Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I am a competitive athlete involved in both contact sports and overhead throwing activities. My throwing arm has dislocated twice now. Evidently I have a significant labral tear. If I have the surgery done arthroscopically, I might be able to get back into action sooner than with an open incision procedure. Are the chances of dislocating again the same with both methods?

Answer:

There was a study done in Italy that might help answer your questions. One surgeon performed arthroscopic surgery on 43 patients with recurrent shoulder dislocations. Here are a few details to give you an idea of just who those patients were. Most were men (only four women in the study). All but two were competitive athletes in contact or overhead sports. Everyone had at least one dislocation after the first injury. Some patients had as many as 10 more dislocations. One of the questions the surgeons who conducted this study asked was, Will patients treated arthroscopically have arthritis later? They also wanted to know if shoulder function improved with the surgery and if the patients would be satisfied with the results. The final question was whether or not they could predict who might have a good (or poor) response to the arthroscopic Bankart repair using suture-anchors. Suture-anchors are stitches that reattach the labrum back onto the bone. The Bankart procedure is done to reattach the labrum (a rim of fibrous cartilage) when it is torn away from the shoulder socket. When the force of injury is enough to tear the labrum, a piece of bone attached to the labrum comes with it. The layers of soft tissue around the labrum (ligaments, joint capsule, tendons) are also damaged and must be stitched back together layer by layer. How did this group do with the arthroscopic Bankart repair? Well, the problem of recurrent shoulder dislocation wasn't eliminated. A fair number of patients (16 per cent) had redislocation spontaneously (meaning without trauma). Adding in those who dislocated again due to trauma, there was an overall recurrent rate of 22.5 per cent (that's almost one-fourth of the entire group). The surgeons tried to tell if there was some specific reason why these athletes were still dislocating after surgical repair. It didn't appear to be related to their age or the number of times they dislocated before surgery. Certainly, overhead throwing athletes had the greatest number of problems. Not having enough shoulder external (outward) rotation seemed to be a factor for some of the patients. What about arthritis? Did these patients develop degenerative changes in the joint despite the surgery? Some did but the majority (two-thirds) did not have any signs of arthritic changes on X-ray. Those who did have changes were mild to moderate. There were no cases of severe degenerative arthritis -- at least not at the end of the first 10 years. And were the patients happy with the results? Eighty-four per cent (84%) said, Yes, they would have the same surgery over again. Most of them based this response on the fact that they could return to their previous level of sports participation. Those who were not satisfied with the results had recurrent dislocation(s) and/or experienced what is referred to as apprehension -- feeling like the shoulder is going to dislocate with certain movements (external rotation, overhead throwing). The authors noted that arthroscopic stabilization does have acceptable long-term results when used to do a Bankart repair on unstable shoulders. Shoulder osteoarthritis isn't really a big concern in the first 10 years after surgery. This group of patients will continue to be followed to see what happens over the next 10 years. Your risk of recurrent dislocation is something your surgeon may be able to address based on your particular injury and activity level. Alessandro Castagna, MD, et al. Arthroscopic Bankart Suture-Anchor Repair. In The American Journal of Sports Medicine. October 2010. Vol. 38. No. 10. Pp. 2012-2016.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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