Evaluation and Treatment of Shoulder Instability

Abstract

The shoulder joint has a wide range of motion as a result of a complex interplay of soft tissue and bone structures. It is also the most frequently dislocated joint in the body. Shoulder dislocations are generally classified as traumatic and nontraumatic. There are many specific causes, each of which necessitate individualized treatment modalities. Accurate diagnosis requires a careful history and physical examination. Arthroscopic surgery and advances in imaging have expanded our understanding of anatomy and pathology relevant to shoulder instability and its treatment. Surgery is the treatment of choice for recurrent traumatic instability. Surgery may also be indicated in some first-time traumatic dislocations in young contact athletes, whereas rehabilitation is the initial treatment of choice in older patients with initial instability and in those with nontraumatic dislocations. Results of arthroscopic capsulolabral repair now equal those of open capsulolabral repair and have become the surgical treatment of choice for most patients. However, in cases of recurrent instability and significant bone deficiency of either the glenoid or humeral head, open bone reconstructive procedures are often necessary to ensure successful outcomes.

Arthroscopic Morphology of Labrum Tear in Recurrent Anterior Dislocation of Shoulder

“…This result quite resembled the results reported by other authors [2]. Most of the authors believed that the mechanic of the lesion was related to the movement of the shoulder joint that let the humerus move to the front, which was the popular movement in hand-dominant sports such as throwing balls, using rackets,.. [1,3]. As much as 12,7%…”

“…Morphology of labrum tear is quite important because it is directly related to the possibility of labrum repair with suture, possibility of recovery of shoulder muscle and especially the possibility of preventing dislocation, possibility of the labrum to heal and continue to develop after the repairing arthoscopy [1,3]. This report aims to discuss the morphology of labrum tear in recurrent anterior dislocation of shoulder via arthroscopy.…”

“…Recurrent anterior dislocation of shoulder accounts for more than 80% of shoulder dislocation cases [1][2][3][4][5]. If fi rst aid for the lesion is not properly given, or if the lesion is too serious, the recurrence is highly likely [1].…”

“…When dislocation is recurrent for a number of times, it becomes easier to happen; patients can even reduce the joint by themselves. This often involves the lesion of glenoid bone and possibly a part of the humerus (Hill Sachs Lesion) [1][2][3].…”

“…Clinically, most of these cases have a small number of recurrence, under 10 times, and dislocation reduction is still diffi cult to perform [2][3][4][5][6][7].…”