This is another form of instability whereby shoulder can dislocate either in the front or back or down. Often this is as a result of inherently lax ligaments. The dislocation occurs even without any injury or only with minor injury. Some of them even can dislocate habitually.
In this group of individuals the ligaments are lax by birth. This can be part of other disease conditions like Marfans syndrome or other collagen abnormalities, but it can also occur for no defined cause. This is common in girls as part of their development around puberty due to the hormonal influence. Some of those who can dislocate are also good in gymnastics as their body can bend so easily.
They can have multiple dislocations of the shoulder joint. They can also come with knee cap dislocations or other joint dislocations. Some of the dislocations are painful, and at times they don’t have that much pain and hence they can relocate the joint themselves without attending to see a doctor.
A thorough physical assessment and investigation such as X ray/MRI as needed will be done.
A general strengthening exercises to build up the muscles around the shoulder joint especially the posterior muscles will help to gain more control and confidence over the shoulder joint. A systematic physiotherapy will be useful for that. If the dislocation is painful and does not get better with physiotherapy then a surgery to tighten the capsule of the shoulder joint may be beneficial. The name of the surgery is “Circumferential capsular plication/ Rotator interval closure and Radiofrequency capsulorrhaphy”. The success of this surgery is not as good as a surgery performed for the anterior shoulder instability occurring as a result of trauma. Hence it is only advised if full course of physiotherapy didn’t help.
The surgery is called as Circumferential capsular plication, rotator interval closure and radiofrequency capsulorrhaphy. This is done as an arthroscopic procedure through two or three tiny stab incision.
Arthroscopic surgery is done after anaesthetising. Two or three tiny stab incision of less than 1cm are made around the shoulder joint. The shoulder joint is thoroughly visualised and the diagnosis of lax capsule in the shoulder joint is confirmed. One could find capsule as a hammock in the front, down and back of the shoulder joint if it is lax.
With the help of a special arthroscopic needle two or three stitches are applied in the anterior (front) capsule of the shoulder joint. Another stitch is applied in the inferior part of the shoulder capsule. Further may be one or two stitch is applied around the posterior aspect of the shoulder capsule.
Rotator interval is a space in the front of the shoulder joint, which is not covered by muscle. This gap is also inherently lax in those who suffer from multidirectional instability; hence this rotator interval is closed with one or two stitches. All these stitches are applied through the arthroscopic stab incisions.
After doing multiple stitches, the capsule is shrunk with the help of radiofrequency probe. The radiofrequency probe emanates radiofrequency waves. This generates heat that is adequate enough to shrink the collagen present in the capsule. The incisions in the skin are closed with small stitches.
A sling will be given for comfort for a period of 4 – 6 weeks. The movements are encouraged after 6 weeks to get to full function. A systematic physiotherapy programme will be initiated until the satisfactory function is achieved.
The outcome of this procedure is equivocal. But it is worthwhile trying, if other simple modalities of treatment does not help. The reason the surgery has equivocal outcome is because we cant treat the inherent reason for laxity and it is probably gene mediated and it is a general problem that applies to the whole of the human body.
The procedure is safe. The rare complications include infection, stiffness, nerve damage and chondral damage.
Lorem ipsum dolor sit amet any as consectetur. Ut tellus suspendisse nulla that aliquam.
2024 bdoctor. All Rights Reserved by Profile Name.
The Vale Specialty Ortho Clinic is committed to advanced medical care through innovative and efficient services, creating an environment of continued quality improvement and expertise of the best physicians.
45, Collector Office Road, Opp.Hotel Star Residency, Anna Bus Stand, Madurai, Tamil Nadu 625020
2026 Vale Hospital. All Rights Reserved by Profile Name.