Monday, February 17, 2014

Eickhoff's Extras: Shoulder Dislocations in the Young and “Old”

Shoulder Dislocations in the Young and “Old”

Shoulder dislocations are more common in young active athletes than in older individuals.  This is because a young person has more laxity or stretching of the ligaments around the shoulder.  Anterior (or front) shoulder dislocations account for 96% of all shoulder dislocations.  Posterior (or back) dislocations are rare and generally only happen during seizures or electrical shock.  
Most true dislocations are diagnosed by xray in an emergency room.  After the dislocation is reduced, or the joint is back in the correct position, another xray is taken for confirmation.  It is important to follow up with Orthopedics for treatment after a dislocation.

In all dislocations, structural damage must occur to allow the joint to “come out of socket”.    In younger individuals there is a possibility of a Bankart tear or a Hills-Sachs lesion.  A Bankart tear is a small tear in the labrum.  A Hills-Sachs lesion is an indention on the humeral head, from the humeral head hitting the glenoid during the dislocation.   In patients over the age of 30 rotator cuff tears are more likely to occur.

For patients under 20, a MR Arthrogram is ordered.  This is a special type of MRI that involves injecting contrast or dye into the joint prior to the MRI.  The dye allows the radiologist and the provider to see the structures in the shoulder better then a regular, non contrast MRI.   The MR Arthrogram will show the extent of the Bankart tear and if a Hill Sachs lesion is present. 
 In general, patients under 25 with a true dislocation will need surgery.  This is because once a young patient has a dislocation, the structures around the shoulder are stretched making it easier for the shoulder to dislocate again.  Multiple dislocations can cause further damage in the shoulder, lead to an unstable shoulder, and eventually arthritis.

For patients between the ages of 20-30, a MR Arthrogram is normally ordered.   The decision for surgical or conservative treatment is determined based on the results of the MR Arthrogram, the patient’s exam, and medical history.  
For patients older then 30, a MRI will be ordered to evaluate the rotator cuff.   If there is a substantial tear in the rotator cuff, surgery to repair the tendon may be needed.   If surgery is not required, most patients do well with six weeks of physical therapy.  They go on to live normal lives with no pain and no further dislocations. 

The surgery to fix a Bankart Repair is about 60 minutes in length.  The patient is under general anesthesia, so they will be asleep during the procedure.  Anchors are used to secure the labrum to the bone.  This is an arthroscopic procedure, meaning the entire procedure is done through small incisions around the shoulder.  There can be anywhere from 4-6 small incisions ranging in size from 0.5-1.5 inches in length.   Sutures are used to close the incisions. 

You can watch Dr. Frisella perform this surgery below:

After surgery for a Bankart repair, the patient can expect to be in a sling for 6 weeks.  During that time the sling can be removed while in a seated position for typing, writing, eating, and while sleeping.  Physical therapy will also be started to work on passive range of motion.  This means the shoulder is stretched to prevent the patient from getting a stiff shoulder.  After 6 weeks, physical therapy will advance to active range of motion, allowing the patient to start lifting their arm themselves.  Strengthening begins at 12 weeks post-op.   Generally the last post-op visit is somewhere between 3-4 months.  There will be lifting and/or range of motion limitations until at least three months after surgery.  There should be no contact sports until 6 months post-op.

1 comment:

  1. Thank you for choosing ETCOE for your orthopedic care. If you have any questions, always feel free to contact our office and our trained staff will assist you in any way possible.
    Orthopedic Shoulder Surgeon