Why does anterior shoulder dislocation recur after resetting?

  Anterior dislocation of the shoulder joint is usually caused by trauma. After dislocation occurs, most people cannot reset it on their own and need to go to the hospital to have it reset by a doctor. However, the resetting operation of the shoulder joint is not the ultimate treatment. Many patients, especially young patients, will dislocate again after resetting, and it is called recurrent dislocation.  The main reason for recurrence of shoulder dislocation after resetting is that although the doctor restores the alignment of the humeral head and scapular glenoid by resetting, the structural damage caused by the shoulder dislocation has not been repaired. First, once the capsule-glenoid labrum structure is torn away from the scapular glenoid, it often does not heal on its own with the scapular glenoid, and the restriction on the humeral head sliding forward is never restored; second, the bone defect of the scapular glenoid is not repaired, and the scapular glenoid becomes smaller, making it easier for the humeral head to slide out from the edge of the scapular glenoid; finally, the bone defect of the humeral head is not repaired, which also increases the likelihood of recurrence of dislocation (Figure 3). After the initial dislocation occurs, it does not recur in all cases, despite causing a series of structural defects. If the patient rarely performs a backward upward swinging motion and experiences minimal stress on the shoulder during normal work and life, the dislocation does not necessarily recur despite the structural defects in the shoulder joint. This condition is mainly seen in older people who rarely exercise. However, in young patients, because of life, work and sports, the shoulder joint is under forward stress at all times and has a tendency to dislocate forward at all times, and when this tendency reaches a certain limit it can cause recurrence. Studies have shown that young patients have a greater than 90% chance of re-dislocation after the initial dislocation, and those who do a lot of arm waving or antagonistic sports have a higher chance of recurrent dislocation.  Because the initial dislocation has already caused a structural defect, a recurrence of dislocation requires less external force than the initial dislocation. When a shoulder dislocation recurs, the structural damage is further exacerbated, including defects in the capsular ligaments, and defects in the scapular glenoid and humeral head, making the next dislocation more likely to occur, creating a vicious cycle.  The most significant manifestation in patients with recurrent shoulder dislocations is frequent solid dislocation of the shoulder joint. Some occur when there is a slight impact on the back of the shoulder, some occur when doing arm waving exercises, some occur when sleeping on the back, yawning and raising the arm, some occur when sleeping on the table, and some occur when taking public transportation and pulling the upper hand. In some cases, there is no actual dislocation, but there is shoulder instability, which means that there is an abnormal movement of the shoulder joint forward when doing the above movements. Even if there is no dislocation, some patients have the feeling of shoulder joint dislocation and are afraid to do the above mentioned movements. The other part of the patients mainly showed pain in the shoulder when doing the abduction and external rotation of the shoulder joint (posterior upper arm swing).  In addition to the above symptoms, patients with recurrent anterior shoulder dislocation may have premature aging of the shoulder joint and osteoarthritis because of the instability of the shoulder joint. For recurrent shoulder dislocation or instability, surgery is generally recommended unless activities can be strictly limited to avoid recurrence.