Arthroscopic stabilization
of shoulder dislocations

shoulder stabilization, arthroscopy, bankart suture

Typical X-ray of a shoulder dislocation: the humeral head is dislocated to the front and bottom
( in the antero-inferior direction )
 
Reasons and types of shoulder dislocations:
Most of the shoulder dislocations occur due to traumatic events. Such shoulder dislocations have to be treated in hospital / outpatient departments at once - with a reposition. Often, habitual dislocations remain, due to damage to the labrum , shoulder capsule or humeral head. Depending on the age of the patient an operative stabilization will be performed in an arthroscopic or open manner.

 

Damage in after shoulder dislocations:
About two to four 0.5 to 1 cm incisions are made. Working cannulas are placed. First, a diagnostic shoulder arthroscopy is performed and the individual damage is analyzed. Most of the time the glenoid labrum is torn in front of the glenoid, which is called a "Bankart lesion". This is nearly always combined with a so called "Hill Sachs lesion" a - more or less - bony impression at the posterolateral humeral head. Capsular damage of the stabilizing capsular ligaments has to be taken into consideration, also.

 

How to operate a dislocated shoulder:
If it´s a standard situation with an anteroinferior torn labrum, surgical instruments are used to mobilize the cartilage wall, prepare the bony bed and fix the labrum and parts of the capsule with suture anchors. For example bioresorbable anchors are used for such a fixation. This means, that the anchor will disolve, without having to perform a second operation - for an anchor removal.
Other suture anchors are made out of metal, like titanium. Sometimes they have a shape of mini screws, sometimes they are like tacs. They all have in common, that they are used to fix the torn labrum and/ or capsular structures, until those structures have healed.

Hill Sachs Remplissage in shoulder instability

Arthroscopic view: backside of the humeral head. The tendon of the infraspinatus muscles
is sutured inside a deep Hill Sach lesion ( into the bony groove ).

 

First a cannula is placed, arthroscopically. The cannula is a kind of a guide. Within the cannula the tap is guided and then the anchor is placed. The grab handle is separated and the remaining filaments are used to suture the labrum and capsule onto the bony glenoid rim.
Additionally, capsular ligaments can be sutured or the widened capsule can be tightened as well as the rotator interval can be closed or gathered. Afterwards the cannulas are removed. The skin is closed, a dressing placed and the splint will be put on.

 

Bankart sutures, labrum sutures, arthroskopy shoulder instability, repair

Arthroscopic sutures of a torn labrum and shoulder capsule.

 

What is happening the operation of a shoulder dislocation ?
The operation is performed on an outpatient basis or with a short stay ( 1-2 days ) in hospital. The splint has to be worn for 2 to 4 weeks, depending on the individual situation. A physiotherapy, with passive motions, 2 to 3 times a week is necessary. The wound has to be monitored and the dressings to be changed. The skin suture filaments are removed after 10 to 12 days after the shoulder stabilization procedure.
Having removed the splints active motions are allowed. 6 to 9 month contact sports is not allowed.
 
 
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Other themes & sites arround the shoulder:

Diseases of the shoulder ( german ): http://www.schulterinfo.de , http://www.schulter.info

Diseases of the shoulder ( english ): http://www.shoulderinformation.com

Shoulder arthroplasty: http://www.schulterprothesen.net , http://www.schulterprothesen.com , http://www.shoulderprosthesis.com , http://www.prothesenatlas.de

Frozen shoulder ( german ): http://www.schultersteife.de

Shoulder specialists ( german ): http://www.schulterspezialisten.de

Shoulder examination ( german ): http://www.schulteruntersuchung.de

Shoulder videos ( german ): http://www.schultervideo.de