About
Recurrent dislocation of the shoulder is due to ligament injury in the shoulder. After 1st shoulder dislocation following sports/ trauma, the labral ligament fails to heal leading to recurrent shoulder dislocation. This happens due to torn soft tissue restraints of the joint & sometimes also due to bone loss at the ball (humeral head) and or the socket(glenoid) forming the shoulder joint. These labral ligament tears and or bone damage makes it prone for repeated dislocation. Dislocations can be painful initially requiring a hospital visit for reduction while they become painless & self-relocating over a period of time. These dislocations can interfere during sporting activities and also hamper day to day activities that require elevation and rotation of the shoulder.
Symptoms and investigations
- Recurrent dislocation/ subluxation/ giving way of the shoulder especially during abduction and external rotation movement of the shoulder.
- dislocation during sleep.
- Some patients have fits associated with the shoulder dislocation.
MRI scan & a CT scan are mandatory for planning the treatment for recurrent shoulder dislocation.
MRI would help the surgeon to identify the torn tissues(labrum)(Bankart lesion)while CT with 3D reconstruction would help in accurately measuring the bone loss (glenoid and humeral head bone loss) that may be associated with recurrent dislocation.
Figure 2: showing the torn tissues in front of the joint (Bankart Lesion)
Treatment
There is no role for conservative treatment for recurrent instability of the shoulder.
- Arthroscopic Repair of the torn tissues is recommended for recurrent instability with minimal or no bone loss. This is an arthroscopic/ keyhole procedure wherein the torn tissue is repaired back to the bone using anchors. This procedure is called Arthroscopic Bankart’s & remplissage procedure.
Figure showing arthroscopic Bankart’s repair
Arthroscopic images showing Bankart’s lesion/labral tear(Right), Anchor insertion(Center), Completed bankart repair
- The procedure for recurrent instability with significant bone loss requires a mini open procedure called Latarjet surgery. This involved transferring a small chunk of bone called the coracoid process along with its muscle attachments to the socket of the shoulder joint. This would compensate for the bone loss, increase the arc of the socket and also provide a soft tissue support due to the muscle attachments.
Figure showing the Latarjet procedure
- Patients would require an admission for 3 days minimum. Patient will have to get admitted one day prior to the surgery for pre anesthetic evaluation, surgery will be scheduled the following day. Patient will be discharged the day after surgery with a sling. Patient will have to adhere to a rehabilitation program for 6 months with regular follow-ups in between.