Arthroscopic Shoulder Stabilization Surgery
The shoulder joint is the joint with the greatest range of motion in the body, but it is prone to instability because the head of the upper arm bone sits in a shallow socket called the glenoid socket. Shoulder stability is provided by both the soft tissue called the labrum, a band of tough fibrous cartilage that lines the rim of the shoulder socket, and the muscles and tendons of the rotator cuff. The shoulder joint is the most often dislocated joint.
What causes shoulder instability?
The soft tissues act as restraints to prevent instability and dislocation. Shoulder instability can occur when the rotator cuff tendons are stretched, torn or detached; when the labrum is torn, stretched or detached; or when the joint capsule is stretched, torn or detached.
Shoulder instability can be caused by trauma from a contact sport, an auto accident or a fall on an outstretched arm, and also by repetitive motion or overuse.
Athletes who play contact and collision sports are particularly at risk for shoulder instability caused by a traumatic dislocation. After a dislocation, the shoulder is more vulnerable to repeated dislocations or subluxations because the ligaments stretch and become loose or tear. Young athletes are particularly at risk for recurrent shoulder instability and dislocations.
Repetitive strain that causes loose shoulder ligaments is also a risk for shoulder instability. Repetitive strain can develop from repeated overhead motions and is common in people who swim, play tennis or volleyball.
Shoulder subluxations are defined as partial or incomplete shoulder dislocations and often occur after a dislocation due to stretched ligaments or a blow to the shoulder.
What is chronic shoulder instability?
When the upper arm bone slips completely out of it socket repeatedly it is called chronic shoulder instability. Symptoms include pain, and the persistent sensation that the shoulder feels loose.
What is a shoulder dislocation?
A shoulder dislocation is where the head of the upper arm bone is forced out of its socket (dislocated) partially or completely. It damages the soft tissues and causes instability. The upper arm bone can be forced out of its socket by trauma or overuse, and rarely by naturally loose ligaments through the body.
A shoulder dislocation predisposes the shoulder to repeated dislocations. Dislocation can be anterior or posterior. Anterior shoulder dislocations are the most common type. It usually leads to recurrent shoulder instability.
A shoulder dislocation can cause:
Instability caused by a traumatic shoulder dislocation can damage the labrum producing a Bankart lesion. A Bankart lesion is a tear of the lower rim of shoulder labrum. Once sustained, a Bankart lesion makes it easier for the shoulder to dislocate.
A Hill - Sachs lesion is an injury to the head of the upper arm bone and the cartilage. that can result when the bone is forced out of the socket. This type of lesion is related to sports, a fall on an outstretched arm or fall directly on the shoulder, a direct hit to the shoulder, and other mechanisms.
Tears of the rotator cuff.
How is shoulder instability diagnosed?
Dr. Johnston will review your medical history and conduct a thorough physical exam to evaluate the shoulder. He will ask about how your shoulder injury occurred, the number of times the shoulder has dislocated and been reduced since the original incident; and the amount of shoulder instability you are experiencing and how and when instability occurs. Dr. Johnston will order x-rays to evaluate your instability and additional imaging studies to evaluate the soft tissue in the shoulder.
A shoulder reduction is a procedure to gently manipulate the shoulder to slide the head of the upper arm bone back in to its correct position after dislocation without causing further damage to the joint.
What are the treatments for chronic shoulder instability?
Nonsurgical treatment will include activity modifications, over the counter pain relief, and physical therapy. When nonsurgical treatment fails to improve stability, surgery may be necessary.
Traumatic shoulder instability is common in sports and is a risk factor for recurrent shoulder instability in young men who participate in collision sports. Recurrence of primary shoulder dislocation is reported to be between 38% and 80% when it is managed without surgery.
Surgery has been shown to decrease the incidence of recurrent instability. Arthroscopic shoulder stabilization surgery is the mainstay of treatment for both initial and recurrent shoulder instability.
What is arthroscopic shoulder stabilization surgery?
It is minimally invasive shoulder surgery to repair damage to the soft tissues including the labrum and surrounding soft tissue to tighten stretched ligaments to restore stability. The goal of arthroscopic stabilization surgery is to restore shoulder stability. However, when recurrent dislocations are caused by bone loss or fracture of the shoulder socket the surgery is called the Latarjet procedure.
Arthroscopic surgery is an outpatient surgery used to view the inside of the shoulder joint to diagnose and treat soft tissue damage to restore shoulder stability. During arthroscopic surgery Dr. Johnston can repair labral tears without significant bone loss in the shoulder socket. He can also repair a torn rotator cuff and tighten loose ligaments. After surgery, rehabilitation of the soft tissue is vital to returning to the activities that make life enjoyable.
