How is the shoulder joint stability maintained normally?

What is Shoulder Instability?

What are the causes for Acute Shoulder Dislocation?

What are the symptoms of Acute Shoulder Dislocation?

How is a Dislocation of Shoulder diagnosed?

How an Acute Shoulder Dislocation is generally treated?

What are the chances of developing Recurrent (repeated) Shoulder
     Dislocations?

What causes Chronic Shoulder Instability?

What are the symptoms of Chronic Shoulder Instability?

How is shoulder Instability Diagnosed and treated?

When is surgery advised in Shoulder Instability?

What are the benefits of Shoulder Stabilization Surgery?

What is done in stabilization surgery for Shoulder Instability?

What are the advantages of arthroscopic shoulder stabilization?

When is open shoulder stabilization recommended?

How is the shoulder joint stability maintained normally?

The shoulder joint is a ‘ball and socket joint’ with a shallow socket (glenoid) and a large hemispherical ball (head of humerus) which makes it unstable. Its lining (capsule) is very loose which allows excellent mobility to the ball. A fibro cartilage tissue called the labrum (lip in Latin) is attached to the circumference of the glenoid. The labrum helps in deeping the shallow socket and forming a type of suction cup for the ball. Additional stability is provided by capsular ligaments, which are thick cord like structures that attach to the labrum, and the rotator cuff muscles. This arrangement helps in stability and movement of shoulder joint.

What is Shoulder Instability?

Shoulder instability is a term describing abnormal looseness of the shoulder joint, such that the ball part of the joint (humeral head) slides out of the socket (glenoid). It is a pathological condition, rather than a normal physiologic variant such as laxity - looseness.

A minor form of instability in shoulder ligaments is called Subluxation wherein the shoulder ball partially slips out of the socket.

A more severe case of instability can cause the shoulder to completely slip out its socket and is known as a Dislocation.

Shoulder instability can develops in two different ways.
Traumatic (injury related) or Atraumatic Instability

Traumatic instability - If the ligaments holding the shoulder ball in its socket become stretched or torn, due to trauma or overloading, the necessary stability of the ligaments throughout the shoulder's large range of motion is compromised.

In atraumatic instability there is a general laxity (looseness) in the joint that eventually causes the shoulder to become unstable.

Understanding the differences is essential in choosing the best course of treatment.

What are the causes for Acute Shoulder Dislocation?

A fall on an outstretched arm that is forced overhead, a direct blow on the shoulder, or a forced external rotation of the arm are frequent causes of anterior (forward) dislocation. This is the commonest type of dislocation.

An epileptic seizure attack or electrocution generates severe abnormal muscular forces around the shoulder which causes posterior (backward) dislocation.

What are the symptoms of Acute Shoulder Dislocation?

Patients give a history of trauma followed by immediate onset severe shoulder pain and a sense of shoulder popping out of socket. They have difficulty in moving the arm. Patients may complain of swelling, deformity, numbness or weakness.

How is a Dislocation of Shoulder diagnosed?

Shoulder dislocation is diagnosed based on patient’s history of injury, clinical examination and x-rays.

A patient with shoulder dislocation usually holds the arm still against his side and any attempts to move the shoulder are painful. A large crease under the acromion (tip of shoulder) and a bulge in the armpit are clues to the direction of the dislocation. Range of motion, strength, and sensation will be tested if possible. Any changes or loss of sensation may point to nerve damage. The physician will also check the pulses in your arm in order to detect the possibility of vascular complications.

In those cases where the shoulder has managed to relocate spontaneously, the diagnosis can be difficult. Patients may only report the feeling of the shoulder "slipping out" before the spontaneous reduction occurred.

X-rays of the shoulder joint are usually taken to confirm the dislocation, its direction, and to check for a related fracture.

X-rays may reveal a "bony Bankart", which is a fracture of the anterior-inferior glenoid (front, lower portion of the glenoid). The presence of this fracture indicates that the labrum and ligaments in the front part of the shoulder are no longer attached to the glenoid.

 
 
 

Pathbreaking radio frequency surgery ends shoulder pain :Indian Express

New Radiofrequency Device Enables surgery for Shoulder Infection : Times of India

Successful Arthroscopic Shoulder Surgery for painful and stiff shoulder : Maharashtra Times

Shoulder Surgery by Arthroscopic Surgery Technique :LokmatSamachar

First Shoulder Arthroscopy in Prime Surgical :Kesari

Success with Arthroscopic Shoulder Surgery :VishaDarpan

Difficult Shoulder Surgery made easy by Arthroscopy :Dayittya

Arthroscopic Surgery for Shoulder Pain : Prabhat

First Successful Shoulder Surgery by Radio-frequency : Pudhari

Boon for a Cricket Enthusiast Doctor - Sakaal

Chinchwad’s Dr. Anand Jadhav appointed as Players Doctor - Antarang

Pune’s Dr. Anand Jadhav appointed as Players Doctor - Sandhya

Dr. Anand Jhadav appointed as a onsite Doctor for IPL players - Aaj ka Anand

Facilities at Subrata Roy Stadium are world-class: Onsite doctor - The Indian Express

