During a shoulder dislocation, the proximal humerus (ball) usually pops out the front of the glenoid (socket). Shoulder dislocations usually occur following a direct impact with the shoulder in a certain position. When the shoulder dislocates, the labrum (bumper) in the front of the shoulder tears and the tissue that surrounds the shoulder joint (capsule) stretches. In addition, in some patients, a piece of the proximal humerus or socket (glenoid) may chip off (fracture) when the ball falls out of the socket. This chip fracture on the humerus is called a “Hill-Sachs lesion.”
- Sharp, intermittent shoulder pain
- Fear or “apprehension” that another dislocation will occur
- Limited ability to play sports
Diagnosis And Treatment
Dr. Keller considers each patient’s symptoms, as well as a detailed physical examination and x-rays to make the diagnosis of shoulder instability. Dr. Keller usually orders an MRI or CT scan to confirm the diagnosis and evaluate the injury further. Most patients with only one dislocation can be treated successfully without surgery with a dedicated physical therapy program that helps strengthen the muscles and ligaments around the shoulder.
In those patients who are young (less than 20 years old), who are competitive athletes, or who sustain more than two or three dislocations, Dr. Keller will likely recommend surgery. Surgery usually involves a minimally invasive procedure in which Dr. Keller uses an arthroscope and surgical instruments to repair the torn labrum in the front of the shoulder. In those patients with a “Hill-Sachs” lesion, Dr. Keller may also perform a Remplissage technique to further stabilize the shoulder. In those patients who have failed previous arthroscopic surgery or in those patients who have glenoid (socket) bone loss, Dr. Keller may recommend a larger procedure called a Latarjet procedure.