Dr. De la Varga is a specialist in Traumatology and Orthopedic Surgery. He has a brilliant career in Sports Traumatology techniques. He currently directs the Advanced Center of Sports Medicine CAMDE, is head of the Ultrasound-guided Surgery Unit of the Integral Private Hospital Complex, is the traumatologist of the Malaga Football Club and is a reference consultant for the Royal Spanish Swimming Federation, and the Andalusian Basketball and Football Federations.
This article is a continuation of another informative text by Dr. De la Varga on a first approach to the explanation of shoulder instability.
Bankart Injury
The type of injury that most frequently causes anterior shoulder instability is capsulolabral instability or Bankart’s lesion, which consists of the detachment of the labrum or glenoid labrum from its anchor in the glenoid, usually in the internal anterior part of the joint. This detachment creates an eyelet through which the humeral head tends to come out of the joint in certain positions, to dislocate repeatedly. When instead of the labrum detaching from the bone, a portion of bone is torn away, we speak of a bony Bankart lesion. A finding frequently associated with a Bankart lesion is the Hill-Sachs lesion, which consists of a notch, a groove in the humeral head as a result of impacting the head against the edge of the glenoid when the shoulder dislocates.
Physical Therapy of Shoulder Instability
Treatment of the first episode of shoulder dislocation is always conservative. When the humeral head slips out of its place, it tears the caosuloligamentous structure. Once the dislocation is reduced, when the humeral head returns to its place, a gap remains in the joint capsule. Treatment consists of three weeks of immobilization with a sling to allow the capsule and ligament injuries to heal, followed by another three weeks of physiotherapy to recover firstly mobility, limited by the adhesions produced by the hematoma and internal inflammation of the capsular tear, and secondly the strength lost due to muscle atrophy secondary to immobilization.
In the case of an already unstable shoulder, with multiple dislocations, the physiotherapeutic treatment is oriented towards strengthening the shoulder musculature as a whole to compensate for the instability caused by the injury to the capsule and ligaments.
In cases in which muscle strengthening is not sufficient to stabilize the joint and the patient reports continuous pain and fear of a new dislocation and insecurity in certain positions, surgical treatment is indicated. Dr. De la Varga usually indicates surgery in young patients with shoulder instability, even if they do not have great symptomatology, because a shoulder instability causes over the years a wear of the cartilage and a shoulder osteoarthritis of difficult treatment.
Shoulder instability surgery
Dr. De la Varga usually performs shoulder instability surgery arthroscopically. Through three small incisions and using a small camera, the detachment of the joint capsule and labrum is repaired. Using three or four 3 mm mini-arms, we suture the capsulolabral complex to the bony edge of the glenoid, closing the buttonhole that had been created by the first dislocation. This is a common surgery, which usually has very good results, completely correcting the shoulder instability.
After spending the night in the hospital the patient is discharged. He will keep the sling for three weeks, during which time he will be able to start physiotherapy to perform limited, passive movements, always performed with the help of the physiotherapist. After the third week, the sling will be removed and physiotherapy will be intensified, first with active movements until full mobility is regained, and then by strengthening the muscles to recover muscle atrophy. The estimated time for return to sporting activity is three months.