The shoulder is made up of three bones, several muscles and connective tissues. Injury to any of these parts can cause dislocation of the shoulder or instable shoulder. Dislocated shoulder or instable shoulder is the condition where the head of the humerus –the upper arm bone – subluxate or slip out of its socket and stretches or tears the ligaments supporting the joint and its nearby muscles causing pain. Repetitive strain on the shoulder loosens the ligaments that allow the head of the humerus to move too freely. Shoulder injuries are more common in children and adolescents active in sports such as baseball, volleyball, swimming, wrestling etc due to their immature bones and joints. Some other reasons that causes shoulder problems in children are:
1. Sports with repetitive overhead motions such as tennis.
2. If the child has hyper-mobility (double-jointed) in the joints
3. family history of the joint problem
4. falls on outstretched arm
5. traumatic dislocation
6. A torn or damage cartilage ring or ligaments
7. A torn rotator cuff
8. Damaged bicep tendons
9. Arthritis of collarbone
10. Loose tissue
In condition like dislocated shoulder or if the child has fallen on shoulder or has direct injury to the shoulder undoubtedly causes pain and may experience:
1. Severe pain, numbness, tingling
2. Restriction of motion
3. Chronic pain in lifting things overhead
4. Muscle weakness
6. Redness and swelling of the shoulder
7. Deformity in the area
8. Muscle spasms
Once the problem is diagnosed through a physical examination, x-rays or MRI, surgeon may suggest the treatment procedure. Sometimes traditional treatment such as taking anti- inflammatory medications, physical therapy, rest or sling can help if the injury is not very severe. In case of serious or traumatic injury that cannot be corrected by conservative methods may require a surgery (also called shoulder arthroscopy) that attempts to tighten the ligaments of the shoulder joint, giving the humerus less space to move which stabilizes the joint.
In shoulder surgery or shoulder arthroscopy, a small camera (arthroscope) is used to examine or repair the tissue inside or around the shoulder joint. Surgeon will place the arthroscope which is connected to a video monitor through a small incision in the skin to examine and repair or remove any damaged tissues that may include the cartilage, bones, tendons and ligaments. Depending on the problem, surgeon may require to perform one or more of the following procedure during the operation:
1. Rotator cuff repair – the edges of the tendons are attached together to the bone with sutures. The small metal or plastic suture anchors are used to attach the tendon to the bone and do no need to be removed after surgery.
2. Surgery for impingement syndrome – when a person raises arm to the shoulder height, the space between the acromion and rotator cuff narrows and acromion can rub against the tendon and bursa causing pain and inflammation. In most of the cases, the front of the acromion is removed along with some of the bursal tissue.
3. Surgery for shoulder instability – in case of torn labrum (a cartilage that lines the rim of the shoulder joint) surgeon will repair it and the ligaments attach to this area.
The incisions will be closed with stitches and bandaged once the surgery is completed. If a person has lot of damage then surgeon will have to use open surgery method in which a large incision will be made to get directly to the bones and tissues. Shoulder arthroscopy usually has less complications and faster recovery than conventional surgery. Some risks are:
1. Shoulder stiffness
2. Repair unable to heal
3. Weakness of the shoulder
4. Blood vessel or nerve injury
Recovery may take time depending on the severity of the injury, patient may have to wear sling for some time, pain medications will be given and physical therapy will be recommended once the healing is complete.