The normal shoulder consists of three joints. The rotator cuff consists of four muscles that connect the shoulder blade to the arm bone. These muscles are called rotator cuffs because they wrap around this ball-and-socket-shaped joint in the form of a cuff. Rotator cuff muscles press the ball into the socket during shoulder movements and provide a stable platform for rotation movements during this movement.
The shoulder head is just like a golf ball on a table, as seen below
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In other words, we can think of it as a balloon kept in balance by a folk fish, where the shoulder joint has a gap and the ball (larger) and the socket (smaller) are not compatible in size.
The socket is expanded by a meniscus-like tissue in the knee called labrum.
Thanks to the labrum and ligaments (glenohumeral) we mentioned, the shoulder head remains stable in the socket. We can compare the labrum and ligaments to airbags that protect us from sudden collisions in cars. It paves the way for shoulder dislocations with the contribution of familial factors.
The meniscus-like labrum we mentioned and especially the strong ligaments try to keep the big ball in the socket with a hammock effect. Shoulder dislocations can be defined as the ball coming out of the socket.
During shoulder dislocation, the meniscus-like labrum and ligaments are torn, resulting in''Bankart lesion'', which typically causes recurrence of dislocations.
With the Bankart lesion, bone fractures may also occur in the socket part called the glenoid during shoulder dislocations (usually in the first dislocation!).
In patients with recurrent shoulder dislocations, the presence of a fracture in the socket (GLENOID) may occur. When suspected, this condition can be diagnosed with computed tomography.
Post-Traumatic Occurrence. Treatment of Sudden Dislocations
Non-surgical treatment and subsequent physical therapy
For the first sudden dislocations, the shoulder should be worn with a sling. It is aimed to reduce the fluid increase and pain caused by fixation. Many experts, including me, recommend shoulder-arm sling application for a maximum of 3 weeks to prevent the dislocation from recurring. We believe that keeping this period longer does not prevent the recurrence of the dislocation. After shoulder stabilization, physical therapy begins and thus the shoulder muscles are strengthened. Despite all efforts, shoulder cuff tears and dislocation recurrence are encountered in some patients over the age of 40 (less than 50%), while more than 90% recurrence of dislocation can be encountered in those around 17-18 years of age.
Surgical treatment of shoulder dislocations
If shoulder dislocations recur and this problem has become chronic, that is, permanent, surgical treatment is necessary. The decision for surgical treatment after a first shoulder dislocation depends on some factors. For example, if there is a lack of bone in the socket, that is, the glenoid bone, that will hold the ball, that is, the head of the shoulder, in place, surgery should be considered immediately. If there is no bone deficiency in the socket, the decision for surgery is made by taking into consideration personal factors such as the person's age, activity level, and sports activities.
Open and Arthroscopic (CLOSED) treatment for shoulder dislocations
If there is no bone loss, the aim of the treatment is to repair the above-mentioned Bankart lesion and capsule tissue and maintain joint stability. Surgical treatment can be performed arthroscopically, that is, closed, in almost all patients. Arthroscopic (closed) treatment is performed by re-stitching the torn meniscus-like soft tissue to the edges of the socket, that is, the glenoid, with small fusible screws from which strong threads emerge from the end seen below.
In what cases is open treatment? Is it necessary?
Arthroscopic, that is, closed treatment can be applied to 90% of the patients. On the other hand, approximately 10% of the remaining patients have socket (glenoid) fractures and bone loss or capsular fractures, especially in the first dislocation. Open surgery may be required for l tears. In these cases, the bone deficiency in the socket is eliminated by bone transfer, which will act as a wedge, with the method called Bristow-Latarjet. Thus, the ball is prevented from coming out of the socket by bone transplantation. This method is extremely effective when done properly and openly.
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