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Dislocation and instability of shoulder

  1. The dislocation of the shoulder is an accident mostly sports, in particular during the practice of the rugby. It is a displacement, usually forward, of the head of the humerus from the glenoid of the scapula. During the dislocation ligaments situated in front of the joint, and which insure the stability of the shoulder, are distended.

The dislocation very aches. Complications are possible (paralysis, fracture), but remain rare.

The put back in place can be made spontaneously, but mostly it is necessary "to fire" at the arm, sometimes at the ground, or ideally after x-ray and painkiller. Once the reduction realized, the purpose is to obtain a good healing of ligaments, so that there are no recurrence. The risk of recurrence, is all the bigger as the subject is young (approximately 1 case over 2 - 18 years). To do it, a immobilization enough prolonged and with a specific reeducation is indispensable.

When nevertheless, a recurrence arises, we speak about instability. The evolution is made then inevitably towards the repetition of dislocations for more and more low traumas (sometimes by doing hair or by sleeping).

2. The examination by the doctor allows to estimate the ligamentary state, the x-ray  can show osseous reorganizations at the level of the insertion of ligaments. In case of doubt, a CT scan with injection iodized in the joint (arthro CT scan ) allows to visualize the ligament injury.

 

3. In case of recurrent instability, the treatment is exclusively surgical.

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  • The ligaments reinsertion  can be made by  CRPS (without opening the shoulder) . Scars are thus very reduced but the repair is more fragile and consequences are marked by a immobilization in sling of one month before the beginning of the rehabilitation, and by a rate of failure about 20 %. For that reason this technique is disadvised in case of glenoid anterior-inferior loss of bone  and\or of contact sport.
  • The "classic" technique, chosen at once or in case of failure of the previous one, contains a cutaneous scar on the front of the shoulder but less than 5 % of failure. It consists of setting up in front of the joint  a small osseous transplant ("abutment"), taken at the level of the shoulder, by the same section, and fixed by means of one screw, so that exists a real "dam" in any new dislocation. This intervention requires 24 hours of hospitalization, the bearing of a sling 15 days, day and night, then 1 additional month during night. The rehabilitation is begun from the day after the intervention and is going to last 3 months, in the stemming from which the sport is taken back at the same level as previously.

4. The complications remain rare in the hands of a pulled surgeon.

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