53 year-old male physician with 15 year history of adult recurrent shoulder instability. Symptoms began initially with a traumatic event and, like most patients with recurrent instability, progressed to occur with greater frequency and less trauma/activity necessary to provoke a dislocation.
Workup/Images of Recurrent Shoulder Instability
X-rays reveal no evidence of arthritis, fracture, or other abnormality. An MRI is ordered which enables assessment of the glenoid (socket), the humeral head (ball), the labrum (cartilage ring that lines the socket), the ligaments, and the rotator cuff. In this case, the MRI demonstrates no evidence of significant bone loss or compromise which can occur from recurrent shoulder dislocations (instability). When bone loss is suggested with recurrent shoulder instability, a CT Scan may be performed to better quantify this however this is not typically necessary. Recent studies and higher resolution MRI scans enable us to better quantify the extent of bone loss to identify an optimal treatment plan. Shoulder dislocations not only result in injury to the labrum and ligaments, but often involve damage to the posterior aspect of the humeral head that impacts on the anterior rim of the socket at the time of a dislocation. Understanding the injury pattern is critical for surgical decision-making in selecting an arthroscopic or open approach.
In this case, there was no significant bone loss and the patient’s injury pattern/history/physical exam indicated that an arthroscopic stabilization would restore stability to the shoulder with a minimally invasive outpatient procedure performed with a high definition fiberoptic video camera through one of three small incisions (less than a cm). Arthroscopic treatment of recurrent shoulder instability involves the placement of three to four anchors that are approximately 2.5 mm in diameter with impregnated suture for repair of the labrum and ligaments back to the rim of the socket and restore the normal anatomy. This procedure is performed under a regional anesthetic with a light general that enables the patient to wake-up pain-free with minimal soreness and no significant nausea or other anesthesia-related issues. Our anesthesia team works diligently on the latest ERAS (Enhanced Recovery After Surgery) protocols from other surgical disciplines to optimize recovery and make the day of surgery an easier, more pleasant experience. The patient goes into a sling after surgery for 6 weeks and returns to the office 5-7 days later for a follow-up appointment where the surgical findings and post-operative protocol are reviewed in detail. By 5-10 days after surgery, over 90% of patients are off narcotic pain medication and most are able to return to work during this time period.
Physical therapy is essential for a good result and our team works collaboratively with patients and therapists for comprehensive care with a tailored protocol. Frequent follow-up and communication with therapists enables us to guide patients, answer questions, and improve outcomes. At approximately 6-9 months, patients are able to return to sports and desired activities with a stable shoulder and a durable repair.
“For over 15 years I had a shoulder injury that dislocated frequently–I became skilled at gritting my teeth and putting it back in place but believe me it was no fun–eventually it dislocated routinely during daily activities like cab rides to the office. I just could not continue to play soccer, ski, sail or continue my work in Africa with any degree of confidence–awkward movements or contact would leave me stranded with a painful dislocated shoulder.
I was very nervous about surgery and being a physician I did the math and saw a few surgeons. Of the doctors I interviewed, Dr. Rudzki was clearly outstanding–he has an interest in research and the latest techniques and it was clear he knew his business. He took the time to explain everything to me until I was set and good to go. The surgery went well and his rehabilitation team was top notch. The SmartTherapy team was amazing. The recovery was exactly as predicted. My shoulder is now repaired and I have returned to sailing, swimming (new sport), and am looking forward to the ski season. I recommend Dr. Rudzki for athletes and others who are interested in staying active. He has a great team and I couldn’t have been more pleased with the results. He gets my highest recommendation”
For more information about Arthroscopic Shoulder Stabilization, an educational surgical video can be seen here: