Talking about habitual dislocation

  Mechanism of injury for habitual shoulder dislocation: During a fall, the shoulder joint is in upper arm abduction with the hand or elbow on the ground. This position moves the humeral head to the underside of the scapular glenoid, leaving the lower part of the joint capsule in a state of tension and traction. Once the external force is too great, the humeral head is dislodged from the glenoid. When the humeral head is dislocated, some of them are dislocated through the joint capsule (a few of them are called extracapsular dislocation), while others are dislocated while the humeral head is still inside the joint capsule, which is called intracapsular dislocation.  Habitual shoulder dislocations are most common in young adults. After the first shoulder dislocation is reset, the shoulder is not fixed properly and there is a defect on the anterior lower border of the shoulder pelvis or the posterior lateral humeral head. When the upper limb is abducted and externally rotated and posteriorly extended, recurrent anterior shoulder dislocation occurs.  The shoulder joint is one of the most unstable and frequently dislocated joints in the body, accounting for approximately 50% of all joint dislocations. The incidence of anterior shoulder dislocation in the population is 2% to 8%. The dislocation is caused by the tearing of the shoulder capsule ligament and the labrum of the glenoid joint, which is difficult to heal by conservative treatment, and therefore the dislocation occurs repeatedly and becomes a “habit”. If the dislocation is not treated effectively for a long period of time, it will cause damage to the cartilage and bony structures in addition to the aforementioned avulsion injury, making treatment more difficult. Repeated dislocations can also significantly aggravate the degeneration of the affected shoulder, leading to the early appearance of osteoarthritis of the shoulder joint.  Clinical symptoms: The complaints of recurrent shoulder dislocation are mostly pain in the affected shoulder and fear of shoulder abduction and external rotation. There is mostly a clear history of traumatic dislocation.  Diagnosis: History of two or more dislocations, physical examination: positive fear test of anterior inferior shoulder dislocation, repositioning test, loading and loading test, sulcus test. The diagnosis can be confirmed with a single x-ray of the anterior subluxation, and with CT or MRI images of Bankart and Hill-Sachs injury if the diagnosis is difficult.  Treatment: So is a patient with this habitual shoulder dislocation only passively accustomed to it? What can doctors do to prevent or eliminate this “habit” other than to help reset the joint when it is dislocated? The International Academy of Sports Medicine and Shoulder Specialists recommends early surgical repair of torn capsular ligaments and glenoid labrums in young patients who are experiencing their first dislocation to prevent this habitual dislocation.  Surgical treatment of shoulder dislocation includes traditional open surgery and minimally invasive arthroscopic surgery.  The more commonly used open surgeries are subscapularis capsule overlap suture (Putti-Plat’s method) and subscapularis stop outgrowth (Magnuson’s method). Repair and tightening of the joint capsule (Bankart’s method) and extra-articular dynamic stabilization reconstruction (Bristow’s method), incisional surgery is very traumatic, with long postoperative recovery time, limited joint mobility and significant postoperative limitation of external rotation of the shoulder joint.  Minimally invasive arthroscopic surgery: With the rapid development of arthroscopic technology and surgical instruments, arthroscopic application of suture anchor technique to suture the avulsed shoulder capsule ligament and glenoid labrum tissue to achieve anatomical repair of shoulder dislocation has achieved very satisfactory results. The arthroscopic shoulder repair technique uses three small incisions of 1.0 cm instead of the large incisions of 10 cm or more in traditional incision surgery to complete the repositioning, suturing and fixation of the glenoid labrum and joint capsule, which has significant advantages such as less trauma, faster recovery, good postoperative functional recovery and shorter hospitalization time.