• Don’t Ignore an Unstable Shoulder

    by Dr. J. Michael Bennett
    on Oct 10th, 2012

Is your shoulder unstable?  Do you keep dislocating your shoulder?  Dr. J. Michael Bennett is a Shoulder Specialist and he created this video to describe how an unstable shoulder and a shoulder subject to recurring dislocations might be treated with minimally invasive arthroscopic surgery.  If you suffer from an unstable shoulder or shoulder dislocations, call 281-633-8600 for an appointment and a shoulder evaluation.  Don’t ignore the problem, because if you do, your shoulder may become arthritic and you’ll be looking at much more significant surgery to get relief from your pain.

This video is not a substitute for professional medical advice, diagnosis, or treatment.  You should not act upon any information provided here without first seeking medical advice from a physician.

Doctor Bennett well qualified as a shoulder specialist.  He’s a Board Certified Orthopedic Surgeon, a Fellowship Trained Sports Medicine Physician, and he’s been named a Texas Super Doctor®.  We accept Aetna, Cigna, United Healthcare and most other medical health insurance plans.  Dr. Bennett serves patients from all over Houston and Texas from our clinics in Sugar Land and Houston.

In this video, Dr. Bennett talks about treatments for various types of shoulder instability and dislocated shoulder.

Summary of the Unstable Shoulder Video

Hello, my name is Dr. J. Michael Bennett with the Fondren Orthopedic Group. I’m a sports medicine specialist who focuses primarily on dealing with pathologies of the shoulder, elbow, and knee. I am fellowship trained and CAQ (Certificate of Added Qualification) certified in sports medicine as well as general orthopedic surgery.

As far as treatment options regarding instability and labrum detachments, and bony detachments of the glenoid, there are a number of different options. There’s always the option of doing nothing. This is an elective procedure, and you always have the option of conservative management. Now that being said, you need to know the prognosis and the possibilities of going along with the conservative option. That prognosis is arthritis, recurrent instability, and chronic problems within the shoulder. Because over time the more the shoulder dislocates and becomes unstable, the more wearing you get in this little ball and socket mechanism, particularly in this glenoid and the more unstable the shoulder can become. What could at one time be treated with a minimally invasive operation, now becomes an arthritic shoulder and a more significant procedure has to be done to get long-term pain relief.

Typically in our younger, athletic populations we recommend, particularly if they want to get back to full contact sports and activities, a shoulder arthroscopy.  With a shoulder arthroscopy, we make three to four little puncture wounds across the shoulder joint. We do one to two in the front, one in the back, and then one out to the side occasionally and we evaluate this glenoid. If there is a detachment of this little bumper there, the glenoid, we can actually put a couple of anchors there. Nowadays we use biodegradable anchors that are broken down by the body and absorbed and they become part of the bone.  Occasionally we use a certain type of plastic anchor, to actually pull that little bumper back down to the bone so it heels. That gives you back the circumference of the shoulder joint, and gives you back the stable ball and socket mechanism that you need to maintain a stable shoulder and get back to full activities.

Once again I remind you of the golf tee scenario. You have a golf ball and you have a golf tee and if part of that golf tee is missing, that golf ball is going to roll off.  So the case where you have a patient with a bony component to the glenoid, it depends on the size of that fragment of bone.  If there’s a large bone fragment that’s broken off or it’s missing or the side is worn down, it changes the shape of this glenoid.  It’s not oval-shaped — it’s pear-shaped. If you have a pear-shaped glenoid that means you are at high risk for recurrent dislocations. In that case something more invasive needs to be done and what we usually do is something called a Latarjet procedure. In that procedure we take this bone here, which is called the coricoid, and we actually make a small cut at the base of this coricoid, and we slide it down to wherever this bone defect is. This coricoid here is actually fixated with two screws, and all that does is increase the surface area of that socket of the glenoid. So the shoulder or the humeral head does not slide off — now it has another bumper that it has to go across to become unstable.   This is a very successful technique, particularly in patients who are chronic dislocators, that her missing bone at the front of that glenoid surface.

For patients who have recurrent dislocations, who not only have that missing bone in front, but they also have a big indention in the back of the human humeral head, there are a number of things that we can do.  One is that we can fix this defect in the front, either with the labrum repair with the anchors, if it is just soft tissue, or with the Latarjet Procedure, if it’s bone included.  And then for the back where the indention is in the back of the humeral head, we fill in those intentions. Sometimes you can do that with a bone graft, sometimes you can do that with a metal type of implant such as the one you’re seeing here, and all that does is give you back the contour of the ball so it no longer has a big indention. That means when you rotate the shoulder, it no longer longer gets caught up on this edge here. If you still have this indention in the humeral head, it can get stuck and then you have to pop it back into place. If you don’t have this indention, it smoothly rotates and give you is you all the degrees of freedom that you need in your shoulder joint.

So that basically describes the glenohumeral joint and the definition of a shoulder dislocation.  If you have any questions or comments, please call my office at 281-633-8600. Thank you.

Author Dr. J. Michael Bennett

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