Anterior glenoid reconstruction for unstable dislocating shoulders. Surgery to restore lost anterior glenoid bone and deep the socket with a bone graft can restore shoulder anatomy and lessen pain and improve function.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Monday, October 09, 2006
Figure 2 - Deficiency of the rim of the glenoid socket: Repeated dislocations can wear away the front lip of the socket of the shoulder Figure 3 - Previous fracture of the lip of the socket: A previous fracture of the rim of the glenoid socket lessens its ability to stabilize the head of the humerus Review of the conditionWhat are some general characteristics of failed surgery for anterior dislocation? What are its usual manifestations? After failed surgery for anterior dislocation there is often a
deficiency of the normal lip of the glenoid (shoulder socket) as well
as a deficiency in the glenoid labrum and capsule (the soft tissues in
front of the shoulder socket). These deficiencies make another try at a
routine repair less likely to succeed.
Individuals with failed shoulder repairs usually notice that the
ball slips forward out of the socket, sometimes with the arm relaxed at
the side and sometimes when the arm is raised backwards. The shoulder
may dislocate at night as well.
There may be a grinding feeling as the arm is moved.
Once the surgery has failed, dislocation of the joint may become easier and easier. What else might be confused with or similar to failed surgery for anterior dislocation? How can these be distinguished from the condition? Failed surgery for instability is usually not difficult for the patient
to recognize. Commonly, the symtoms are similar to those before the
surgery--sometimes they are even worse.How common is failed surgery for anterior dislocation (statistics, demographics, risk factors)? Surgery for anterior dislocation of the shoulder fails in one out of
ten to one out of twenty cases. There is a higher incidence of failure
when the repair has been done arthroscopically. There is also a higher
incidence of failure in individuals who smoke, those who begin using
their shoulder vigorously very early after the repair, and those with
very loose ligaments. If part of the lip of the socket is missing,
conventional repairs have a higher chance of failure.How is failed surgery for anterior dislocation diagnosed? What tests or exams may be used? The shoulder surgeon diagnoses failure of surgery for anterior
dislocation from the patient's history, performing a thorough physical
examination of the joint, and taking the proper X-rays.
The examination often reveals that the shoulder slips easily out of
the front of the socket, even when it is pressed into it. This is
called the "load and shift test." It is similar to checking the
adequacy of a golf tee by pressing the golf ball into it and seeing how
easily the golf ball can slide out of the tee.
X-rays of the shoulder may reveal that bony lip of the glenoid
socket is rounded or deficient. They may also reveal that the humeral
head (ball) is not centered in the glenoid (socket).
Can medications help failed surgery for anterior dislocation? Medications are usually not helpful in improving the stability of the shoulder joint after failed surgery.Can exercises help failed surgery for anterior dislocation? Exercises can help to stabilize the shoulder. Particularly internal
and external rotation strengthening exercises and exercise that develop
coordinated movements may increase the joint's stability.
However, if the shoulder is unstable at rest or at night, exercises may not be of benefit. Specifically, how is failed surgery for anterior dislocation improved by surgery to deepen the socket of anteriorly dislocating shoulders (using an anterior iliac crest bone graft)? If the cause of recurrent instability after a previous repair for
anterior dislocation is a deficiency of the lip of the socket or lack
of soft tissues of sufficient strength, an anatomically contoured
extracapsular bone graft harvested from the iliac crest (hip at the
beltline) may restore stability by deepening the socket. In experienced
hands, this procedure may help restore function of the unstable
shoulder.
While this surgery can improve stability, it cannot make the joint
as good as it was before the onset of dislocations. In many cases, the
tendons and muscles around the shoulder have been weakened from
prolonged disuse and recurring dislocations.
After the surgery, it may take months of gentle exercises before the
shoulder achieves maximum improvement in comfort and function.
The effectiveness of the procedure depends on the health and motivation
of the patient, the condition of the shoulder, and the experience of
the surgeon. Surgery for failed surgery for anterior dislocation at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment.
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