SHOULDER DISLOCATION/
LABRAL TEAR
A dislocated shoulder is an injury in which the shoulder actually “pops out of place.” The arm has to be manipulated to be put back into place.
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PHYSICIAN: DR. PAGNANI, DR. JONES
SHOULDER DISLOCATION/LABRAL TEARS
A dislocated shoulder is an injury in which the shoulder actually “pops out of place”. The arm has to be manipulated to be put back into place. After the shoulder is in place, a lot of the initial pain improves immediately. In some cases, the diagnosis is not so obvious. The shoulder can slip part of the way without coming all the way out of the socket (“subluxation”).
If you are experiencing pain in your shoulder, see our Questions and Answers section below and call our office at (615) 329-2520 for a consultation.
PROCEDURES: BANKART REPAIR FOR SHOULDER INSTABILITY
Introduction
The shoulder is a complex multi-directional ball-and-socket joint which allows movement in many directions. Shoulder instability and dislocations occur when the ligaments between the ball and socket are stretched or torn, and/or when the labrum is detached from the socket (glenoid).
Open or Arthroscopic
Whether this procedure is done using a scope or through a small open incision is depends on the severity of the tear and the activity of the patient. In football players and other contact athletes, an open procedure is usually performed. The method shown in these animations is with a scope.
Incisions
Small incisions (portals) are made around the joint. The scope and surgical instruments will go into these incisions.
Visualization
The scope is inserted into the back of the shoulder joint. Saline solution flows through a tube (cannula) and into the shoulder capsule to expand the joint and to improve visualization. The image is sent to a video monitor where the surgeon can see inside the joint.
Repair
Surgical instruments are inserted into the joint. They will be used to reattach the labrum to the socket using screw-like devices called “suture anchors.” The anchors are placed in the bone of the socket and sutures are then passed through the labrum. Knots are tied through the portals to reattach the labrum to the bone. This type of injury is also associated with tears to the capsule that surrounds the shoulder joint. The capsule tear is also repaired using sutures.
End of Procedure
After the labrum is reattached, the surgical instruments are removed and the procedure is complete.
PROCEDURES: SLAP REPAIR
Introduction
The shoulder is a complex multi-directional ball-and-socket joint which allows movement in many directions.
SLAP Tears
The labrum is a ring that goes around the shoulder socket (glenoid) like the washer on the end of a hose. The labrum deepens the shoulder socket and also serves as an attachment site for tendons ligaments that hold the ball and socket together. Tears of the top part of the labrum are called “SLAP” lesions (short for Superior Labrum Anterior and Posterior).
Incisions
Small incisions (portals) are made around the joint. The scope and surgical instruments will go into these incisions.
Visualization
The scope is inserted into the back of the shoulder joint. Saline solution flows through a tube (cannula) and into the shoulder capsule to expand the joint and to improve visualization. The image is sent to a video monitor where the surgeon can see inside the joint.
Repair
Surgical instruments are inserted into the joint. They will be used to reattach the labrum to the socket using screw-like devices called “suture anchors.” The anchors are placed in the bone of the socket and sutures are then passed through the labrum. Knots are tied through the portals to reattach the labrum to the bone.
End of Procedure
After the labrum is reattached, the surgical instruments are removed and the procedure is complete.
QUESTIONS AND ANSWERS
1. How do I know if I have a dislocated shoulder?
Unfortunately, it is usually obvious. There is an injury in which the shoulder actually “pops out of place”. The arm has to be manipulated to be put back into place. After the shoulder is in place, a lot of the initial pain improves immediately. In some cases, the diagnosis is not so obvious. The shoulder can slip part of the way without coming all the way out of the socket (“subluxation”).
2. What might have caused the dislocation?
Most people have a specific injury in which the arm is rotated above and away from the body. This position tears the ligaments that hold the ball and socket together. Once they are damaged, these ligaments rarely heal by themselves.
3. How long does the procedure last?
The operation to fix a dislocation generally takes between between 60 and 90 minutes in our hands.
4. Will I have to go under general anesthesia?
Not necessarily. The Nashville Knee & Shoulder Center is one of a select number of centers where dislocation surgery can be performed without general anesthesia. Instead, patients normally receive a nerve block combined with a “twilight” anesthesia to relax the patient. Avoiding general anesthesia markedly reduces the risks of surgery.
5. Will I have to stay in the hospital overnight?
No. Dislocation surgery is now performed on an outpatient basis.
6. What will the aftercare be?
You may remove your bandage 48 hours after surgery. After the initial bandage has been removed, you may shower. You will be in the sling for one month. Gentle movement of the shoulder will prevent scar tissue from forming while early healing occurs and, during the first month, you will do some simple motion exercises at home.
7. How long will I be in physical therapy?
You will attend physical therapy on a regular basis for 2-4 months after surgery. Therapy will begin one month after surgery.
8. How long will I be out of work?
You can expect to be out of work for at least 2 weeks after surgery to repair a dislocating shoulder. If your work requires heavy lifting, you may be unable to perform your usual job for several months.
9. How long until I can resume normal activities?
After a dislocation repair, most patients can resume normal activities (except for heavy lifting and sports) at about 6 weeks after surgery.
10. How long before I can throw or play sports?
Generally, 4-6 months are required before athletes can return to sports after a dislocation repair. Throwing is usually begun at 4-6 months, but it may several additional weeks before an athlete is allowed to attempt to throw at full speed.
11. Are there any additional resources I can reference?
Yes! Please see the American Academy of Orthopaedic Surgeons information on:
Shoulder Dislocation:
https://orthoinfo.aaos.org/en/diseases--conditions/dislocated-shoulder/
Labral Tears in the Shoulder:
https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-joint-tear-glenoid-labrum-tear/