Question

Bankart tear of the anteroinferior labrum is seen, with extension of the tear from inferior to superior. There is no glenoid bone loss. Associated alpsa lesion with another-inferior labroligamentousperiosteal sleeve avulsion is also seen. There is no dislocation of the labrum. Hill sach’s defect is also seen along the posterolateral aspect of the humeral head laterally with associated marrow edema as described. The hill sach’s index of left shoulder is less than the glenoid track and the hill sach’s lesion appears be 'on thrice or not engaging. Should I go for arthroscopic bankart repair and why?

Dr.Julie Mercy J David · Accepted Answer

1.pendulum stretch do this exercise first. Relax your shoulders. Stand and lean over slightly, allowing the affected arm to hang down. Swing the arm in a small circle — about a foot in diameter. Perform 10 revolutions in each direction, once a day. As your symptoms improve, increase the diameter of your swing, but never force it. When you're ready for more, increase the stretch by holding a light weight (three to five pounds) in the swinging arm.
2. Towel stretch hold one end of a three-foot-long towel behind your back and grab the opposite end with your other hand. Hold the towel in a horizontal position. Use your good arm to pull the affected arm upward to stretch it. You can also do an advanced version of this exercise with the towel draped over your good shoulder. Hold the bottom of the towel with the affected arm and pull it toward the lower back with the unaffected arm. Do this 10 to 20 times a day.
3. Finger walk face a wall three-quarters of an arm's length away. Reach out and touch the wall at waist level with the fingertips of the affected arm. With your elbow slightly bent, slowly walk your fingers up the wall, spider-like, until you've raised your arm as far as you comfortably can. Your fingers should be doing the work, not your shoulder muscles. Slowly lower the arm (with the help of the good arm, if necessary) and repeat. Perform this exercise 10 to 20 times a day.
4. Cross-body reachsit or stand. Use your good arm to lift your affected arm at the elbow, and bring it up and across your body, exerting gentle pressure to stretch the shoulder. Hold the stretch for 15 to 20 seconds. Do this 10 to 20 times per day.
5. Armpit stretch using your good arm, lift the affected arm onto a shelf about breast-high. Gently bend your knees, opening up the armpit. Deepen your knee bend slightly, gently stretching the armpit, and then straighten. With each knee bend, stretch a little further, but don't force it. Do this 10 to 20 times each day.
Starting to strengthen as your range of motion improves, add rotator cuff–strengthening exercises. Be sure to warm up your shoulder and do your stretching exercises before you perform strengthening exercises.
6. Outward rotationhold a rubber exercise band between your hands with your elbows at a 90-degree angle close to your sides. Rotate the lower part of the affected arm outward two or three inches and hold for five seconds. Repeat 10 to 15 times, once a day.
7. Inward rotation stand next to a closed door, and hook one end of a rubber exercise band around the doorknob. Hold the other end with the hand of the affected arm, holding your elbow at a 90-degree angle. Pull the band toward your body two or three inches and hold for five seconds. Repeat 10 to 15 times, once a day.
Shoulder exercises and stretches regular exercises and stretches can keep your shoulder strong and flexible. A few things to remember before swinging in to exercises:
•stop any exercise if you have more shoulder pain. It may be too soon for you to try.
•watch your form. Exercising incorrectly can also cause or worsen shoulder problems.
•warm up, even before deep stretching. Light shoulder rolls, gentle movements, or even a warm shower are all ways to warm up your muscles before exercise and stretching.
Pendulum stretch for range of motion•stand and bend at the waist.
•let your arm on the injured side hang straight down.
•keep your neck relaxed.
•move your arm in a circle up to 20 times.
•do once or more times in a day.
Overhead shoulder stretch•sit or stand to do this shoulder stretch.
•intertwine your fingers in front of you.
•bend your elbows and raise your arms above your head. You can also place your hands on your head or behind it.
•gently squeeze your shoulder blades together to move your elbows back.
•continue for up to 20 repetitions. Repeat 5 to 10 times a day.Do’s and don’ts for shoulder pain
do’s do the prescribed exercise regularly to maintain strength, flexibility and range of motion.
Do keep the affected arm supported.
Use an ice pack for pain relief. Apply the ice pack 3-4 times a day for 10 minutes.
Don’ts don't sleep on the affected side. Don't lift heavyweight with the affected arm. Don't jerk your shoulder to avoid stress.
Don't use the arm to push yourself up in bed or from a chair.
Don't participate in contact sports or do any repetitive heavy lifting.
We suggest you to wear shoulder support brace which is available in two different sizes which makes the patient to feel comfortable as it maintains the shoulder in anatomical position and the short lever is maintained. The reason to maintain the short lever in the shoulder joint is it helps the shoulder to prevent the movements which itself is the key to have better progression of healing in the shoulder region. This is suggested for the following conditions.
This shoulder support brace what we are suggesting for you is available at our clinic. If you want you can buy from us, if you are far away from chennai we can send you by courier. The reason why we are conveying you to buy from us is we can demonstrate over the videocall (using whatsapp) and also we can monitor you throughout when to wear it and how long to wear it. And also if you find any difficulty wearing the brace you can also revert back to us for few more suggestions and we can propose you good solution how to go about it.

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