Shoulder luxation
What to do in case of a first-time luxation of the shoulder? What structural damage occurs in the event of a first-time luxation and what are the therapeutic consequences? Is surgery advisable or rather a conservative treatment?At the congress of the American Orthopaedic Society for Sports Medicine a study was presented which showed that the question of whether a conservative or an operative treatment is advisable depends both on the patient’s age and sports activity.
In the framework of the study, young cadets’ shoulder luxations were examined at the military training base West Point, NY, U.S.A. For the interpretation of this study it is important to note that only a specific age group (19 to 22 years of age) were involved.
Mostly, shoulder luxations occur in the framework of sports accidents (winter sports, contact sports). After a primary repositioning generally performed by an emergency or hospital doctor the X-ray diagnosis often shows further smaller accompanying injuries as well as a Hill-Sachs-lesion (osseous lesion in the area of the humeral head) and signs of arthrosis. Therefore, an additional MRT diagnosis is advisable which in particular enables the delineation of soft tissue injuries which essentially influence the therapy concept.
MRT shoulder normal findings
In case of younger patients shoulder luxations often lead to so-called “Bankart“ lesions. These are tears or ruptures of the cartilaginous labrum which stabilises the upper arm in the shoulder joint.
In case of older patients in contrast, accompanying injuries in the area of the rotator cuff (total or partial rupture) or avulsion fractures of the humeral head (tuberculum majus fracture) are more frequent.
A surgical therapy is recommendable in particular for younger patients who suffer from pronounced accompanying injuries (as described above) and who are very active in terms of sports (in particular overhead sports such as tennis, handball, volleyball etc.). Nowadays there is an increasing number of arthroscopic surgeries with very good results.
In the framework of the above-mentioned study a follow-up examination of 39 patients after an average of 11 years showed that the shoulder’s functioning is excellent even after more than 10 years, as described by Dr. Brett Owens, El Paso/TX, U.S.A.
The interviews of the patients who had been operated on indicated that the functioning of the shoulder amounted to an average of approx. 93% as compared with the state prior to the luxation. The ratio of renewed luxations amounted to approx. 10% and is slightly higher than in case of the open procedure by means of skin incision.
Accordingly, with a view to the short-term and the long-term success of an arthroscopic shoulder surgery we recommend the surgical intervention for young and active patients in case of a first-time shoulder luxation with corresponding accompanying injuries.
For older patients and those who mainly perform sitting professional activities and who are not very ambitious in terms of sports a conservative therapy (physiotherapy, initial immobilization for no more than 8 to 10 days) might be the best choice.
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