Dislocated shoulders are common injuries for athletes playing contact sports and they can occur in accidents outside of sports. In this video, Dr. J. Michael Bennett talks about what happens when a shoulder dislocation occurs and how the injury is treated. Dr. Bennett is a Board Certified Orthopedic Surgeon and Fellowship Trained Sports Medicine Physician serving patients from Metro Houston and surrounding counties from clinic locations in Sugar Land and in the Galleria area of Houston. Call our office at 281-633-8600 for an appointment.
Here’s the video:
Here’s a transcript of the video by Dr. Bennett:
Now moving onto the ball and socket mechanism of the shoulder, many times if you have a contact athlete or somebody who gets hit and falls on an outstretched extremity, there is a likelihood of a shoulder dislocation. That dislocated shoulder occurs when the ball and socket mechanism of the shoulder joint is disrupted.
In this injury the ball, which is the humeral head, either pops out posteriorly or anteriorly. When it does, it will usually take a portion of bone of this cup here or a bumper of tissue from that cup [demonstrating with a model of the shoulder joint] and displace it and that makes that patient have a higher likelihood of re-dislocation at a later time.
Most young patients who have this type of injury have about an 85% chance of re-dislocation after a primary dislocation. If you continue to play sports that likelihood increases significantly, so for most patients who are high-contact athletes, that have a dislocation eventually they should get a stabilization-type procedure.
The good news is that the majority of those shoulder stabilization procedures are performed arthroscopically through some poke holes in the shoulder where we actually re-contour this little bumper back here [demonstrating with the shoulder joint model] to give the shoulder stability, and that keeps it from popping in and out of joint.
The problem with living with a dislocated shoulder and not treating it is that, especially if you’re young, you will develop arthritis long-term due to the instability of the shoulder. The more frequently your shoulder dislocates, the more likely you are to develop arthritis as you age.
Every time the shoulder dislocates, the cartilage, which is the soft rubbery surface of the bone will eventually wear down. When that wears down, sometimes you even get wearing down of this cup. When a portion of this cup is worn down, you can think of it almost like a golf ball and a golf tee. If you have a normal golf tee, and it’s intact and you lay the golf ball in the golf tee, it stays on the tee and does not roll off. If you’re missing a portion of the golf tee and your missing a portion of the circumference of the tee, the golf ball will roll off the golf tee and not be stable.
The same thing occurs with the shoulder socket here [demonstrating with the shoulder model]. If you’re missing a portion of the bone, or if you’re missing the soft tissue constraints that hold that ball and socket mechanism intact, you have an unstable shoulder and that increases your likelihood of arthritis.
If you are missing bone due to a shoulder dislocation, sometimes it may require a different surgery and that surgery is called the Latarjet procedure. That’s it’s a French term for what we actually do. The Latarjet procedure involves creating a bone block to restore the integrity of the cup, by grafting a piece of bone to the front of this cup, so the shoulder doesn’t pop out of joint [demonstrating with the shoulder model].
The Latarjet procedure is an open procedure. It does require a small incision in the front of the shoulder where we remove this portion of the bone [demonstrating with the model of the shoulder joint] and we swing this portion of the bone in front of the cup here, to keep the shoulder from popping out of joint. Usually this is not a first-time surgery — we do this when you’re missing bone and have most likely had multiple dislocations over time. Or it’s a revision surgery where you’ve had your shoulder treated previously with arthroscopic surgery and it did not work. Or perhaps you developed instability due to another fall and that previous stabilization surgery did not hold and you’re missing bone, then we usually rely on the Latarjet procedure.
The Latarjet procedure usually allows very fast incorporation of this bone and get you back to contact sports relatively quickly after fixation and stabilization of the shoulder.
Please remember to always do your due diligence in picking your surgeon, discuss your surgical options, and never ever hesitate in asking for a second opinion. If you have any questions regarding any of these issues please feel free to contact my office at 281-633-8600. Thank you!