Unstable Shoulder Repair
Shoulder instability is a very common condition that is treated in our practice. Although this problem is not as commonly seen as in North America, or Europe, a large number of these cases are seen and treated annually. In younger active athletes, especially those who compete in contact sports like rugby, American football, martial arts, or sports that require overhead activity the chances of repeated dislocation is very high, and because of this fact, many of these patients should undergo repair of the damaged ligaments and cartilage.
The most important fact found in evaluation, is the history as reported by the client of a dislocation of the shoulder previously, and that the function and movement of the shoulder is not trusted. On physical exam, if the client allows, the dislocation and subsequent relocation can be demonstrated. Video of the load and shift examination help to determine the location of the injury and is helpful for determination of the best procedure to perform.
Usually prior to surgery we obtain important tests. In most cases we obtain an MRI, and or CT scan if we feel that we need to get an exact measurement for the amount of bone loss.
Image CT Scan of patient with massive bone loss on humerus
Image of MRI of shoulder of patient with massive humeral bone loss on humerus, and anterior labral tear
For the operation we can set-up the patient in either the beach-chair position or the lateral position, see images below. For anesthesia, usually a regional block is given by the anesthesiologist, and this really helps with minimizing the pain, after the surgery.
Beach-chair position and portal position.
Lateral position with portal placement
Video of the steps of the surgery for typical arthroscopic bankart reconstruction
Images of other anterior labral tears
After surgery, the repair is usually quite durable, and looks like this at the time of surgery.
Sometimes when there is a big defect in the humeral head, we have to fill the defect with rotator cuff, we use the French word “remplessage” to describe this.
Afterwards it looks like this.
Sometimes the bone loss is too great, and alternative procedures must be done. One such procedure is the Latarjet procedure. Although the procedure it open, it can be done through a very small incision, and is a quite effective, and durable procedure with very good outcome. An image follows demonstrating the radiographic findings following Latarjet procedure.