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Shoulder Dislocations

The shoulder is a ball and socket joint where the ball is the top of the arm bone (humerus) and the socket is part of the shoulder blade (scapula).  The socket portion of the scapula (glenoid) is covered by a ring articular cartilage called the labrum.  This ring serves as a “bumper” for the ball of the shoulder (humerus) to deepen the socket (up to 50%) and help prevent dislocations (like a rubber ring on a blender).  If the socket is visualized as a clock face with twelve at the top, six at the bottom, three on the right side and nine on the left, the upper tendon of the biceps muscle attaches at twelve o’clock.

 

Traumatic injuries to the shoulder can result in a variety of different injuries.  One of the most common injuries experienced in the shoulder is a dislocation, where the ball and socket are no longer aligned.  Shoulder dislocations can be either to the front (anterior) or to the back (posterior).  An anterior dislocation of the shoulder usually results from the arm being forcefully rotated outward (external rotation) when the arm is overhead.  Posterior dislocations can result from a forceful backward blow when the arm is in front of the body.  Posterior dislocations are much less common than anterior dislocations.  Any shoulder dislocation can cause damage to the surrounding tissues including the joint capsule, ligaments, tendons, muscles and bones.  Commonly, acute shoulder dislocations disrupt the labrum on the socket of the shoulder resulting in a tear of the glenoid labrum.

 

Glenoid Labrum Tears

 

Tears of the labrum can occur as a result of an acute, traumatic event such as a shoulder dislocation or as a chronic, repetitive microtrauma (usually overhead motions).  These tears can be found anywhere on the labrum but are commonly seen at the top or bottom.  A SLAP tear (superior labrum [top], anterior [front] to posterior [back]) is a tear of the top of labrum.  This pathology may also involve the biceps tendon attachment at twelve o’clock on the clock face.  A Bankhart lesion is a tear of the labrum below the middle of the glenoid and involves one of the ligaments in the shoulder.  If you have a labral tear, you may experience pain in the shoulder, popping, clicking, locking, sensations of instability, loss of motion or strength.

 

Not all labral tears require surgical intervention for repair.  Some labral tears can be successfully treated with rest, activity modification, anti-inflammatories and proper rehabilitation.  Building strength in your shoulder and arm muscles to support the damaged tissue is the primary goal of rehabilitation.  Additionally, an evaluation of your scapular posture may be performed as this can contribute to chronic shoulder pathology.

 

Labrum Repair / Debridement

 

During this procedure, the surgeon will first evaluate the rim of the labrum as well as the integrity of the biceps tendon.  If the labral tear does not involve the tendon the surgeon may merely trim the torn flap of labrum.  Often times, when the biceps tendon is involved, the surgeon may need to repair and reattach the labrum and tendon using absorbable sutures or metal anchors.  If the tear involves the lower portion of the labrum, the capsule is sometimes stabilized and “tightened down” by folding over the tissues with sutures.

 

After the surgery, a sling with a cushion is worn for approximately 4 weeks for immobilization and protection.  Rehabilitation will begin within one to three days after surgery to begin passive range-of-motion and to learn home exercises.  Gradual restoration of motion will occur over the first few weeks.  Eventually a gentle strengthening program can be initiated per the surgeon’s orders and a rehabilitation specialist’s guidance.  Generally, full strength and return to activity is seen within 3-4 months after the repair.

 

Any surgical procedure has possible risks and complications. Surgeons make every effort to minimize them. They include:

 

  • Nerve Damage
  • Infection
  • Blood Loss
  • Stiffness
  • Labral re-tear