Players take injuries seriously - Sakaal Times

Timely treatment - Express News Service

Rare Reverse Shoulder Replacement was Performed for the First time in India - Express Healthcare

First-of-its-kind shoulder surgery performed at pvt hospital in city - Sakal Times

First case in India of Reverse Shoulder Replacement as Revision Surgery by Dr Anand Jadhav - PRLog (Free Press Release) and PR-inside.com (News and Free PR)

Doc uses latest surgery technique - DNA Pune

Reverse shoulder replacement as revision surgery performed for failed fracture fixation - Syndication(Indian content licensing)

British expert in town, to perform live knee surgeries - Express News Service

Joints clinic opens at Chinchwad - Indian Express

London Joints Clinic performs Revision Surgery - Pharmabiz

Medical miracle - The Indian Express

 

For all appointments please call :
+91 904 905 9282

To speak to Dr. Anand Jadhav
please call :
+ 91 99 22 44 6272

 

Dr Anand Jadhav is Sr. Consultant for Joint Replacement and Arthroscopic Surgeries in the following hospitals.

Ruby Hall Clinic ,Sassoon Road,Pune

Jehangir Hospital, Pune

Prime Surgical Centre,Law College Road, Pune

Nova Specialty Hospital,Saras Baug, Pune.

Aditya Birla Hospital,Chinchwad, Pune

Sahyadri Hospital,Deccan, Pune

Inamdar Hospital,Fatimanagar, Pune

Sahyadri Hospital, Pune

 

PRIVATE CLINICS :

London Joints Clinic
J-1 Building, Empire Estate, Old Pune-Mumbai
Highway, Chinchwad, Pune
Mon, Tues, Thurs, Sat: 6pm to 8pm

Usha Nursing Home
M.G. Road , Near Poolgate Police Chowky,
Camp, Pune
Mon to Sat: by Appointments only

Apollo Clinic
Wanowrie, Near NIBM Chowk,
Pune
Mon and Sat: 9am to 10:30am.
Other days by appointments only.

Apollo Clinic
Nigdi, PCMC, Pune
Mon, Tues, Thurs, Sat: 5pm to 6pm

Healthberries Clinic
Baner, Pune
By Appointments

Aditya Birla Clinic
Aundh, Pune
By Appointments only

Hospital OPD Timings :

Ruby Hall Clinic, Sassoon Road, Pune
Tues and Thurs: 9am to 11am

Prime Surgical Centre, Law College Road, Pune
Mon to Sat: by Appointments

Ruby Hall Clinic, Wanowrie, Pune
By Appointments

Nova Specialty Hospital, Pune
Mon: 9-11am, Tue: 11am-1pm, Fri : 5-7pm


      - - - - - - - - - - - - - - - - - - - - - - - - -

How an Acute Shoulder Dislocation is generally treated?

After confirming shoulder dislocation by clinical examination and x-rays, the patient is given sedation or a general anesthesia to relax the muscles around shoulder region. With the help of an assistant the doctor will give gentle traction and manipulate the arm to relocate the shoulder joint. This is called closed reduction. X-rays are done again after reduction to confirm that the joint is in place.

Patient’s pain is immediately relieved after shoulder reduction. A shoulder sling is given for support and comfort. The sling is to use for 2-4 weeks.

On discharge from the hospital, the patient is advised to see a physiotherapist and a Shoulder Specialist for follow-up.

What are the chances of developing Recurrent (repeated) Shoulder Dislocations?

Recurrent dislocations are most common in young people, athletic people and those involved in heavy physical activities.

The younger and more active the patient is at the time of first dislocation, the more likely it is that recurrent instability will develop. For example, if the first dislocation occurs during the teenage years, there is a 70-90% chance that recurrent instability will develop. However, people over 40 years of age with a first dislocation have less than a 10% risk of developing recurrent instability.

What causes Chronic Shoulder Instability?

Chronic shoulder instability is caused by:

Traumatic shoulder dislocation:
The labrum, which deepens the socket, is torn and the capsular ligaments, which hold the shoulder ball in its socket, become stretched or torn. As a result the necessary stability of the ligaments throughout the shoulder's large range of motion is compromised.

Repetitive overhead activities: (as seen in sports like Swimming, tennis, and volleyball) can stretch out the shoulder ligaments due to chronic overloading. Similar things happen to people in jobs needing repetitive overhead work. These loose ligaments cannot support the humeral head within the socket. Such patients will develop shoulder instability and pain when doing repetitive stressful activities.

