Different surgical techniques for the shoulder

Surgery for shoulder instability

The shoulder is a joint that can move in many directions. Because the shoulder joint can move so well, there is a greater risk that the joint will dislocate. In the medical world we call this a shoulder luxation. When the shoulder dislocates, there is possible damage to the ligaments, tendons and capsule of the shoulder. Often this happens with a quick sudden movement but even more often after a fall. Once the shoulder has been dislocated, we see that it dislocates more easily. The reason for this is that the ligaments and the capsule can no longer offer enough strength when great forces are put on the shoulder during sports or other moments in daily life. At this point we speak of shoulder instability. When physiotherapy no longer offers sufficient results, surgery may be necessary to prevent worse.

Possible causes of shoulder luxation

Young athletic people are more likely to have a shoulder luxation. This is often the result of a fall or collision. When this happens more often, the likelihood of new injury is greater. The flexibility of the ligaments and tendons can also be congenital. We then speak of hypermobility of the shoulder. Often this is also genetically determined. People with hypermobility have a greater chance of dislocating a shoulder. To a certain extent, this can be prevented by putting a good load on the muscles and ligaments through strength training. Chronic conditions may also play a role. The Ehlers Danlos syndrome increases the risk of shoulder instability because of degradation of connective tissue. Our tendons, ligaments, muscles are all different forms of connective tissue types. In Ehlers Danlos, the connective tissues in our body become highly elastic. So, this significantly increases the risk of a luxation. 

inversion trauma

Diagnosis of shoulder instability

When the shoulder has been dislocated more than once, the likelihood of persistent shoulder instability is significantly increased. Imaging studies such as an MRI scan, X-ray or CT scan often provide a good picture of the anatomical structures in and around the shoulder.

Some examples of injuries or injuries to the shoulder are:

A bankart lesion. A bankart lesion can occur in two ways: a bony Bankart lesion or a normal bankart lesion. A bankart lesion is located in the lower part of the labrum. The labrum is a cartilage-like ring that provides additional stability to the shoulder. This ring enlarges, as it were, the naturally small socket of the shoulder and sits like a suction cup around the head of the shoulder. A bankart lesion is an injury to the labrum. In a bankart lesion, the labrum is damaged or even torn away from the socket of the shoulder. When a piece of bone from the socket is also torn off, we speak of a bony bankart lesion. 

A bankart lesion can occur in several ways. We often see that excessive force on the shoulder causes damage to this part of labrum. A bankart lesion can also be caused by repeated overuse of the shoulder. Think of overhead sports like baseball where a lot of force comes on the shoulder over a long period of time. The pain is usually located at the front of the shoulder and sometimes there is a recognizable click during movements of the shoulder.

Conservative vs. Operative 

If surgery is chosen not to be performed, physical therapy is an option. The muscle strength of the shoulder is trained to increase the stability of the shoulder. NSAIDs can also be used to relieve the pain. If the symptoms do not subside sufficiently, surgery can be considered. The damaged lower part of the labrum will be sutured back in place. In some cases the capsule of the shoulder is also damaged. This will also be repaired during the operation. After surgery, the shoulder should not be loaded heavily. In the first phase of the rehabilitation, the mobility of the shoulder will be restored before training is done to increase the capacity of the shoulder.

Treatment of a SLAP lesion

A SLAP lesion can be treated with physical therapy. This involves looking at how best to train the shoulder without causing too much discomfort. Painkillers are also often used to suppress the symptoms. In some cases a corticosteroid injection can be chosen. The treatment is mainly aimed at increasing the muscle strength of the muscles around the shoulder. Overhand activities and overhand sports are not recommended during rehabilitation. In some cases it is possible to function painlessly again within the chosen sport. If this is not the case after 4-5 months, surgery can still be chosen.  

When physical therapy does not give the desired results, surgery may be necessary. Through keyhole surgery, the torn part of the biceps attachment is sutured to the socket of the shoulder. Normally, the biceps tendon can resume its normal function after this operation. However, research shows that this does not always have the desired effect. A large group of people still have a certain degree of pain and reduced function of the shoulder after surgery. The choice can also be made to detach the biceps tendon as a whole from the place where it attaches to the socket of the shoulder. We call this a biceps tendon tenotomy. This method often gives better results in terms of pain relief. 

After the surgery
After surgery, a sling(sling) will be fitted. This will be worn for 4-6 weeks. A shoulder rehabilitation after surgery lasts on average 8 months to a year. In the first 8 weeks, a person is often not able to drive a car or ride a bike by himself. After 4-6 months, one can participate again in various sports. For contact sports this will take a little longer.

Physio Fitaal specializes in rehabilitation after surgery. Rehabilitation after surgery often has a big impact and can be exciting. Fysio Fitaal makes rehabilitation after surgery insightful, manageable and transparent. Self-reliance and independence are important pillars within the rehabilitation. The team of Fysio Fitaal in Tilburg provides an exclusive service with a personal approach. On your own power to a fit and pain free life. Together with you we will set up a rehabilitation plan to help you get closer to your goals.

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