Significant contemporary advances have permitted a more comprehensive understanding and development of some interesting concepts about the shoulder instability. The clinical syndrome of shoulder instability represents a wide spectrum of symptoms and signs which may produce various levels of dysfunction, from slight Subluxation to gross joint instability. The occurrence and reoccurrence of the joint instability may be due to age, forceful collision, falling on an outstretched arm or a sudden wrenching movement. Dislocation of the shoulder is a common and often disabling injury which is more common in athletes. Depending upon the state of the instability either exercise can be rec- ommended or a surgery can be performed.

1. R cn A vne IM n g me t fh u e I t i y
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2. Apollo Medicine 2012 December
Review Article
Volume 9, Number 4; pp. 315e317
Recent advances in management of shoulder instability
Sughran Banerjeea,*, Neha Sharmab, Aparajita Sharmab
ABSTRACT
Significant contemporary advances have permitted a more comprehensive understanding and development of some
interesting concepts about the shoulder instability. The clinical syndrome of shoulder instability represents a wide
spectrum of symptoms and signs which may produce various levels of dysfunction, from slight Subluxation to gross
joint instability. The occurrence and reoccurrence of the joint instability may be due to age, forceful collision, falling on
an outstretched arm or a sudden wrenching movement. Dislocation of the shoulder is a common and often disabling
injury which is more common in athletes. Depending upon the state of the instability either exercise can be rec-
ommended or a surgery can be performed.
Copyright © 2012, Indraprastha Medical Corporation Ltd. All rights reserved.
Keywords: Shoulder instability, Arthroscopic stabilization, Open shoulder stabilization, Types of sutures
INTRODUCTION a tear of the labrum or rotator cuff, a Bankart lesion or
a HilleSachs defect.1
The end of the shoulder blade or scapula that creates the There are mainly two types of dislocation:
shoulder socket is known as the Glenoid. It is surrounded 1. Dislocation due to trauma called as Bankart lesion, and
by a small, flexible tissue known as the labrum, which 2. Dislocation due to Lax ligaments.
acts like a speed bump to keep the ball in the shoulder In some cases there is partial dislocation where the
socket. A group of four muscles and their respective shoulder slips out of the joint partially and slips back into
tendons; known as the rotator cuff, stretches from the normal position again, this is called as Subluxation. The
humerus to the glenoid and serves two purposes. First, younger the patient at first dislocation the more will be
the rotator cuff helps to raise, lower, and swing the arm, chance of recurrent dislocation.
giving the shoulder a large range of motion. Secondly, The diagnosis can be made through the symptoms
the cuff serves to keep the humerus inside the glenoid of instability, physical examination, X-ray, CT-scan,
socket. The cuff is covered by a pack of tight ligaments, MRI etc.
known as the capsule that attaches the humerus to the gle- A patient with Bankart lesion usually needs an operation
noid. Repeated dislocation or Subluxation of the humerus to repair the ligaments to the bone, even after the first dislo-
out of the glenoid is known as Instability. cation as the lesion usually does not heal. On the other hand
Instability is the weakening of capsule at the shoulder in case of Lax ligaments, can be first managed with exer-
joint, which allows the ball to slip out of the socket, cise, strengthening and operations are required only when
causing pain, frustration and loss of faith in the shoulder symptoms becomes unbearable. The operations can be
as a sturdy joint. Instability is often accompanied by done either arthroscopically or open i.e. it can be an
a
Consultant Shoulder Surgeon, Apollo Gleneagles Hospital, Kolkata, bTrainee AHERF, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi,
India.
*
Corresponding author. email: sughran@gmail.com
Received: 13.7.2012; Accepted: 4.8.2012; Available online 28.8.2012
Copyright Ó 2012, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2012.08.001

3. 316 Apollo Medicine 2012 December; Vol. 9, No. 4 Banerjee et al.
arthroscopic Bankart repair/arthroscopic stabilization, open group. There was no significant loss of external rotation
shoulder stabilization or Bristow-Latarjet procedure.1 and return to prior activity.2
The fixation of shoulder by various suture anchor’s
provided similar results while tested for pullout strength.
In arthroscopic repair
Thus in conclusion arthroscopic Bankart repair is an estab-
How the shoulder should be fixed is also shrouded in lished benchmark for shoulder surgery, however with
controversy. Some recommend arthroscopic stabilization inverted pear glenoid Latarjet procedure is recommended
while other’s advocate open Bankart’s repair.2 and in acute sport’s injuries acute repair prevents recurrence
There are reported failure rates following arthroscopic of shoulder dislocation. With further development of
stabilization, but these are early literature and not so well arthroscopic techniques gradually the shift is considered
technically.3 Later reports suggest a much better success to be toward fixing everything arthroscopically.4
rate for arthroscopic shoulder stabilization.4 The arthroscopic Thus arthroscopic shoulder stabilization is here to stay
shoulder stabilization and open shoulder stabilization are and improve further technically with time, gradually
comparable.5 Thus the benchmark for shoulder stabilization making open stabilization an obsolete procedure or kept
procedure from open repair has gradually shifted to arthro- for those cases which cannot be repaired arthroscopically.
scopic stabilization.3 The arthroscopic shoulder stabilization
procedures are more patient friendly, less of operative stress
and lesser morbidity.2,6 A study in young athletes demon- CONCLUSION
strated a significant reduction in recurrence following acute
repair of Bankart lesion as compared to those who were There have been significant advances in methods to restore
treated conservatively.1 In patients with glenoid bone defect function in case of shoulder instability. The techniques
a Bristow-Latarjet procedure is recommended, this consists involved in stabilization of shoulder have complex proce-
of an open procedure taking the coracoid and fixation of dures that require a degree of experience and expertise.
the coracoids to the glenoid by a screw.7 This increases the Hence the development of arthroscopic training is therefore
radius of curvature of the glenoid and thereby increases the an important skill which needs to be developed among
stability biomechanically.8 The Bankart’s repair is supple- surgeons and increase the awareness to refer shoulder stabi-
mented by this method in cases of glenoid bone defect. lization to arthroscopically trained surgeons.
High success rate has been reported following Bristow-Latar-
jet procedure in inverted pear glenoid and in these situations
arthroscopic Bankart repair seems inadequate mode of CONFLICTS OF INTEREST
fixation.7
Boileau (2007) has recommended primary Latarjet All authors have none to declare.
procedure in high-energy athletes determining a scoring
system as to who needs to undergo which surgery. The
Latarjet procedure is being successfully done Arthroscopi-
cally9 and thus is gaining popularity. In the procedure the
REFERENCES
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J Bone Jt Surg. 2003;85:1479e1487.
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10% in open group and 10.2% in the arthroscopic repair shoulder joint. Arthroscopy. 1986;2:35e40.

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7. Hovelius Lennart K. Long-term results with the Bankart and Bris- 10. Hovelius L. Operative treatment of recurrent anterior shoulder
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8. Boileau P. The instability severity index score. A simple pre- delphia: BC Decker Inc.; 1984:87e90.
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