Hello and welcome. My name is Dr. J. Michael Bennett. I am a fellowship trained
Sports Medicine surgeon with the Fondren Orthopedic Group. Today we're going to
talk a little bit about shoulder instability. It's something that we often
times run into in our clinics and I'm sure many of you have questions about it
in regards to what exactly it is. Most people when they describe a shoulder
dislocation, it usually occurs in what we call the abducted external rotation
position. So if you're a football player or a soccer player and you fall and your
arm's outstretched, and you a feel large clunk or pop, and it's very painful and
then it snaps or pops sometimes back in or sometimes you have to go to either an
emergency room, or the athletic trainer on the sidelines or the physician on the
sidelines will reduce the shoulder back into position. It's important that you do
reduce these as soon as possible to prevent any neurovascular issue regarding
the upper extremity. So that being said, what exactly is going on internally in the
shoulder when you have a dislocation, what does that mean? When you think about the
shoulder, I'd like to put this into simplistic terms as possible and I think
of the humeral head as a golf ball and the glenoid as a golf tee and you can see
the curvature of this glenoid or this golf tee here mimics the curvature of the
glenoid. So if you play golf and you go out and you put your golf ball on the
golf tee usually it's a very well-balanced structure okay. Now the problem
occurs when you have a dislocation and that ball slides off the golf tee. And
when it slides off the golf tee, it takes a chip off of the golf tee and so you end
up missing a portion of that circumferential support okay. So then the
next time you try to put the golf ball on the golf tee it doesn't sit still. You
can't maintain the balance okay. So it ends up recurrently dislocating.
If you've had your shoulder dislocate once and your a young athlete, the recurrence
rate of another dislocation occurring is usually about 80%. So you really want to
get it evaluated and you really want to discuss thoroughly your options with an
orthopedic surgeon. So that being said, here are some pictures regarding shoulder
dislocations. So once again, this is looking at the shoulder from the top down.
If you had a camera looking down at the shoulder joint, here's the ball. Here's
the socket. This is your golf tee right here and this is what's called the
labrum. And the labrum is really, it's like an O ring around the socket okay. So
it gives it a little bit of a bumper. It's a bumper basically and it sits on, all the
way around that socket of the glenoid. And often times what happens in dislocations
is that ball will slide off and it will take off that little bumper, that labrum
and then sometimes it can take off a piece of bone in the glenoid and at the same
time create an indention in the humeral head. And the indention in humeral head is
called the Hill-Sachs lesion. If this piece that gets knocked off with the
labrum, it's called the Bankart lesion okay. Or you could just have a strictly, a
soft-tissue lesion just involving the labrum itself, which would be just a
labral tear with instability. The ways that we fix this, there are a number of
different ways of fixing this and it all depends on whether or not there's bony
deformity, whether or not there's a large bone fragment involved, how many
dislocations you've had, age of the patient, activity status of the patient.
And most of the patients we see that have this type of problem are younger, athletic
patients that play a lot of sports and activities
and have these recurrent dislocations.
Most of the time it's going to be a straightforward labrum or Bankart with a
little bit of a small sliver of bone involved and that usually can be fixed
arthroscopically with a small camera with minimally invasive incisions and we
go in there with a camera and we find these little labral tears, that little
bumper that's detached and then we put a little anchor with a little stitch around
it into the bone and wrap it around that little labrum and pull it back up into
position and let it heal okay. And that basically builds up the border of that
socket. It gives you back that support.
Now in chronic situations and the reason that you want to
get this evaluated if you have multiple dislocations you don't want to let this
go on too long because the more dislocations you have the more damage
you're doing to your bone. And over time, you're basically sanding down that bone
the more dislocations occur the ball rubs down that anterior glenoid or posterior
glenoid and creates a bony deformity and that makes it much more difficult to fix
this arthroscopically. So there are ways to fix it but it involves a little bit
more invasive procedure and it's called the Latarjet procedure and we do those as
well but it involves an incision. And basically what we do is we take another
bone, a bone in the shoulder joint. It's actually called the coracoids and if you
look at a model of the shoulder here this is the coracoid bone right up front. So we
make an incision in the front. We take a little osteotome and cut off this bone
here and we swing it around and basically give you a bony bumper to the
front of that glenoid and fix it with two screws. And that just keeps the shoulder,
it keeps the ball in position so it no longer can slide out of joint. It runs
into this bumper here. So now, it has the support that it needs so you can go back
to your activities. So in the end if you do have recurrent instability I highly
recommend getting evaluation by a sports medicine orthopedic surgeon just to know
what your options are and to discuss what's available to you.
If you have any more questions, please feel free to go to our website or feel
free to call our office at 281-633-8600. Thank you.