A shoulder dislocation is what occurs when we colloquially say that the shoulder has “popped out of place” due to major trauma.
Fig 1: left: dislocated shoulder. Right: shoulder in place
Due to the rupture of the ligaments, the head of the humerus “pops out” and is no longer in contact with the glenoid (the superficial cavity of a bone in which the head of another bone fits). This causes excruciating pain and the patient needs to go to an emergency center so that the doctor can “put it back in place”.
Recurrent dislocations
Up to 1/3 of these injuries do not heal well and become recurrent. This means that, at the slightest movement, the dislocation is reproduced, causing significant functional limitations to patients. This percentage can increase up to 85% if we are talking about young men practicing contact sports and with a dominant arm.
Once two episodes have occurred, and above all the 2nd one has been with minimal trauma, we can say that this dislocation will be recurrent and will be repeated over time. The more episodes of dislocation that have occurred and the longer the injury has evolved, the more worn tissues will be and the more associated injuries there may be, which makes repair more difficult.
The injured ligaments are the primary stabilizers of the shoulder. The musculature surrounding the shoulder are secondary stabilizers. Once it has become recurrent, the only way to fix it 100% is surgery, as the ligaments are repaired. Muscle toning through rehabilitation can help, but in no case will it solve the problem or prevent new episodes in a safe manner.
The surgery
As in other arthroscopic techniques, a camera is introduced through small incisions that allow us to visualize, in a complete way and much better than with open surgery, the totality of the joint.
Usually the injured ligaments are “torn” from the bone, therefore, by means of small biocompatible “screws” of 1.5 mm, we “sew” the broken ligament, until putting everything back in its place.
Fig 2: shoulder arthroscopy showing the upper part of the labrum “unhooked” from its place.
Fig 3: shoulder arthroscopy with the implants and threads used to repair the injury.
Depending on the size of the lesion and the different injured structures, we will use the number of implants necessary. All this can be done by outpatient surgery and we usually use regional anesthesia with sedation for patient safety.
Postoperative
After surgery the patient can go home the same day with the arm in a sling. Generally speaking, the next day the sling can be removed to eat, read, type on the computer… and physiotherapy with passive movements is started.
Progressively more intensive exercises are started, so that after approximately 6-8 weeks the patient can move the shoulder completely in an active way, and the return to the previous sport is authorized after about 4 months.
Risks of recurrence of dislocation
When we operate surgically, we put everything back “in its place”, this means that if the patient suffers another trauma, the injury can reoccur.
This should not be reproduced with more “normal” movements and sports (swimming, weight training, tennis…) although recurrence rates may vary between 3-10% depending on the series. Risk factors predisposing to new dislocations are: contact sports, patients with hyperlaxity, type of injury and more frequently young men.