Shoulder Anatomy
The shoulder is a ball-and- socket type of joint that permits a wide range of movement. Its bony structures include the upper arm bone (the humerus) and the shallow cavity (the glenoid) of the shoulder blade. The ball of the humerus (humeral head) is meant to stay close to the socket, like a ball bearing in a holder. The humeral head is held into the socket by the lining of the joint (the capsule), thickenings of the capsule called ligaments and a cartilage rim (the labrum).
What Is Shoulder Instability?
Shoulder instability usually occurs when the lining of the shoulder joint (the capsule), ligaments or labrum become stretched, torn, or detached, allowing the ball of the shoulder joint (humeral head) to move either completely or partially out of the socket.
The different types of labral Tears:
Slap Tear - The term SLAP (superior –lab um anterior-posterior) lesion or SLAP tear refers to an injury of the superior labrum of the shoulder.
Bankart Tears - Bankart tears typically occur in younger patients who have dislocated their shoulder. When the shoulder joint ball slips out of the socket, the joint capsule (fibrous tissues that surround and protect the joint) can pull on the lower portion of the labrum and tear it. This in turn creates instability because the breached labrum makes it easier for the shoulder to dislocate again. A dislocation where the head of the humerus shifts toward the front of the body, it leads to what is called "anterior instability." When the ball slips toward the back of the body, it leads to "posterior instability."
Treatment:
Conservative Management-
The goal of therapy is to restore shoulder motion and increase the strength of the muscles around the shoulder. Strong muscles, especially those of the rotator cuff, are required to protect and prevent the shoulder from re-dislocating or subluxing. Once full function of the shoulder has returned, the patient can gradually return to activities.
Conservative treatment options include physical therapy, oral anti-inflammatory medications, and activity modification.
Surgical Management
When conservative treatment options fail to relieve shoulder instability, your surgeon may recommend shoulder stabilization surgery. Shoulder stabilization surgery is performed to improve the stability and function of the shoulder joint and prevent recurrent dislocations. It can be performed arthroscopically or open.
See surgical options below.
Arthroscopic Slap/Labral Repair
During this procedure, the torn labrum is visualized with the use of an arthroscope, inserted through a small incision in the shoulder. The surgeon will clean up any scar tissue and rough edges of the labrum and prepare the bone of the socket (glenoid), then reattach the labrum to the bone. This is achieved with the use of special implants called suture anchors. These anchors are made of different types of material (suture, metal, bioabsorbable material) and are inserted into the glenoid bone arthroscopically through small incisions. Each anchor has a suture that is used to reattach the labrum back to the bone. Multiple suture anchors are used to hold the labrum in place and to tighten the injured shoulder joint. The sutures hold the labrum permanently, however, to be successful and to avoid recurrence of a shoulder instability or labral tear problem, the labrum must heal directly to the bone of the socket (glenoid) in its normal position.
Open Latarjet
The goal of Latarjet is to augment the glenoid with additional bone to hold the head of the humerus within the shoulder socket more securely. The bone augmentation comes from the part of the scapula (shoulder blade) called the coracoid. The surgeon removes the coracoid from its original attachment site and moves it a few centimeters forward, to the front of the shoulder socket. Once in place, the coracoid is screwed into the shoulder socket.
Postoperative Care and Recovery
After the surgery, the small surgical wounds take a few days to heal and the surgical dressing is replaced by simple Band-Aids. The recovery time depends on the type and extent of problem for which the procedure was performed. Pain medications are prescribed to keep you comfortable. The arm of the affected shoulder is placed in a sling for a short period as recommended by your doctor. Physical therapy is advised to improve shoulder mobility and strength after the surgery.
Risks and Complications
Complications are the same as with any surgery which include infection, bleeding, damage to nearby nerves or blood vessels, or delayed healing after the surgery. In certain cases, stiffness of the shoulder joint may occur after the surgery. It is important to participate actively in your physical therapy to prevent this from occurring.