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  • www.sportordination.at
  • www.sportordination.at

Shoulder dislocation

Dislocation of the shoulder joint is a common injury in sports such as handball, skiing or rugby. The most common form of dislocation is anterior dislocation downwards. This can lead to a shearing off of the so-called articular lip (glenoid labrum) from the glenoid cavity (= Bankart lesion). The labrum is a connective tissue cartilage structure (not dissimilar in structure to a meniscus), which surrounds the joint and serves to stabilise the shoulder joint (just like a saucer with its shallow recess protects a tea cup from slipping).

If a part of the labrum is sheared off in the context of an initial dislocation, dislocation of the shoulder joint can occur again and again (shoulder dislocation) even without any trauma (= post traumatic recurrent dislocation). According to large studies, over 90% of all young athletes suffer additional dislocations following an initial traumatic dislocation, which in turn can lead to further damage to the shoulder joint. Simply put, you could say that the likelihood of a recurrent dislocation is greater the younger the patient and the higher the level of sporting/physical activity.

A Bankart lesion, however, is not necessarily the cause of the instability. Other causes of constantly recurring dislocations after initial dislocation can be: Hill-Sachs lesion (= osseous defect in the head of the humerus), weakness in the capsular ligaments, loss of proprioception, muscle weakness despite adequate rehabilitation, recurrent shoulder dislocation. See also here (PDF download)!

Diagnosis of a dislocation, or damage to the shoulder joint is carried out using X-ray and MRI (magnetic resonance imaging).

TREATMENT

 

In the case of a post-traumatic recurrent shoulder dislocation, investigation by means of an arthro-MRI should be carried out early in the case of young, physically active patients, due to the high rate of recurrent dislocation. This is a special examination that also shows ruptures of the labrum. A labrum rupture is an important prognostic factor. If the labrum is ruptured, surgical refixation should be carried out in all cases. This can be performed arthroscopically or in an open procedure.

Depending on the aetiology, type and direction of dislocation and the extent of intra-articular damage, various surgical procedures can be used individually or in combination, for which open and arthroscopic techniques and anatomical and non-anatomical reconstruction procedures are available. Of the 200 different surgical procedures available, the following techniques have proven particularly effective:

Open surgical techniques
  • Bankart operation
  • Inferior capsular shift according to Neer

 

Arthroscopic surgical techniques
  • Labrum capsule refixation
  • Inferior capsular shift according to Neer


In the case of elderly patients and those with reduced sporting and physical activity levels, patients should be treated more conservatively (= non-surgically). This means intensive physical therapy, paying particular attention to joint-centring measures.

 

Please note that medical indications and treatments change constantly. Sometimes these changes occur more rapidly than I am able to update on my homepage. Some information regarding dosage, prescription and compositions of medications may have changed in the meantime. Reading an internet page cannot replace visiting a doctor - it may be that during an examination and subsequent discussion with your doctor, other information is also communicated as a result of new scientific knowledge.