Operative therapy of shoulder dislocation
After a shoulder dislocation, the top priority is to achieve the fastest possible reduction. Otherwise, the malalignment may result in soft tissue damage and a circulatory disorder. If such an attempt at reduction is not successful in a conservative manner, those affected absolutely need surgical treatment.
In addition to this main indication, there are other constellations that require surgery to treat shoulder dislocation. Despite a successful conservative attempt at reduction, surgery may still be necessary in special cases where instability persists. Trauma-related dislocations can also be operated on, regardless of whether it is a first-time or recurrent dislocation.
If patients are young and active in sports, surgical treatment is also preferred. The reason for this is that there is an increased risk of a recurrent shoulder dislocation afterwards if purely conservative treatment is used. An operation reduces this probability of recurrence.
In general, surgery is necessary when patients want to put full weight on their shoulders again after recovery and the goal is a complete restoration of functionality. In general, the decision for surgery should always be made individually, taking into account various aspects. In addition to the factors already mentioned, such as age and degree of activity, aspects such as existing damage to the shoulder, the degree of instability or neurological deficits are also important.
Additional injuries to bone, cartilage or nerve tissue caused by dislocation are also an indication for surgery. The course of an operation in the presence of a shoulder dislocation can be differentiated in terms of the type of access route and the type of reconstruction. Today, the arthroscopic variant is preferred to open surgery.
For the open access route, an approximately 10 cm long incision is made at the front. In arthroscopy, the operation is performed according to the keyhole principle. Both instruments and a mini-camera are inserted through three small incisions to treat injured structures.
These can be the joint capsule, ligaments or the joint lip, the so-called “labrum glenoidale”. In the case of more serious dislocations, bony structures may also have been affected, which can also be treated intraoperatively. The exact surgical procedure depends on which structures were injured.
Damage to the labrum and capsule can be operated on either openly or arthroscopically, whereby the labrum is more often treated arthroscopically. In the case of a capsule injury, a capsule tightening or a capsule shift, which is a capsule-reducing procedure, can be performed. In the case of a shoulder dislocation, a tear in the rotator cuff may occur, which can also be reconstructed arthroscopically.
Bony involvement sometimes manifests itself as a tearing fracture of the tuberculum majus of the humerus. In such a case, the fragment can be fixed with a screw fixation or a suture anchor fixation. Which procedure is ultimately used is usually decided on a case-by-case basis.
Overall, shoulder arthroscopy is preferred to open surgery because it is less risky. In general, there are always general and specific risks associated with surgery.This is also the case for surgical treatment of shoulder dislocation. The general risks of shoulder dislocation surgery include bleeding with hematoma formation, injury to surrounding nerve and soft tissue, infection, thrombosis and pulmonary embolism.
In the later course, wound healing disorders of the scars also play a role. Depending on whether open or arthroscopic surgery was performed, the extent of the risks can vary. Wound healing disorders are less likely in the case of an arthroscopic approach than in open surgery with a large skin incision.
It is generally accepted that arthroscopy is less risky in the presence of shoulder dislocation than open access surgery. The specific risks of the operation include, for example, a permanent restriction of movement up to and including stiffening of the shoulder joint. As a late consequence, surgical treatment of the shoulder can also lead to arthrosis, i.e. non-inflammatory, degenerative cartilage damage.
Arthrosis of the shoulder joint is medically known as omartrhosis. There is also the possibility that metal or foreign tissue introduced during surgery may lead to complications. These include loosening or infection of the material.
After a shoulder dislocation, patients should follow special guidelines that specify how long one should refrain from doing sports after surgery and how much strain should be applied. During the first 6 weeks, the shoulder should be protected as much as possible and not be subjected to too much strain. Pure weight bearing is prohibited for the first 3 months.
How long you should not do a certain type of sport varies from person to person. So-called “cyclical” sports such as jogging or cycling may be resumed after only 3 months. A 6-month break applies to sports such as swimming or playing tennis, as the shoulder is subjected to greater strain in these sports.
Sports with a high risk potential for the shoulder, such as handball or martial arts, should be paused for at least 9 months. As a general guideline, those affected should be free of pain and their full ability to work under pressure should be regained through therapeutic measures. In the end, the individual healing process can last for the duration of the sports leave.