Multidirectional Instability:
In a small group of patients, the shoulder can become unstable without any history of injury or repetitive strain. These patients have naturally loose ligaments throughout the body and may be "double-jointed." The shoulder can dislocate in many directions. Hence it is called Multi-directional instability (MDI). Such patients can produce a shoulder dislocation (voluntarily) at will without pain.

What are the symptoms of Chronic Shoulder Instability?

Common symptoms of chronic shoulder instability include:
Pain caused by shoulder injury
Repeated shoulder dislocations
Repeated instances of the shoulder giving out
A persistent sensation of the shoulder feeling loose, slipping in and out of the joint, or just "hanging there"

How is shoulder Instability Diagnosed and treated?

A thorough history and clinical examination is done initially to diagnose instability.

Investigations like x-rays and MRI of shoulder are done to confirm the underlying pathologies.
X-rays will show fracture of rim of glenoid – Bony Bankart’s Lesion, Impaction fracture of humeral head - Hill Sach’s lesion

MRI will show: Rotator cuff tears, lesions of biceps tendon, Avulsion of labrum and capsular ligaments from the glenoid - Soft tissue Bankart’s lesion, capsular avulsion from humerus

MRI showing Bankart lesion (arrow)

 

CT scan may be required in cases where damage to the glenoid is noted on x-rays.

Treatment for shoulder instability is based on a variety of factors including the severity of the condition, and the patient's age, activity level, occupation, and natural degree of looseness in the joint.

Initial treatment for any shoulder instability relies on physiotherapy, activity modification and pain-killers as required.

Strengthening the rotator cuff muscles and periscapular muscles (those around the scapula) gives stability to the joint. The goal of physiotherapy is to help the muscles provide stability to the shoulder that the torn ligaments are not able to provide. The physiotherapy is carefully designed for each patient since this condition often causes apprehension about certain arm positions or exercises. Often physiotherapy can help regain lost motion, reduce apprehension, and restore shoulder function.

Changes to lifestyle and modification of activities are necessary to avoid repetitive stress to the shoulder and to resolve symptoms.

When is surgery advised in Shoulder Instability?

Surgery is usually recommended if recurrent instability cannot be controlled even after adequate physiotherapy and activity modification.

Surgery is recommended after the first dislocation in young persons (< 20 years) who have a higher risk of re-dislocation, in contact athletes who plan on continuing to participate in sports that put their shoulders at risk and in people involved in heavy physical activities.

What are the benefits of Shoulder Stabilization Surgery?

The shoulder becomes stable which improves patients' confidence, shoulder strength and function. The stabilization surgery allows them to return to normal work or sporting activities. It also prevents further damage to the surfaces of ball and socket due to repeated instability.

What is done in stabilization surgery for Shoulder Instability?

Shoulder instability surgery is a surgical attempt to reconstruct the normal shoulder anatomy by repairing the torn cartilage ring (labrum) and re-tensioning the stretched capsular ligaments without over tightening. The aim of surgery is to return stability to the shoulder with the least loss of motion.

Depending on the extent of damage to the labrum, 2 to 3 suture anchors ( metallic or biodegradable) may be buried at different locations on the rim of glenoid (socket). Non-absorbable sutures that are pre-loaded on these anchors are then tied to repair the labrum to its normal place and to re-tension the capsular ligaments.

Surgery will re-create the normal bumper effect of the labrum and the tension of capsular ligaments. This will help in keeping the joint in place throughout its normal range of motion.

Torn Labrum (Bankarts Lesion) being repaired with suture anchors

What are the advantages of arthroscopic shoulder stabilization?

Arthroscopic shoulder stabilization is done using a fibre-optic telescope, camera and specialized instruments via 3 to 4 tiny scars.

It has the following advantages:
Small scars give better cosmetic result
Minimal tissue trauma and pain
Less bleeding
Shorter hospitalization
Excellent visualization of shoulder joint and the associated lesions of instability
Additional shoulder pathologies like rotator cuff tears or biceps tendon lesions can be dealt within the same operation
Can give same success rate as that with open stabilization surgery

When is open shoulder stabilization recommended?

It has the following advantages:
There is co-existing fracture of the socket (glenoid) or humeral head
Glenoid is worn out into an inverted pear shape due to recurrent anterior instability
Failure of previous shoulder stabilization surgery
Surgeon is not experienced in arthroscopic stabilization techniques
Tissue transfer with bony block – done if capsular tissue is not repairable

 

Concept bybrand.wise@yahoo.com,Powered bySumeru Infosystem Pvt. Ltd.

Copyrights@2009, Dr. Anand Jadhav