Arthroscopic Management of Recurrent Shoulder Dislocations

Arthroscopic Management of Recurrent Shoulder Dislocations

Introduction: The shoulder joint comprises three main joints, including the glenohumeral joint, acromioclavicular joint, and sternoclavicular joint, along with the scapulothoracic joints. Recurrent shoulder dislocations often stem from imbalances in these joints, particularly the glenohumeral joint.

Anatomy of the Shoulder: The glenohumeral joint, crucial for shoulder movement, resembles a ball-and-socket structure. Surrounding this joint is the rotator cuff, a combination of four muscles that stabilizes the shoulder during movement. The labrum, akin to a meniscus, expands the socket and, along with ligaments, aids in stabilizing the shoulder.

Shoulder Dislocations: Shoulder dislocations can occur when the ball and socket relationship is compromised, as seen in trauma, ligament laxity, or genetic factors. These dislocations may lead to tears in the labrum and ligaments, notably resulting in a ‘Bankart lesion,’ contributing to recurrent dislocations.

Diagnostic Procedures: In cases where fractures are suspected, especially in the glenoid part, computed tomography (CT) imaging helps diagnose bone deficiencies in recurrent shoulder dislocation patients.

Non-Surgical Treatment: Immediate treatment involves immobilization with a sling, followed by a maximum of three weeks of immobilization to prevent recurrence. Physical therapy aims to strengthen shoulder muscles, yet some age groups may still experience recurrence, highlighting the need for surgical intervention.

Surgical Treatment Options: Persistent and chronic shoulder dislocations necessitate surgical intervention, depending on factors like bone deficiency, age, and activity levels. Arthroscopic (closed) techniques have become the preferred method for repairing Bankart lesions and maintaining joint stability.

Advantages of Arthroscopic Repair: Arthroscopic treatment offers advantages such as reduced pain, same-day discharge, and smoother physical therapy compared to open treatment. The closed technique involves suturing torn labrum-like tissue to the glenoid edges, enhancing patient recovery.

When Open Treatment is Necessary: While arthroscopic treatment suffices for 90% of cases, open surgery becomes necessary in instances of significant bone loss, fractures, or capsule tears. The Latarjet method, involving bone graft transfer, addresses bone deficiencies, ensuring effective prevention of dislocations.

Illustrative Case: An illustration depicts a patient who underwent Latarjet surgery, showcasing the incision and movements three weeks post-operation.

In summary, arthroscopic management of recurrent shoulder dislocations has become a leading choice, offering improved outcomes and minimizing patient discomfort compared to traditional open techniques. Surgical decisions are based on careful consideration of factors, ensuring tailored approaches for optimal patient outcomes.