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| Treatment of Shoulder Dislocations and
Subluxations
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| The shoulder has the most motion of any joint in
the body. Unfortunately, it
is also the most susceptible to instability.
Dislocation of
the shoulder joint, which occurs when the ball (head of the humerus bone)
pops out of the socket (glenoid cup of the scapula bone), is common. When the shoulder dislocates, the rim of soft tissue which
surrounds the glenoid rips and tears. This rim, called the lip or labrum,
is like a bumper which helps keep the ball in the cup. When the labrum is
torn, dislocation can commonly recur (happen over and over again) |
| Disappointing
Natural History
When a younger person dislocates their shoulder, the
recurrence or re-dislocation rate may be as high as 90%. In addition, in
those patients who don’t have recurrent dislocations, activities like
sports or throwing must frequently be modified. Some patients even have
difficulty sleeping comfortably. When a patient who is older than 40 years
old suffers a shoulder dislocation, the rotator cuff (the main tendons and
muscles which move the shoulder) may tear.
In either case, without repair, continued instability and
disability may result.
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| Shoulder Pain and
the Throwing Athlete
Sometimes, the head of the humerus bone may only
partially slide out of the socket. This
partial dislocation is known as a subluxation.
Repetitive
overhead throwing, serving as in tennis or volleyball, weightlifting
or swimming can cause the subtle instability resulting in
subluxation. Accidents may also cause injuries to the labrum and result in
subluxations. Patients may note pain or weakness and may not fully
appreciate that the problem is their shoulder sliding out of the joint. |
| History
Patients commonly complain of symptoms of a loose
shoulder joint. They may experience popping or grinding or pain in certain
positions. Patients may feel afraid to use their arms in certain ways.
Athletes may complain of a dead arm, weakness, pain or fatigue in their
shoulder. Most patients who
have had even one dislocation will tell you that it is extremely
uncomfortable.
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| Treatment
The goal of shoulder stabilization is to restore
stability, strength, function and provide pain relief. While
non-operative treatment is preferred in most cases, surgery is recommended
when non-operative management fails.
In addition, because of the high risk of recurrence, surgery is
recommended for patients with dislocation who are less than 25 years old.
Surgery is also recommended for older patients who suffer a tear of
the rotator cuff tendons. |
| Minimally Invasive Repair
Minimally invasive
arthroscopic techniques are now used to perform repair of the torn
shoulder labrum or rotator cuff. Taos Orthopaedic Institute Research
Foundation’s Dan Guttmann, MD, is nationally recognized as a
subspecialist in arthroscopic shoulder repair and is sought out as an
instructor, teacher and lecturer so that he may share this expertise. With
arthroscopic surgery, smaller scars, reduced pain, faster rehabilitation
and lower rates of complications tip the balance in favor of repair for a
patient with shoulder dislocation or an athlete with subluxation. |
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