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Recurrent Dislocation Shoulder

The shoulder is the most moveable joint in your body. It helps you to lift your arm, to rotate it, and to reach up over your head. It is able to turn in many directions. This greater range of motion, however, can cause instability.Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse. Once a shoulder has dislocated, it is vulnerable to repeat episodes. When the shoulder is loose and slips out of place repeatedly, it is called chronic shoulder instability.

Severe injury, or trauma, is often the cause of an initial shoulder dislocation. When the head of the humerus dislocates, the socket bone (glenoid) and the ligaments in the front of the shoulder are often injured. The labrum — the cartilage rim around the edge of the glenoid — may also tear. This is commonly called a Bankart lesion. A severe first dislocation can lead to continued dislocations, giving out, or a feeling of instability.

Operative Treatment:

Most young patients and those involved with any type of active sport are likely to need surgery to stabilize their unstable shoulder.

Arthroscopic Bankart repair (Key-hole surgery)

This is performed through 3 small holes (called portals). The Bankart repair involves re-attaching the detached capsulo-labral complex to the glenoid using suture anchors which are bio degradeable.This is a functional surgery done in patients who dont have severe bone loss due to repeated dislocations.

Bony operations

In cases where there is significant bone loss in the glenoid or a large Hill-Sach’s lesion (engaging Hill-Sach’s), a Bankart repair alone is likely to fail. In such situations a Latarjet procedure (transfer of coracoid process to the glenoid defect) or a bone graft to the Hill-Sach’s lesion needs to be performed.

Post-operative course after surgery

The patient is discharged on the next day of Surgery. The arm is placed in a shoulder immobilizer sling . Depending upon the type of surgery performed and the strength of the repair achieved, the arm will be immobilized in the sling for a period of 3- 6 weeks. At around 2-3 weeks after surgery, pendulum exercises (gravity assisted movements of the arm) are initiated. At around 6 weeks after surgery, full range-of-motion exercises as well as shoulder strengthening exercises are started.

Return to routine activities and sporting activities

Overall it will take around 2-3 months after surgery for any patient to return to pre-operation status as far routine day-to-day activities are concerned. It may take around 3-4 months for a recreational athlete to return to sports, and even longer for a professional athlete (depending upon the nature of sport and the level of competition involved).