Bologna – Istituto Rizzoli
Misano Adriatico – Mendel
San Marino – Nova Clinic
Roma – Salvator Mundi
San Lucido – Studi Medici ARS

Shoulder stabilization

Dislocation is defined as the complete loss of the relationships between the joint heads of a joint. When this is partial it is called a subluxation.
Shoulder dislocations are, in the vast majority of cases, glenohumeral dislocations (dislocations affecting the largest joint of the shoulder, that between the gleno and head of the humerus)
Glenohumeral dislocations can usually be of 2 types: anterior or posterior, depending on the dislocation of the humeral head. Anterior ones, in which the humerus loses its normal joint relationships and dislocates anteriorly, are the most common of all (Fig.1).

When dislocations occur repeatedly, even a long time apart, it is called a recurrent dislocation, leading to a condition that is called chronic instability.

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Fig.1 Representation of the most common shoulder glenohumeral dislocations: A, anterior dislocation; B, posterior dislocation.

Certain types of sports activities (basketball, tennis, baseball, volleyball) particularly stress the joint between the scapula and humerus, thus exposing it to a greater likelihood of traumatic events. Falls and traffic accidents are also among the most common causes of shoulder dislocation. Moreover, some people, are genetically predisposed to dislocations because they were born with lax capsuloligamentous and tendon structures.

In recent dislocation of the shoulder (a few hours), emergency reduction should be used after ascertaining any bony (by double-projection X-ray) and nerve complications. Thereafter, the shoulder should be immobilized with a cast/brace for about 30 days. Thereafter, a period of functional rehabilitation and hydrokinesitherapy will be necessary.

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Fig.2 Arthroscopic capsuloplasty (shoulder stabilization): A, arthroscopic accesses (minimally invasive surgery, the shoulder is not "opened," "holes" are drilled, and the procedure is performed with the aid of an endoscopy camera); B, capsular lesion identification (in red); C, capsular lesion repair (in blue, "anchors" are used to secure the torn capsule to the bone)

In case of persistence of instability (recurrent dislocation) with increasingly frequent episodes one should consider undergoing joint stabilization surgery.

Stabilization can be performed arthroscopically (without opening the joint, through small holes using a camera) if the damage is limited to the “soft parts” i.e. capsule and ligaments (arthroscopic capsuloplasty) (Fig.2). [1-5]

Video 1 –  shoulder stabilization with INNOVATIVE KNOTLESS MINIMALLY-INVASIVE technique

If the number of recurrences is high and/or capsuloligamentous damage is associated with bone deficits, “open” stabilization is used. The surgery that is usually performed is arthrotomy capsuloplasty according to Latarjet (Fig.3). [1-5]

In case of surgery, the average hospital stay time is 1-2 days. It is necessary to immobilize the arm with a brace for 3 weeks and follow a course of functional rehabilitation and hydrokinesitherapy. Sedentary work can be resumed after 7-10 days, heavy work activity needs about 3 months.

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Fig.3 Arthrotomic (open shoulder stabilization) capsuloplasty (shoulder stabilization) according to Latarjet: A, arthrotomic ("sky-open") modified minimally invasive access (in red); B and C, repair of capsular lesion by transposition of the conjoined tendon with coracoid "bone brat" (to fill bony defect of the glenoid, present after numerous recurrent dislocations) fixed with 2 metal screws.
Bibliography

  1. Comparison of arthroscopic and open anterior shoulder stabilization. Cole BJ, L’Insalata J, Irrgang J, et al. A two to six year follow-up study. J Bone Joint Surg Am. 2000 Aug;82(8):1108-14.

  2. Comparison of an arthroscopic and an open procedure for posttraumatic instability of the shoulder: a prospective, randomised multicenter study. Sperber A, Hamberg P, Karlsson J, et al. J Shoulder Elbow Surg. 2001 Mar-Apr;10(2):105-8.

  3. Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomised clinical trial. Bottoni CR, Smith EL, Berkowitz MJ, et al. Am J Sports Med. 2006 Nov;34(11):1730-7.

  4. Surgical interventions for anterior shoulder instability in adults. Pulavarti RS1, Symes TH, Rangan A. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD005077.

  5. Long-term outcomes after repair of recurrent post-traumatic anterior shoulder instability: comparison of arthroscopic transglenoid suture and open Bankart reconstruction. Zaffagnini S, Marcheggiani Muccioli GM, Giordano G, et al. Knee Surg Sports Traumatol Arthrosc. 2012 May;20(5):816-21.

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