for about 2 - 6 weeks, taking it off only for the duration of rehabilitation. During this time, the patient should exercise with a physical therapist. Initially, exercises are performed based on passive movements and isometric muscle contractions. The limb should not be overloaded, as this may damage the suturing site of the labrum. The physiotherapist will also recommend performing exercises that mobilize the shoulder blade. The patient should also actively exercise the elbow joint, wrist and fingers. This will avoid the formation of contractures due to the immobilization of the limb. Rehabilitation may be supported by physical therapy. In particular, treatments such as electrostimulation, magnetic field, and cryotherapy are recommended. The orthosis is removed when the doctor allows it. Rehabilitation in this period consists of active exercises of the shoulder joint, exercises that mobilize the shoulder blade and strengthen the muscles of the shoulder girdle. After 12 weeks, most patients can exercise alone at home and drive. Recovery takes place between 6 and 9 months after the surgery. Then patients can also return to practicing sports.
Important information
| Duration of the procedure (depending on the method) | 1 - 2 hours |
| Basic tests required for the procedure | basic - preparation for surgery tab |
| Anesthesia | general or axillary block |
| Hospital stay | 6 - 12 hours |
| A period of significant dysfunction | 3 - 4 weeks |
| A period of limited dysfunction | 4 - 12 weeks |
| Removal of stitches - first visit | 12 - 16 days |
| Change of dressings | every 3 - 4 days |
| Contraindications to the procedure | infection, dysplasia of the shoulder-scapular joint |
Frequently asked questions about the treatment of shoulder instability:
Shoulder instability is a condition in which the head of the humerus is displaced relative to the acetabulum. Recurrent slipping of the humerus head out of the acetabulum is called chronic shoulder instability.
The symptom of a dislocation in the shoulder joint is stinging and sharp pain in the shoulder area. People with a dislocated shoulder joint have problems with moving the arm, and distortion of the outline around the shoulder can often be observed. Accurate diagnosis of the injury should be performed by an orthopedic surgeon.
After a shoulder dislocation, conservative treatment is undertaken in most cases. When the dislocation is accompanied by severe damage to the labrum and / or the acetabulum of the scapula, surgical treatment is required. The orthopedic doctor makes the final decision regarding the choice of treatment.
In the case of damage to the labrum of the acetabulum, it is necessary to undergo surgical treatment. Surgery is also necessary if the damage is extensive or the dislocation is habitual.
The aim of the operation is to reattach the acetabular labrum in its anatomical place. Depending on the type of injury, anatomical conditions and the degree of labral damage, the operation can be performed arthroscopically or with the classic opening of the joint.
The return to full fitness takes place within 6 to 9 months after the surgery.
