PATHOLOGIES

Instability and recurrent dislocation

Shoulder Dislocation or “pulling-out" is an acute event that occurs the first time after a pretty violent trauma. The shoulder is put back in place urgently in a specialized environment. Often after this first episode there is a recurrence and new episodes of secondary dislocations even for harmless moves (catching a high located object, turning over in bed ...). Sometimes it can be a feeling of instability and lack of security at the shoulder.

DIAGNOSTIC

• Recurrent dislocation: evident table with necessity of emergency, sometimes spontaneous reduction by the patient.

• Feeling of instability and insecurity when performing strong shoulder movements.

• Clinical examination: feeling of apprehension during movements simulating balloon shooting

• Additional tests:
  • Initial check-up: standard radiographs in different rotations: often enough to show the bone notch at the humeral head level ,ultrasound scan
  • Complementary check-up: CT and arthrography are sometimes required in case of strong suspicion of instability without obvious radiographic

TREATMENT

• Medical : MEDICAL: very little space, rehabilitation does not greatly affect the course and the risk of recurrence.
• Surgical : treatment of choice for active patients:
  • Open surgery: bone block stabilization according LATARJET, indicated for recurrent dislocation for active patients with presence of bone disease. This represents a reliable technique with a very low recurrence rate.
  • TECHNIQUE performed in ARTHROSCOPY: anterior stabilization according to Bankart.There is a strengthening of the previous capsulo-ligamentous structures. This method is proposed for instabilities or patients having few episodes of recurrence.

FOLLOW-UP

Hospitalizations are of very short duration: almost 2 days. Rehabilitation is immediate, it is adapted according to the gesture performed. Recovery is complete in a period of 2 to 4 months depending on the used technique.