Accidental glenoid labral injury

Recently, we admitted a case of young army soldier, who only said that he had shoulder pain in the outpatient clinic and did not provide any other medical history, so he was examined by X-ray and found that the acromion was large, and the symptom manifested the pain of lifting the shoulder, so he was considered to have acromioclavicular impingement, and it was recommended to treat him conservatively, but the soldier himself was more active, and he was willing to have direct surgery and did not want to be treated conservatively. He was admitted to the ward, and when the shoulder joint was explored during surgery, a glenoid labral tear was accidentally found, and a glenoid cartilage fracture was also found. Based on the patient’s condition and considering that the patient was still young (less than 20 years old), the glenoid labrum was sutured and fixed with bio-type anchors with resorbable wires, the cartilage was removed, the acromion was shaped and polished, and the patient was fixed and then sent back to the ward. After the operation, the patient told us that he had a shoulder dislocation 8 years ago and did not do any treatment after the reset. 2 weeks ago, he had a shoulder sprain during a training session, and he could hear a clicking sound coming from the joint at that time. It was painful for a while and then relieved without any concern and did not tell the doctor about it. Combined with what we saw intraoperatively, we considered that it was still due to the recent training. Fortunately, the treatment was timely and the glenoid labrum was repaired in a timely manner, otherwise, it would have been an incalculable loss for a young patient. In patients with shoulder dislocations, the majority are anterior dislocations (84%) and we occasionally encounter cases of posterior dislocations in our clinic. In general young people are more common. Troopers, athletes, and young people who enjoy sports are particularly vulnerable to injuries during contact sports activities (wrestling, basketball, football, weightlifting, etc.). Older adults are at risk of shoulder dislocation if they encounter low-energy violence. And it can easily be complicated by fractures or rotator cuff injuries. In patients with dislocation, MR and CT scanning of the shoulder is needed to rule out rotator cuff or glenoid labral injuries, bony labral tears, or depressed fractures of the humeral head. This is because anterior dislocation occurs when there is a violent collision between the posterior superior aspect of the humeral head and the anterior inferior aspect of the glenoid labrum. If there is one, it needs to be treated promptly rather than left alone. Otherwise, the glenoid labrum that falls off from the impingement will be slowly absorbed away due to tearing affecting the stability of the shoulder joint, and multiple repeated dislocations will result in loss of time for minimally invasive surgery, and ultimately, major surgery with incision will have to be performed to transfer a block of bone (rostral eminence or iliac crest) to fill in the damaged glenoid, which is more than worth the cost. Our hospital has extensive experience in the management of shoulder instability and has different surgical protocols specific to the different injuries within the shoulder joint. There is a wide range of materials to be implanted during the surgery, and there is a “supermarket” of choices depending on the patient’s needs. Patients who have already had dislocations and are still experiencing recurrent dislocations (one or more per year, with some movements that they are afraid to do) are advised not to take it lightly, and to find a professional doctor to do the treatment that suits their needs.