Shoulder Dislocation and Bone Issues: Treatment Options - Orthopedics

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Shoulder dislocation is a common injury that can lead to significant complications if not treated properly. In your case, it seems that you have undergone a labral repair surgery (often referred to as a Bankart repair) due to recurrent dislocations. However, it appears that your shoulder continues to dislocate, possibly due to a bony defect on the posterior aspect of the shoulder joint, which may be contributing to the instability.


Understanding the Condition
When a shoulder dislocates, it can cause damage not only to the ligaments but also to the bony structures of the shoulder joint. In particular, a bony Bankart lesion occurs when a piece of bone is detached from the glenoid (the socket of the shoulder joint) during dislocation. If this bony fragment is missing or if there is significant bone loss, it can lead to recurrent instability, making the shoulder prone to dislocating with specific movements.


Treatment Options
1. Physical Therapy:
- Before considering further surgical options, a structured physical therapy program can help strengthen the muscles around the shoulder, improve stability, and enhance the range of motion. A physical therapist can design a program tailored to your specific needs, focusing on strengthening the rotator cuff and scapular stabilizers.

2. Surgical Options:
- If conservative management fails and the shoulder continues to dislocate, further surgical intervention may be necessary. Given the potential bony defect, a procedure known as a Latarjet procedure might be considered. This involves transferring a piece of bone from the coracoid process to the anterior glenoid to provide additional stability.

- Another option could be glenoid reconstruction if there is significant bone loss. This procedure aims to restore the anatomy of the shoulder joint and improve stability.

3. Arthroscopic Surgery:
- If the dislocation is primarily due to soft tissue issues, an arthroscopic procedure may be performed to repair any remaining labral tears or to tighten the joint capsule.

4. Rehabilitation Post-Surgery:
- Regardless of the surgical approach, a comprehensive rehabilitation program is crucial for recovery. This typically involves a gradual return to activities, focusing on regaining strength and stability.

5. Lifestyle Modifications:
- Avoiding activities that put excessive strain on the shoulder, especially those that involve overhead movements or heavy lifting, can help prevent further dislocations.


Conclusion
It is essential to have a thorough discussion with an orthopedic surgeon who specializes in shoulder injuries. They can evaluate your specific case, including imaging studies like MRI or CT scans, to determine the extent of any bony defects and recommend the most appropriate treatment plan. If you feel that your current treatment is not addressing your concerns, seeking a second opinion from a shoulder specialist may provide you with additional insights and options.

In summary, while shoulder dislocation can be a challenging condition to manage, there are various treatment options available, ranging from physical therapy to surgical interventions. The key is to address both the soft tissue and bony components of the injury to achieve the best possible outcome.