It is a frequent outlet of the gleno-humeral joint, which originates for several reasons, being in many cases multifactorial.
Why does it occur?
Broadly speaking there are two reasons: traumatic, what the specialists in Traumatology call TUBS (Traumatic, Unidirectional, presents Bankart lesion, and has surgical solution “Surgery”).
There is a second group of dislocations that occur spontaneously, i.e. without a clear cause that justifies it, or if there is such a cause, it is usually not important enough to produce a dislocation in a normal shoulder. These are called AMBRII (Atraumatic, Multidirectional, Bilateral, Rehabilitation based treatment, affecting the interval and inferior capsule.
All these classifications are somewhat artificial and each case should be analyzed separately to see the best treatment options.
How is it treated?
As I said before, each case should be analyzed independently, since several factors often coexist in recurrent dislocations.
It is usual that, in AMBRII, treatment begins with rehabilitation, understood as the strengthening and re-education of the periscapular, dorsal and cervical spine, pectoral and latissimus dorsi muscles. This implies an individualized treatment, with a personalized physiotherapist who works with the patient in a continuous and progressive way. If this fails, surgery may be considered, although in these cases the failure rate is higher than in TUBS.
The surgical treatment begins with arthroscopic surgery for reconstruction by this route of the injured structures, which can be several. Therefore, before surgery, an exhaustive study should be made with magnetic resonance imaging, even with contrast, to determine the surgical strategy. If there are only lesions of soft tissue support structures, capsule, labrum, ligaments, tendons, etc., these structures are usually retensioned with knotted anchors that hold them in place. When there are also lesions of the bony structures, especially of the glenoid cavity, it is necessary to perform, in addition to retensioning of the “soft parts”, the placement of a bone stop, either extracted from the patient himself or from a bone bank. There are several techniques, but the principle is the same: to increase the anterior articular surface of the glenoid so that the humeral head does not come out.
When should surgery be performed?
In my opinion, when a traumatic shoulder dislocates for the second time in a short period of time (months), surgery is indicated. Although there are authors who speak of surgery from the first dislocation, I prefer to do a correct treatment of that first dislocation and then see the results. In AMBRII it is possible to be more permissive, always taking into account what was said above about the failure rate. It depends on the age, but above 20 years of age and with more than 4 dislocations, surgery should be considered.
What guidelines can we follow on a day-to-day basis?
I always advise these patients
1. Do not raise the arm above the head.
2. Do not perform combined movements of abduction and external rotation (take the seat belt, take an object that is behind the back without turning, throw objects, swim, put on backpacks, etc.).
3. Strengthen the muscles of the anterior shoulder region (subscapularis, pectoralis).
4. Do not handle or lift weights (suitcases, children, etc.).
5. Targeted and personalized physiotherapy.