Causes
The Glenohumeral joint is the most commonly dislocated joint in the human body. The labrum, shoulder muscles, and ligaments stabilize the joint. The shoulder becomes unstable usually from an injury or an imbalance of muscles. This can cause dislocation or subluxation events. With chronic dislocation events, glenoid bone loss can occur. No amount of physical therapy will reduce the pain and dislocation recurrences. Bone loss can cause early arthritis, rotator cuff tears, shoulder mechanic compensations and muscle soreness and fatigue.
Diagnosis
The most common age is between 20-35 years old. To diagnose glenoid bone loss, advanced imaging is required. An MRI will show musculatures and CT scan will show bone loss. Symptoms include:
(1) Normal range of motion, but pain at end range
(2) Decreased strength
(3) Chronic pain
(4) Difficulty returning to activity
(5) Apprehension or Instability
(6) A failed instability repair
(7) <20% of glenoid bone loss
Surgical Treatment
Dr. Nicholson will perform a Latarjet Procedure (Lat-tar-jay). This is an open procedure where bone is moved to compensate for the glenoid bone loss. The coracoid bone, the small hook-like structure on the front part of the scapula, is resected. The subscapularis muscle will be “split” to allow the resected bone to pass through and attach to the glenoid using screws.
Recovery consists of 4 weeks in a simple sling and 12 weeks of physical therapy. This is a faster recovery than an instability repair because “bone heals bone.” Patients can return to sport in 3-4 months and contact sport between 5-6 months.
