This is the fifth in a series of videos describing common shoulder injuries that we see in our clinic. In this video, Dr. Bennett talks about shoulder instability and the injuries to the shoulder that can result. If you have questions, please call our Sugar Land office for an appointment at 281-633-8600 and our Houston office at 713-234-3152.
– – 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. It can happen anteriorly [toward the front of the body], it can happen posteriorly [toward the back], it can happen inferiorly [downward toward the feet]. Then in rare cases can happen superiorly [toward the head], but most of the time it’s going to be happening anteriorly inferiorly [toward the front of the body and downward].
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? Now, in severe cases, it can even knock off some bone here, and that’s called a bony Bankart. 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. 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. 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.OrthopedicSportsDoctor.com or come in for an evaluation. Thank you.
Please call our Sugar Land office at 281-633-8600 or our Houston office at 713-234-3152. If you’re experiencing shoulder instability or recurring shoulder dislocation, don’t ignore it.
