Dr Brian Cable MD Shoulder Dislocations and Treatment for a Painful, Unstable Joint
Brian Cable MD shoulder dislocation and treatment is discussed. Shoulder dislocations are a common injury that often leads to chronic pain and instability. Treatment for a shoulder dislocation can be nonoperative, involving physical therapy and activity modification. If conservative measures fail, surgical treatment for a dislocated shoulder usually requires arthroscopic techniques to repair anatomy and restore function.
Surgical management of glenohumeral instability uniformly addresses glenolabral pathology, specifically both capsulolabral repair and repair or augmentation of deficient glenoid bone. However, in the setting of an engaging humeral head defect associated with instability, defining the size of the humeral head defect, known as a Hill-Sachs lesion, is an important first step in helping to guide the orthopedic surgeon.
The management of an engaging Hill-Sachs lesion is likely best served with a biologic and focal solution. The premise of “tissue filling” was initially described in the 1970s. Since that time, the field of orthopedic surgery has witnessed the maturation of this method into today’s arthroscopic Remplissage procedure.
Several treatment options exist for the management of recurrent anterior shoulder instability. Arthroscopic Remplissage, which, in conjunction with Bankart repair, has proven to be a safe and effective means to treat anterior glenohumeral instability.
When executed properly, Remplissage favorably alters the “glenoid track” and thus lessens the risk of glenohumeral engagement in abduction and external rotation. Remplissage is a biologic tissue transfer that confers much less morbidity than glenoid bone grafting procedures while demonstrating comparable efficacy. It has proven effective in minimizing recurrence, has been shown to incorporate, and has not been shown to appreciably affect motion. For these reasons, arthroscopic Remplissage continues to gain widespread acceptance as a treatment option for shoulder instability with a concurrent humeral head defect.
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