Recurrent Shoulder Dislocation Treatment

What is Recurrent Shoulder Dislocation?

Recurrent shoulder dislocation occurs when the shoulder repeatedly slips out of its socket (the glenohumeral joint). The shoulder is the most mobile joint in the body, allowing a wide range of motion, but this mobility also makes it susceptible to instability. After an initial dislocation, the supporting structures of the shoulder—including ligaments, labrum (the cartilage rim around the socket), and joint capsule—may be damaged, leading to a higher risk of repeated dislocations. Each subsequent dislocation can cause further damage to the joint and increase the likelihood of developing chronic instability, arthritis, and other long-term complications.

Causes and Risk Factors

Several factors can contribute to recurrent shoulder dislocations:

• Previous Dislocation: The most significant risk factor is having experienced a prior shoulder dislocation, especially at a young age.
• Bankart Lesion: Damage to the labrum, particularly to the anterior-inferior labrum (known as a Bankart lesion).
• Hill-Sachs Lesion: A compression fracture of the humeral head that can occur during dislocation.
• Ligament Laxity: Naturally loose ligaments or conditions like Ehlers-Danlos syndrome can increase risk.
• Age: Younger patients (under 25) have a significantly higher recurrence rate after initial dislocation.
• Athletic Activities: Participation in contact sports or activities requiring overhead arm movements.
• Inadequate Rehabilitation: Insufficient or improper rehabilitation after the initial dislocation.
• Bone Defects: Significant bone loss on either the glenoid (socket) or humeral head (ball).

Symptoms and Diagnosis

Common symptoms of recurrent shoulder dislocation include:

• Repeated episodes of the shoulder "giving way" or coming out of place
• Visible deformity of the shoulder during dislocation episodes
• Pain and swelling after dislocation
• Limited range of motion
• Feeling of looseness or instability in the shoulder
• Apprehension or fear when the arm is positioned in certain ways
• Clicking, catching, or grinding sensations

Dr. Saxena uses a comprehensive diagnostic approach that includes:

• Detailed Medical History: Including information about previous dislocations and circumstances surrounding them.
• Physical Examination: Specific tests to assess stability and identify signs of labral tears or other damage.
• Imaging Studies: X-rays, MRI with contrast (MR arthrogram), and sometimes CT scans to evaluate bone and soft tissue damage.
• Assessment of Bone Loss: Quantifying glenoid and humeral bone loss, which is crucial for surgical planning.

Treatment Options

Dr. Abhishek Saxena develops personalized treatment plans based on several factors, including the patient's age, activity level, number of previous dislocations, and degree of structural damage. Treatment options include:

Non-Surgical Management

• Physical Therapy: Focused on strengthening the rotator cuff and scapular stabilizing muscles to improve dynamic shoulder stability.
• Activity Modification: Avoiding positions and activities that put the shoulder at risk for dislocation.
• Bracing: In some cases, temporary bracing can help during the healing or rehabilitation process.

While non-surgical approaches may be attempted, particularly in older, less active patients, they are generally less effective for younger, active individuals with recurrent dislocations.

Surgical Management

Dr. Saxena specializes in advanced surgical techniques for shoulder instability:

• Arthroscopic Bankart Repair: Minimally invasive procedure to reattach the torn labrum to the glenoid rim using special anchors and sutures.
• Capsular Shift/Plication: Tightening the loose joint capsule to enhance stability.
• Remplissage Procedure: Addressing Hill-Sachs lesions by filling the defect with part of the infraspinatus tendon.
• Latarjet Procedure: For cases with significant bone loss, involving transfer of a portion of the coracoid process to the front of the glenoid.
• Glenoid Augmentation: Using bone grafts to reconstruct the glenoid in cases of severe bone loss.
• Combined Procedures: Tailored approaches addressing multiple aspects of instability simultaneously.

Our Advanced Surgical Approach

Dr. Saxena utilizes state-of-the-art techniques for treating recurrent shoulder dislocation:

• 3D preoperative planning for precise assessment of structural damage
• High-definition arthroscopy for minimally invasive procedures
• Advanced suture anchor systems for superior fixation
• Modified Latarjet techniques with specialized instrumentation
• Customized approach based on individual patient's pathology and needs
• Comprehensive intraoperative assessment of all potential contributing factors

The Surgical Experience

Most shoulder stabilization procedures are performed arthroscopically, allowing for smaller incisions, less pain, and quicker recovery. The procedure is typically performed under general anesthesia, often supplemented with a regional nerve block for postoperative pain control.

Arthroscopic procedures usually require 2-4 small incisions (portals) around the shoulder. Through these portals, Dr. Saxena inserts a camera and specialized instruments to repair the damaged structures. Most patients can return home the same day, though some complex procedures may require an overnight stay.

For open procedures like the Latarjet, a slightly larger incision (approximately 5-7 cm) is made at the front of the shoulder. These procedures typically require more extensive dissection but provide robust solutions for complex instability cases.

Recovery and Rehabilitation

Recovery from shoulder stabilization surgery follows a progressive timeline:

• Initial Phase (0-6 weeks): The arm is protected in a sling, with limited movement allowed. Passive range of motion exercises begin under the guidance of a physical therapist.
• Intermediate Phase (6-12 weeks): Progressive transition to active motion exercises as healing progresses. The sling is discontinued, and gentle strengthening exercises begin.
• Strengthening Phase (3-4 months): Focus shifts to building rotator cuff and scapular muscle strength with progressive resistance training.
• Return to Activity Phase (4-6 months): Sport-specific or activity-specific conditioning and gradual return to full activities.

Dr. Saxena and his team provide a customized rehabilitation protocol for each patient, with regular follow-up appointments to monitor progress and ensure optimal healing. Full recovery can take 6-9 months, depending on the procedure performed and individual healing rates.

Outcomes and Success Rates

Modern surgical techniques for treating recurrent shoulder dislocation have excellent success rates:

• Over 90% of patients experience no further dislocations after appropriate surgical stabilization
• Most patients can return to their previous level of activity, including sports
• Significant improvement in comfort and confidence in shoulder function
• Reduced risk of developing arthritis from repeated dislocations
• High patient satisfaction rates

Factors that influence outcomes include the number of previous dislocations, amount of bone loss, type of procedure performed, and adherence to rehabilitation protocols. Dr. Saxena carefully evaluates each patient to select the procedure with the highest likelihood of success for their specific situation.