Logan, an avid power lifter,Joint
FLX injured his shoulder 5 years ago at age 25. He was performing a heavy bench press when he felt like his shoulder "slipped." He had extreme difficulty performing the bench press and military press after the injury and gradually started to have difficulty with other activities. He was initially evaluated by an orthopedic surgeon and an MRI was ordered, but he was told "there is nothing wrong." He gradually stopped lifting weights and reduced his activities, but when the pain and discomfort persisted he sought a second opinion from another orthopedic surgeon and a diagnosis of impingement was made with a recommendation to "shave down a spur that is cutting into your rotator cuff."
Confused, Logan did some research and took a friend's advice and scheduled an evaluation at our shoulder clinic. His history and examination were both highly consistent with chronic posterior instability and we recommended an MRI arthrogram to confirm the diagnosis. The MRI arthrogram confirmed extensive posterior labrum tearing that now also extended at least half way around the glenoid (socket). We reviewed our arthroscopic surgical protocol for unstable shoulder and he was extremely relieved to finally have a diagnosis and wanted to proceed with arthroscopic repair. An arthroscopic global capsular shift with labrum repair was performed and although his primary direction of injury was posterior he required a labrum repair both in the front and the back of the shoulder.
According to one study on posterior shoulder dislocation, "more than 60% of posterior dislocations are misdiagnosed initially by the treating orthopedic surgeon, and the correct diagnosis is often delayed for months or years." The other major point to observe is that because the shoulder is a "circle" labels such as anterior and posterior instability are not as valid or helpful today because with the ability to evaluate and treat the entire joint using advanced arthroscopic techniques, we are learning that many different types of injuries (labrum, cartilage, capsule, ligament, nerve, and rotator cuff) can be part of the injury spectrum regardless of the primary direction of the shoulder dislocation. So it is vital to have a surgical technique that allows us to evaluate and treat the entire "circle" and not just a limited area of focus. This shift in thinking about shoulder dislocation has also resulted in a significant improvement in outcomes with modern arthroscopic techniques in experienced hands.
Confused, Logan did some research and took a friend's advice and scheduled an evaluation at our shoulder clinic. His history and examination were both highly consistent with chronic posterior instability and we recommended an MRI arthrogram to confirm the diagnosis. The MRI arthrogram confirmed extensive posterior labrum tearing that now also extended at least half way around the glenoid (socket). We reviewed our arthroscopic surgical protocol for unstable shoulder and he was extremely relieved to finally have a diagnosis and wanted to proceed with arthroscopic repair. An arthroscopic global capsular shift with labrum repair was performed and although his primary direction of injury was posterior he required a labrum repair both in the front and the back of the shoulder.
According to one study on posterior shoulder dislocation, "more than 60% of posterior dislocations are misdiagnosed initially by the treating orthopedic surgeon, and the correct diagnosis is often delayed for months or years." The other major point to observe is that because the shoulder is a "circle" labels such as anterior and posterior instability are not as valid or helpful today because with the ability to evaluate and treat the entire joint using advanced arthroscopic techniques, we are learning that many different types of injuries (labrum, cartilage, capsule, ligament, nerve, and rotator cuff) can be part of the injury spectrum regardless of the primary direction of the shoulder dislocation. So it is vital to have a surgical technique that allows us to evaluate and treat the entire "circle" and not just a limited area of focus. This shift in thinking about shoulder dislocation has also resulted in a significant improvement in outcomes with modern arthroscopic techniques in experienced hands.
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