I am Dr. Shailesh Mishra, I am orthopaedic surgeon. I am specialized in arthroscopic surgery and joint replacement. Today I am going to talk about shoulder injuries particularly shoulder dislocation. Dislocation means popping up of joint that is joint is made up of two bones together joined by the fibrous tissue. The shoulder joint is made up of glenoid; glenoid which is part of scapula bone and humeral head which is part of humerus bone. These two are held together by fibrous tissue which is capsule and the thicker portion of capsule is labrum. In case of a dislocation, these capsular-labral structures are tonged and this humeral head pops out of the joint. Why shoulder dislocation is the most common dislocation? The shoulder is made up of two bones where glenoid is smaller as compared to the humeral head, because of this mismatch in the two bones, the shoulder joint is inherently unstable joint and hence this dislocation is the most common. What are the types of dislocation? The dislocation can be anterior, posterior or inferior.
The dislocation can be partial where not the entire head has come out, only the half of head has come out and it reduces back, it can be complete dislocation where the entire humeral head pops out of the joint. Typically, patient presents with pain around the shoulder joint, swelling, deformity where the roundness of the shoulder is lost, patient is not able to touch the opposite shoulder, the rotations of the shoulders are restricted. Causes of the shoulder dislocation: shoulder dislocation can occur because of the sudden blow as it is during the vehicular accident, because of the sudden force around the shoulder joint like in sports injuries like hockey, football, rugby. It can occur also because of the sudden fall where the patient falls on the shoulder joint and because of sudden force shoulder joint pops out of the capsule. Treatment for the shoulder dislocation in case of the acute event the manual reduction of the shoulder joint is recommended. The reduction should be under sedation or general anaesthesia. Manual reduction without anaesthesia or sedation can cause more damage to the shoulder joint because of the contraction of the muscle along the shoulder joint.
When there are two or more episodes of dislocation that is recurrent dislocation of shoulder joint it requires a surgery. There is a dictum in the shoulder once dislocated always dislocated that is that means once a dislocation has occurred the capsular-labular structure which is damaged do not repair on their own and repeated dislocation can occur. There is almost 80-90% of the incidents of repeated dislocation after the first dislocation. Particularly in sports injury cases, there is always surgery is required. When there are two or more episodes of dislocation that is recurrent dislocation, surgery is recommended because in case of recurrent dislocation this capsular-labular structure has not healed. Surgery, we recommend, is in the form of arthroscopic surgery where the 2-3 keyholes are made around the shoulder joint and the repair is performed with the help of arthroscope and vidoescope, through specialized thing 4-6mm instruments.
The advantage of the surgery is that it is painless, there is no blood loss or very minimal blood, loss recovery is very fast, the patient can be discharged same day or at the max next day. In case of multiple dislocations, the glenoid bone may be lost to a certain extent, depending upon the magnitude of the glenoid bone loss different surgery is recommended as a portion of the clavicoid bone is transferred to the anterior part of the glenoid which is called latarjet surgery. In this, the dislocation is prevented because of the coracoid bone which is transferred and the muscle attached along the coracoid bone which acts as a sling effect. After surgery patient has to undergo physiotherapy and rehabilitation which lasts for around 6 months to 12 months, to undergo rehabilitation and physiotherapy. Physiotherapy goes for around 3 months to 12 months depending upon the lifestyle activity. In sports injuries, the physiotherapy and rehabilitation go for around 12 months. We make sure that they reach to their pre-injury level and they resume their sports. If you have any query, you can contact Lybrate.