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Treatment
How is a dislocation
and traumatic shoulder instability treated?
The initial reduction of a dislocation can be quite difficult. Contractions
of the shoulder muscles can trap the humeral head against the glenoid.
Gentle traction, and at times, medication may be needed to accomplish
the reduction. Once the shoulder is reduced, a sling is used for a
few days to protect it, and relieve discomfort. Physical therapy may
help the patient regain motion in the joint.
Non-Operative Treatment
Initial treatment for recurrent instability of the shoulder centers
on physical therapy. Strengthening the rotator cuff muscles
and periscapular muscles (those around the scapula)
gives stability to the joint. The goal of physical therapy is to help
the muscles provide stability to the shoulder that the torn ligaments
can no longer supply. The therapy for recurrent instability should
be carefully designed for each patient since this condition often
causes apprehension about certain arm positions or exercise maneuvers.
Very often, physical therapy can help regain lost motion, reduce apprehension,
and restore shoulder function.
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External
Rotation
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Pendulums
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Stand Parallel to the cord, your elbow should be bent 90 degrees
at your side. Slowly rotate your hand away from your body
using your elbow as a hinge. Rotate until your arm is in a
neutral position.
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Bend
at your waist and let your affected arm hang relaxed. Move
your arm in all directions. Try to let momentum move your
arm in all directions.
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Operative Treatment
Surgery is usually recommended if recurrent instability cannot be
controlled with physical therapy and activity modification. The goal
of surgery is to return stability to the shoulder with the least loss
of motion. All shoulder procedures designed to stabilize the shoulder
involve some loss of motion. The current procedures for anterior
shoulder instability attempt to restore the normal anatomy without
over tightening the ligaments. Surgery is generally not performed
on first dislocations unless the patient is an athlete who will continue
to participate in a sport that puts the shoulder at risk.
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Use the bottons above to see the different steps.
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Open Labral Repair
Currently, the preferred procedure for anterior instability is an
open labral repair with an anterior capsular shift.
This procedure is performed through a two to three inch incision on
the front of the shoulder. The torn labrum is repaired and the stretched-out
anterior shoulder capsule is imbricated (overlapped)
to make it smaller. This procedure is successful approximately 95%
of the time in eliminating recurrent dislocations.
Arthroscopic Techniques
Arthroscopic procedures to repair the torn labrum and reduce capsular
laxity have been recently developed. Arthroscopic techniques are approximately
80% successful. These procedures are performed with visualization
through a small fiberoptic scope. Instruments are inserted into the
joint through two or three small incisions to repair the labrum. The
surgical technique is similar to the one used in an open repair. A
loose capsule is more difficult to address arthroscopically. Procedures
using thermal energy to shrink the loose capsule have been developed,
and are still being evaluated.
What types of complications may occur?
The major complications of anterior stabilization techniques are recurrent
instability and/or loss of motion. The rate of recurrent instability
depends largely on the technique used for the repair. The loss of
motion can be severe, and is a function of over tightening the anterior
capsule. In general, the operative shoulder should lose no more
than ten degrees of external rotation. Other small risks (less
than 1%) include infection, post-operative stiffness, nerve damage,
or blood vessel injury.
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