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Shoulder instabilities and dislocations


Bankart lseion, shoulder instability, dislocation, labral tear

A so called Bankart lesion - a tear of the anterior and inferior labrum - is responsible for an unstable shoulder, amongst others.
Here you can read:
What is a shoulder instability ?
Signs and symptoms of a shoulder dislocation or instability ?
Development of shoulder dislocations or instabilities ?
How to treat shoulder instabilities and dislocations ?
Why is it important to stabilize an unstable shoulder joint ?
Classifications for shoulder instabilties


What is a shoulder instability ?
If a shoulder dislocates, the humeral head is completely separated from the glenoid. Most of the dislocations happen traumatically and in about 90% of all cases the “ball” moves out of the joint in an anteroinferior direction. Isolated inferior or posterior dislocations are rare and an upper dislocation is a very rare event.

Instabilities are characterized by a loosening of the shoulder joint. The humeral head is moving too much in the glenoid. It´s a kind of partial dislocation. Quite a few instabilities are multidirectional, which means that it is a very loose shoulder joint, where the “ball” can move out of the joint to the back, bottom or anteriorly.


Signs and symptoms of a shoulder dislocation or instability ?
Dislocations are acute events. The patient is suffering from a trauma and has acute, severe pain. He is nearly unable to move his arm. A kind of numbness or tingling might occur. Those symptoms disappear when the humeral head is placed back into the glenoid. Different reposition techniques exsist for such a maneuver.
An instability has a more chronic character. Some special movements of the arm cause pain, some not. Some people describe a kind of snapping or clicking, only. While others are suffering from complaints that are very similar to an impingement syndrome.


Posterior shoulder instability

Posterior shoulder instability.


Development of shoulder dislocations and instabilities:
As mentioned above, most of the dislocations happen due to a trauma. Depending on the age and traumatized structures in the shoulder joint, dislocations happen again and again, after such an initial traumatic event. A grand mall event in epilepsia might another and rare cause of a dislocation. Besides those aspects, a few youngster can dislocate their shoulder joint voluntary. Until today, we don´t know the exact mechanism of this kind of voluntary dislocations.
Instabilities develop due to repetitive microtraumata, e.g. in sports. People are swimming, playing handball or other sports and the shoulder capsule is stretched year after year, until the joint will get loose and instability complaints occur. Predominantly baseball and football are typical sporting acitivities, that lead to these problems in english speaking countries, like USA or United Kingdom. In a lot of these ( or similar ) cases a genetic component ( very elastic capsular tissue ) might be associated or the main reason for the shoulder problems.


How to treat shoulder instabilities and dislocations: ?
After a dislocation the arm will be put back by a reposition maneuver and placed into a sling for a few days. Depending on the age of the patient it will be operated. Younger people ( between 20 and 40 years ) have a chance about 90% that the shoulder will dislocate again and again. Older patients ( 60 years and older ) have a chance of about 90% that the arm will remain stable, which means that an operation won´t be necessary in most of the patients in this age group.
If only a few dislocations ( 2 to 5 ) had happened, the shoulder joint can be stabilized in an arthroscopic operation. The more dislocations happened in the past, the shoulder will be stabilized in an open operation.
Youngsters who can dislocate their shoulder voluntary, won´t be operated, because of the bad operative results in these cases.


arthroscopic bankartsuture

Arthroscopic reconstruction with bioresorbable anchors of a torn labrum.


First, instabilities are treated by a special physiotherapy program. The physiotherapist uses special excercises to strengthen shoulder muscles, which will stabilize the joint. If a physiotherpeutic training has no success, the shoulder joint will be stabilized using different arthroscopic or open techniques.


Why is it important to stabilize an unstable shoulder joint ?
1. Dislocations of the shoulder can harm the nerves near the shoulder. Especially, the axillary nerve is at risk to be hurt during a shoulder dislocation. If such a nerve is hurt it can result in permanent numbness / tingling and / or palsy of the arm.
2. Redislocations of the shoulder are very painful.
3. The more shoulder dislocations occur the more internal structures of the shoulder joint are hurt and an arthrosis of the shoulder joint will develop.


Classifications for shoulder instabilties:
There are serveral types of classifications. E.g. the acute dislocation is distinguished from the chronic shoulder instabilty. Depending on the direction it is called an anterior instability ( to the front ), a posterior shoulder instability ( to the back ), an inferior or superior instability and if the shoulder is unstable in multiple directions, it is called a multidirectional shoulder instability. Unidirectional instabilities are responsible for about 90% of all dislocations.
Depending on a trauma or not - we call it a traumatic or atraumtic shoulder instability.
Another classification for shoulder instabilities is to distinguish between voluntary and involuntary shoulder dislocations.
Most of the time a damage occurs at the anterior shoulder side ( so called Bankart lesion ). This is classified in grade 1 to 3.
These are only a few examples to describe shoulder instabilities and dislocations.
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