A shoulder dislocation (anterior, posterior and inferior) occurs when the top of the arm bone (humeral head) happens to slip out of the socket (glenoid). Forward or anterior dislocations occur when the humerus sits in front of the shoulder blade. Anterior dislocations are most common. However backward (posterior) and downward (inferior) shoulder dislocations can also occur. Recurrent dislocations and multidirectional shoulder instability may occur in some cases.
- Significant pain, which may be all around the shoulder and further down, and all along the arm.
- Cannot move the arm from its present position, especially when in positions with the arm trying to reach away from the body or the top of the arm moving backward.
- The arm remains numb.
- The shoulder is visibly displaced. In some dislocations, the shoulder appears unnaturally square.
- No bone is visible at the side of the shoulder indicating a dislocation of the shoulder.
A new shoulder dislocation injury most commonly occurs due to falling. Sports related injury can also result in dislocation of the shoulder.For example, when the arm may be turned into an awkward position with some amount of force when a sportsperson maybe in some kind of a violent action during play such as tackling in football. However if a dislocation or even a partial dislocation (subluxation) occurs with very little force, recurrent or multidirectional instability must be taken into consideration.
Medications are often required to lessen pain. After a dislocation is confirmed by x-ray, medicine may be given to reduce the pain and allow the surrounding muscles to relax during the reduction procedure (relocating the shoulder joint and align it). A mild sedative may be necessary in certain cases so that the body is also relaxed. Patients are placed in a sling to rest the shoulder. Once the shoulder dislocation is back in position, x-rays are repeated to make sure that shoulder is in the correct position, and also to see whether there are other injuries such as fractures, or ligament damage. If ligament damage is diagnosed, the patient is most likely to have recurrent dislocation and therefore surgery is recommended.
Patients who have one shoulder dislocation is at great risk to have another shoulder dislocation. There is also a great likelihood of recurrent dislocation for younger people too. In such cases with repeated dislocations, surgery may be a viable option. The surgery requires repairing and tightening the structures within the shoulder that were damaged during the dislocation. The conventional procedure is an open reconstruction.
Arthroscopy is recommended for shoulder problems, like:
- Evaluation and treatment of instability.
- A torn or damaged cartilage ring (labrum) or ligaments(shoulder instability).
- A damaged biceps tendon.
- A torn rotator cuff.
- A bone spur or inflammation around the rotator cuff.
- Stiffness of the shoulder.
- Shoulder Arthritis.
- Subacromial decompression.
- Arthritis of the end of the clavicle (acromioclavicular joint).
- Treatment of calcific tendinitis.
- Treatment of frozen shoulder.
- Removal of loose bodies.
- Debridement/drainage of shoulder joint infection.
What is Arthroscopy?
Arthroscopy is a surgical procedure in which an arthroscope is inserted into a joint
What are the benefits?
The surgeon makes 2 small incisions (about ¼ of an inch), around the joint area. Each incision is called a portal. These incisions result in very small scars, which in many cases are unnoticeable. In one portal, the arthroscope is inserted to view the shoulder joint. Along with the arthroscope; sterile solution is pumped to the joint which expands the shoulder joint, giving the surgeon a clear view and room work. With the images from the arthroscope as a guide, the surgeon can look for any pathology or anomaly. The large image on the television screen allows the surgeon to see the joint directly and to determine the extent of the injuries, and then perform the particular surgical procedure, if necessary. The other portal is used for the insertion of surgical instruments.
A surgical instrument is used to probe various parts within the joint to determine the extent of the problem. If the surgeon sees an opportunity to treat a problem, a variety of surgical instruments can be inserted through the portal. After treating the problem, the portals (incisions) are closed by suturing or by tape. Arthroscopy is much less traumatic to the muscles, ligaments and tissues than the traditional method of surgically opening the shoulder with long incisions (open techniques).
Why is arthroscopy necessary
Certain conditions of the shoulder which cannot be cured by medications and therapy require Arthroscopic surgery.
What are the joints that can be viewed with an arthroscope?
Arthroscopy has become highly advanced traditionally the knee, shoulder, ankle and hip joint conditions could be treated with Arthroscopy surgery. Presently even the problems of wrist and finger joints and toe joints can be treated.
What are the conditions that can be treated by arthroscopy?
Shoulder instability/Recurrent dislocations, impingement syndrome, rotator cuff tears, Frozen shoulders, Synovitis, Arthritis of shoulder.
What are the possible complications?
Infections, pain, injury to surrounding nerves and blood vessels, Post surgery stiffness.
Recovery after arthroscopy.
Patients can go home the same day depending on their condition. They may require pain medications for a few days. In some cases, they can start using the hand in a few days, while in some other cases they may take even a year for full recovery. They can take bath within a few days after surgery. Driving, using computers, writing and playing sports will depend on each individual case and the disease.