Page 40 - Waterfall Issue 11 2021

Waterfall News

will have an arm sling for three weeks to allow the soft
tissues to heal, followed by graded physiotherapy.

A young patient who has dislocated their shoulder in
the absence of exaggerated ligament laxity may benefit
from an MRI scan of the shoulder to assess the damage
to ligaments and bones. keyhole/Arthroscopic surgery
could be performed to reattach the ligament and
capsule structures onto the socket rim (Arthroscopic
Bankart Repair), to reduce the likelihood of future
Shoulder Anatomy dislocation. Recovery involves wearing a sling for three
IMAGE CREDIT: HTTPS://WWW.GAuTENGORTHO.CO.ZA/SHOuLDER-ANATOMY
weeks followed by four to six weeks of physiotherapy.
A dislocation is defined as the complete disturbance Remplissage or parachute surgery may be done to fill
in the relationship between joint surfaces. This usually an impression defect in the ball should it be present.
occurs during a traumatic event involving: forced
abduction external rotation in anterior (forward)
dislocations; or electrical shocks and epileptic
seizures in posterior (backward) dislocations. Inferior
dislocations also occur but are less common. Some
people are born with exaggerated laxity in their
ligaments and are more prone to dislocating joints.

Bankart Repair
IMAGE CREDIT: HTTPS://WWW.BRENDANCOLEMAN.CO.NZ/SHOuLDER-INSTABILITY
Bankart repairs are less successful with recurrent
dislocation. A Modified Latarjet procedure is more
appropriate to address instability. This involves open
surgery wherein a portion of the coracoid bone is
transferred to the anterior rim of the socket and fixed in
place with screws to widen the arc and reduce dislocation.

Shoulder Dislocation Rehabilitation after a Latarjet procedure involves
IMAGE CREDIT: HTTPS://WWW.GAuTENGORTHO.CO.ZA/SHOuLDER-DISLOCATION
wearing an arm sling for three weeks followed by
gradual physiotherapy from week two to six. Return
When the shoulder is dislocated, various structures inside to sport is expected around three months later.
the shoulder can be damaged, most notably the labrum
(or cartilage rim), anteroinferior and middle glenohumeral
ligaments, and even the humerus and glenoid (ball and
socket). In addition, bone damage at the socket causes
either an acute loss at the lower margin (Bony Bankart)
or an impression in the ball (Hill Sach Lesion). These
defects increase the likelihood of future dislocations.

Once they dislocate their shoulder, a high percentage
of patients have a risk of re-dislocation, especially if
the first dislocation occurred at a young age. We use
100 minus your age as a rough estimate as to your
re-dislocation risk. With each successive dislocation,
a lower force is required to cause a re-dislocation. Modified Latarjet Procedure
IMAGE CREDIT HTTPS://WWW.LOuISCATALANOMD.COM/LATARJET-PROCEDuRE

At the first dislocation, the shoulder is generally reduced For further information about common shoulder
(skilled manipulation to return the bones to their normal and other orthopaedic conditions and their
position) under sedation in a casualty environment or, management, visit the Gauteng Orthopaedic Associates
rarely, in theatre if reduction as an outpatient fails. You patient portal on www.gautengortho.co.za.

38 Waterfall Issue 11 2021