What Happens When a Shoulder Dislocates?
Shoulder dislocations are one of the most common shoulder injuries seen in our work hard, play harder environment. The shoulder joint (glenohumeral joint) is comprised of the glenoid (socket) and humeral head (ball). This joint is often compared to a golf ball on a golf tee due to the bony socket being very shallow. Because of the shoulder’s shallow bone socket, we are very reliant on our shoulder ligaments to hold the ball in the socket.
First time shoulder dislocations frequently occur during a high energy fall, such as a skiing or mountain biking accident. In most cases, the ball (humeral head) tends to dislocate off the front of the shoulder socket (anterior dislocation). The labrum, which is like a rubber gasket that attaches circumferentially around the edge of the socket, commonly tears away from the socket during a dislocation. Unfortunately, the labrum does not heal back in the correct position after a dislocation and for this reason, young, active people are more likely to continue to dislocate their shoulder after dislocating it for the first time.
When the shoulder first dislocates, it is common for the labrum to tear and the shoulder ligaments to stretch. However, as more dislocations occur over time, more significant damage is done to the shoulder. Often, patients begin with a simple labral tear, but after continuing to dislocate their shoulder, they further tear the ligaments and patients can chip away or just wear down the bony edge of the shoulder socket. This bone loss makes patient’s shoulders even more unstable just like a chip in a golf tee allows for a golf ball to fall off more easily. Given this, young people with recurrent shoulder instability often come to surgery to stabilize the shoulder.
What are the Types of Surgery Used to Stabilize a Shoulder?
Most patients undergo a Bankart procedure, wherein the labrum is anchored to the edge of the socket where it once attached and at the same time the ligaments of the shoulder are tightened. However, if patients have worn away 20% or more of their bony socket, then this soft tissue repair procedure is usually not sufficient to prevent the shoulder from further dislocations. In cases of significant bone loss from the glenoid socket, a Latarjet procedure may be needed, as it builds back up the bone that has been lost, thus restoring shoulder stability.
A Latarjet is a bone transfer surgical procedure. The Latarjet procedure was first described by a group of French surgeons. The Latarjet procedure is performed by transferring a piece of the coracoid, which is a bone directly adjacent to the shoulder socket, and attaching this piece of bone to the edge of the socket. Fortunately, the shape of the coracoid perfectly matches the contour of the socket. The coracoid piece is held in place with 2 screws. One’s body will then heal this bone graft to the socket like healing a bone fracture.
What is the Rehabilitation after Latarjet Surgery?
Latarjet surgery is outpatient, so patients can go home the same day. The anesthesiologist will do a nerve block so that the arm is numb and therefore there is not much pain for the first few days. Patients are otherwise placed in a shoulder sling. Physical therapy is started soon after surgery, with the initial goal to start gentle shoulder range of motion exercises while not stressing the repair. The sling is discontinued at 6 weeks from surgery. The bone is usually reasonably well healed in 8 weeks, and at this point, more aggressive strengthening exercises are started. Patients can often resume all activities by 4-5 months.
Dr. Cunningham is a shoulder instability surgeon at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating shoulder dislocations for patients in Vail, Summit County, Aspen, and Denver, CO.