SHOULDER INSTABILITY
It usually occurs when the shoulder comes out of the glenoid, which causes a lot of pain and functional disability.
Etiology:
The instability of the shoulder is usually post-traumatic with a gesture of the arm in external rotation and abduction, very common in sports such as rugby. Most of the time the shoulder dislocates forward.
In rare cases, the dislocation is posterior. The most important thing about this type of instability is that they are discovered initially.
Diagnosis:
A detailed clinical history and a thorough physical examination is vital to determine the degree of instability and the direction of it.
Generally the diagnosis is confirmed by magnetic resonance.
Treatment:
The lesion that usually occurs in the anteroinferior instability is the Bankart lesion (disinsertion of the labrum and ligaments), which in many cases is associated with a Hill-Sachs fracture, due to impaction in the posterosuperior part of the humeral head.
1. REPAIR OF ARTROSCOPIC BANKART:
If indicated, it is possible to opt for arthroscopic repair of the displaced anteroinferior shoulder labrum (Bankart rupture), which consists of:
1. In the first place, a release of the capsulolabral complex has to be carried out, which is often medialized and / or unstressed. (Illustration 3)
2. Secondly, the suture of the Bankart rupture is started, performing a retension of the capsulolabral complex thanks to the passage of sutures whose knots bring the unstressed tissue to the anchor, restoring the anatomy. (Illustration 4)
2. REMPLISSAGE:
In some cases the anterior BANKART repair is completed with the remplissage technique, which consists of suturing the infraspinatus to the posterosuperior Hill-Sachs defect in the humeral head with the intention of further stabilizing the shoulder.
3. POSTOPERATIVE CARE OF THE SUTURE OF BANKART:
This intervention requires the use of a sling for 4 weeks to achieve the healing of the ligaments and the labrum to the bone. Subsequently, it is necessary to perform a smooth and progressive rehabilitation, around 3-4 months. During the first month, Dr. Aramberri will prescribe and teach you the exercises you must do to accelerate your recovery.
4. LATARJET ARTROSCOPIC IN SEVERE PREVIOUS GLENOHUMERAL INSTABILITY:
There are shoulders that, due to various factors to be assessed by the Physician, require a different surgical technique. Patients who have previously failed surgery of a previously unstable condition, patients with considerable glenoid defect or young patients with contact / competition sports with numerous episodes of recurrence may be candidates for this technique.
In such cases, the technique called arthroscopic Latarjet is performed, which consists of the transfer of the coracoid process along with the conjoint tendon to the anteroinferior glenoid ridge and its subsequent synthesis with 2 screws, as you can see in the figure. This technique also offers very good results in terms of stability due to its double effect of anterior bumper and dynamic effect, acting the coracobiceps as a hammock that holds the head of the humerus in the launching gesture, especially for contact sports . (Illustration 5)
It is a technique that provides excellent stability and functionality (see photos below), to which is added the arthroscopic miniinvasive technique, which allows a quick recovery and return to early sport. Dr. Aramberri is one of the pioneers of this technique in Spain, with over 120 cases of experience.
Photos of the clinical outcome of a patient who underwent arthroscopic Latarjet at 3 months postoperatively in severe anterior instability of the right shoulder.
5. POST-OPERATIVE CARE OF ARTHROSCOPIC LATARJET:
This intervention requires the use of sling 1-2 weeks in an antalgic manner. Subsequently, it is necessary to carry out a progressive rehabilitation, around 3 months. During the first month, Dr. Aramberri will prescribe and teach you the exercises you must do to accelerate your recovery. Return to competition is expected at 3 months postoperatively.
