Shoulder Instability including Lartarjet Procedure

Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint.

Causes of Shoulder Instability

A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder. A partial dislocation is referred to as a subluxation whereas a complete separation is referred to as a dislocation.

Risk Factors of Shoulder Instability

The risk factors that increase the chances of developing shoulder instability include:

• Injury or trauma to the shoulder
• Falling on an outstretched hand
• Repetitive overhead sports such as baseball, swimming, volleyball, or weightlifting
• Loose shoulder ligaments or an enlarged capsule

Symptoms of Shoulder Instability

The common symptoms of shoulder instability include pain with certain movements of the shoulder; popping or grinding sound may be heard or felt, swelling and bruising of the shoulder may be seen immediately following subluxation or dislocation. Visible deformity and loss of function of the shoulder occurs after subluxation or sensation changes such as numbness or even partial paralysis can occur below the dislocation because of pressure on nerves and blood vessels.

Treatment Options for Shoulder Instability

Conservative Treatments for Shoulder Instability

The goal of conservative treatment for shoulder instability is to restore stability, strength, and full range of motion. Conservative treatment measures may include the following:

• Closed reduction: Following a dislocation, your surgeon can often manipulate the shoulder joint, usually under anesthesia, realigning it into proper position. Surgery may be necessary to restore normal function depending on your situation
• Medications: Over the counter pain medications and NSAIDs can help reduce the pain and swelling. Steroidal injections may also be administered to decrease swelling
• Rest: Rest the injured shoulder and avoid activities that require overhead motion. A sling may be worn for 2 weeks to facilitate healing
• Ice: Ice packs should be applied to the affected area for 20 minutes every hour

Surgery for Shoulder Instability

When the conservative treatment options fail to relieve shoulder instability, your surgeon may recommend shoulder stabilization surgery. Shoulder stabilization surgery is done to improve stability and function to the shoulder joint and prevent recurrent dislocations. It can be performed arthroscopically, depending on your situation, with much smaller incisions.

Latarjet Procedure for Shoulder Instability

The Latarjet procedure is indicated for anterior shoulder instability that is recurrent and caused by a bony Bankart lesion. The surgery is considered when a surgical repair of the labrum does not correct the damage of the shoulder joint.

The Latarjet procedure is performed under general anesthesia. You will be positioned in a semi-reclined or beach-chair position. An incision of 5 cm is made from your shoulder blade towards the armpit. Retractors are used to separate the muscles of the shoulder and chest, and expose the coracoid process (a small hook-like process of the shoulder bone) and its attached tendons.

The coracoid process is freed of its attachments and along with the conjoined tendon is transected from its base. Holes are drilled into the transected coracoid process. The subscapularis muscle, which passes in front of the shoulder joint, is split in line with its fibers. The capsule of the shoulder joint is entered and the glenoid is exposed and prepared to receive the coracoid.

The transected coracoid with the conjoined tendon is passed through the separated subscapularis muscle and fixed to the glenoid rim with screws through the previously drilled holes. This increases the glenoid surface and stabilizes the joint. The conjoined tendon and subscapularis muscle provide additional stability by acting as a sling.

Upon completion, the instruments are withdrawn, the incision is closed and covered with a sterile bandage.

Post-procedure Care for the Latarjet Procedure

Following the procedure, your arm is placed in a sling to rest the shoulder and promote healing. You may remain in the hospital the night of the surgery and discharged the next day. Pain is controlled with medication and ice packs. You will be instructed to keep the surgical wound dry and to wear your sling while sleeping for a few weeks after the procedure. The sling may be removed in 3 to 6 weeks.

Rehabilitation for Laterjet Procedure

Rehabilitation usually begins early on the first postoperative day with finger movements and passive assisted range of motion exercises. A physical therapy program is recommended for 3 months, after which you can return to your regular activities.

Risks and Complications of Laterjet Procedure

The Latarjet procedure usually provides good results but as with all surgical procedures, complications can occur and may include:

• Hematoma (bleeding)
• Fracture or failure of union of the coracoid
• Stiffness due to inadequate rehabilitation
• Recurrence of instability and infection