Call 281-633-8600 for an appointment at our Sugar Land office near First Colony Mall and 713-234-3152 for an appointment at our Houston office, near the Houston Galleria. In this video, Dr. J. Michael Bennett talks about how a shoulder dislocation occurs and how shoulder instability can develop from a dislocation. Dr. Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Specialist with a Certificate of Added Qualification in Sports Medicine. He has many years of experience as a shoulder specialist, and he also treats injuries of the elbows and knees and some hand and wrist injuries such as carpal tunnel syndrome.
Hello and welcome. My name is Dr. J. Michael Bennett. I am a Fellowship Trained Sports Medicine surgeon with the Fondren Orthopedic Group. Today we’re going to talk a little bit about shoulder instability. It’s something that we often times run into in our clinics and I’m sure many of you have questions about it in regards to what exactly it is.
Most people when they describe a shoulder dislocation, it usually occurs in what we call the abducted external rotation position. So if you’re a football player or a soccer player and you fall and your arm’s outstretched, and you a feel large clunk or pop. It’s very painful and then it snaps or pops sometimes back in or sometimes you have to go to either an emergency room, or the athletic trainer on the sidelines or the physician on the sidelines to reduce the shoulder back into position. It’s important that you do reduce these as soon as possible to prevent any neurovascular issue regarding the upper extremity.
So that being said, what exactly is going on internally in the shoulder when you have a dislocation, what does that mean? When you think about the shoulder, I’d like to put this into simplistic terms as possible and I think of the humeral head as a golf ball and the glenoid as a golf tee and you can see the curvature of this glenoid or this golf tee here mimics the curvature of the glenoid. So if you play golf and you go out and you put your golf ball on the golf tee usually it’s a very well-balanced structure okay.
Now the problem occurs when you have a shoulder dislocation and that ball slides off the golf tee. And when it slides off the golf tee, it takes a chip off of the golf tee and so you end up missing a portion of that circumferential support okay. So then the next time you try to put the golf ball on the golf tee it doesn’t sit still. You can’t maintain the balance okay. So it ends up recurrently dislocating. If you’ve had your shoulder dislocate once and you’re a young athlete, the recurrence rate of another dislocation occurring is usually about 80%. So you really want to get it evaluated and you really want to discuss thoroughly your options with an orthopedic surgeon.
So that being said, here are some pictures regarding shoulder dislocations. So once again, this is looking at the shoulder from the top down. If you had a camera looking down at the shoulder joint, here’s the ball. Here’s the socket. This is your golf tee right here and this is what’s called the labrum. And the labrum is really, it’s like an O ring around the socket okay. So it gives it a little bit of a bumper. It’s a bumper basically and it sits on, all the way around that socket of the glenoid. And often times what happens in dislocations is that ball will slide off and it will take off that little bumper, that labrum and then sometimes it can take off a piece of bone in the glenoid and at the same time create an indention in the humeral head. And the indention in humeral head is called the Hill-Sachs lesion. If this piece that gets knocked off with the labrum, it’s called the Bankart lesion okay. Or you could just have a strictly, a soft-tissue lesion just involving the labrum itself, which would be just a labral tear with instability.
The ways that we fix this, there are a number of different ways of fixing this and it all depends on whether or not there’s bony deformity, whether or not there’s a large bone fragment involved, how many dislocations you’ve had, age of the patient, activity status of the patient. And most of the patients we see that have this type of problem are younger, athletic patients who play a lot of sports and activities and have these recurrent dislocations. Most of the time it’s going to be a straightforward labrum or Bankart with a little bit of a small sliver of bone involved and that usually can be fixed arthroscopically with a small camera with minimally invasive incisions and we go in there with a camera and we find these little labral tears, that little bumper that’s detached and then we put a little anchor with a little stitch around it into the bone and wrap it around that little labrum and pull it back up into position and let it heal okay. And that basically builds up the border of that socket. It gives you back that support.
Now in chronic situations and the reason that you want to get this evaluated if you have multiple dislocations you don’t want to let this go on too long because the more dislocations you have the more damage you’re doing to your bone. And over time, you’re basically sanding down that bone, the more dislocations occur, and the ball rubs down that anterior glenoid or posterior glenoid and creates a bony deformity and that makes it much more difficult to fix this arthroscopically. So there are ways to fix it but it involves a little bit more invasive procedure and it’s called the Latarjet procedure and we do those as well but it involves an incision.
And basically what we do is we take another bone, a bone in the shoulder joint. It’s actually called the coracoids and if you look at a model of the shoulder here this is the coracoid bone right up front. So we make an incision in the front. We take a little osteotome and cut off this bone here and we swing it around and basically give you a bony bumper to the front of that glenoid and fix it with two screws. And that just keeps the shoulder, it keeps the ball in position so it no longer can slide out of joint. It runs into this bumper here. So now, it has the support that it needs so you can go back to your activities.
So in the end if you do have recurrent instability I highly recommend getting evaluation by a sports medicine orthopedic surgeon just to know what your options are and to discuss what’s available to you. If you have any more questions, please feel free to go to our website or feel free to call our office at 281-633-8600. Thank you.
Dr. Bennett has another video describing how he does a typical shoulder examination. If you’ve had a shoulder dislocation, you should get your shoulder evaluated by s shoulder specialist. Early evaluation will likely minimize any damage to your shoulder and speed your full recovery. For an appointment to answer your questions or for a shoulder evaluation, please call our Sugar Land office at 281-633-8600 or our Houston office at 713-234-3152 or use our Appointment Button at the top of the page.