- Number five.
This is a generalized topic called shoulder instability.
There are different types of injuries that can occur
with shoulder instability, but basically what it means
is that when you have the bone socket, the ball dislocates
out of the socket, and it can happen anteriorly,
it can happen posteriorly, it can happen inferiorly.
Then in rare rare rare cases can happen superiorly,
but most of the time it's going to be happening
anteriorly inferiorly.
But that means, what that means is
the ball in the socket looking at it
from a top down perspective.
If I'm looking directly down my shoulder joint,
this is the ball, that's the socket.
The ball and socket has labrum and capsule
all around it and rotator cuff that holds it in place,
so it's important to keep the rotator cuff strong
to hold the ball and socket in position.
Sometimes, if the patient is hit in the right way,
that ball can dislocate and slide out
anteriorly or posteriorly.
When that happens, it knocks off this little tissue ring
here called the labrum, and that creates
an injury here, okay?
Now, in severe cases, it can even knock off some bone
here, and that's called a bony Bankhart.
This is just a labral tear.
When that happens, the ball may be reduced
back into place, and most people think they're okay.
If you're young, and you have an anterior dislocation
or any kind of dislocation, you have
a higher risk of redislocation.
Sometimes a greater than 80% risk of redislocation,
particularly if you continue to play contact sports.
So what happens over time is that shoulder continues
to pop out of joint over and over and over again.
Every time it does, it tends to wear down this bone
a little bit more, and unfortunately, because it's popping
out anteriorly, you get a little bit of a divot back here.
It's called a Hill-Sachs lesion, where this little divot
engages with this loss of bone, and often times,
if you can get to this early enough and fix it early enough,
you can actually reattach that little labrum back
to the bone and prevent all this bone wear from happening.
If you get past that, and you're years and years
down the line of multiple dislocations,
there's not a lot of other options other than bone grafting
that area where we actually put a bone block in that spot
with a couple screws to hold that in place.
And that's called a Latarjet.
And that's actually done open.
It's not done, for the most part it's not done
arthroscopic; there are some individuals doing this
arthroscopic, but for the most part, it's done
as an open procedure.
So the key with this is once again getting an accurate
diagnosis early on and knowing what your expectations are
and making sure you're following the right treatment
algorithms for this type of problem.
There are some patients that pop out of joint
all over the place.
What that means, they can pop out inferiorly,
they can pop out posteriorly and anteriorly.
These patients are what we call
multi-directional instability.
It means that their capsule, or the lining of the joint,
is very very loose and patulous and so they have
a lot of mobility across the shoulder joint.
These patients actually respond very well
to rehabilitation and strengthening.
So even though they may pop out of joint,
as long as those muscles are conditioned appropriately,
you can actually prevent that from happening.
So once again, it's very important
to get the diagnosis early, so make sure you get evaluated
by a sports trained physician, and make sure
they're ordering the accurate tests to make the diagnosis.
For any more information on any of these topics
that we just discussed, please feel free
to go to my website at www.jmichaelbennet.com
or www.OrthopedicSportsDoctor.com
or come in for an evaluation. Thank you.