Arthroscopy surgery of atraumatic instability of the shoulder

[corrected] Atraumatic shoulder instability makes roughly 4% of all instability cases. Subluxation or dislocation may either have no actual cause or be the result of minor accident. Because of its multi-directional character and coexisting disturbances, atraumatic instability is a serious therapeutic issue. The basics of the treatment are strengthening the shoulder stabilizing muscles and exercises aimed at optimising nerve-muscle control.

6 patients - 10 shoulders, who suffered non-traumatic multi-directional shoulder instability were operated on at our Dept. Lack of positive results after at least 6 months' rehabilitation was the direct indication for surgery, along with night and activity related pain. Three patients from the above mentioned group suffered additionally single sided idiopathic instability. Arthroscopy was carried from three portals: two front and one back. During the surgery we observed high capsule laxity, generally hypoplastic labrum, and partial cartilage loss within the humeral head. Non-absorbing sutures - Ethiobond 2, anchors, and screws we used to stabilize the capsule and labrum. After inserting the scope we made 3-4 anchors and sutures of capsule and labrum at the anterior and posterior aspect of the glenoid. The next thing to do was to apply sutures closing rotator intervals. Remaining, non-sutured parts of the capsule, were thermally shrunk.

The observation covers period from six months to two years after the surgery. The decrease of pain score has been observed from 4 points before surgery to 0.33 points after the treatment. The UCLA score increased after the surgery by about 13 points. In Simple Shoulder Test the score of positive answers increased from 7 to 11. Results of the treatment were lack off pain and restored stability of the shoulder. There was stronger patients' motivation to exercise in order to strengthen the muscles and muscle coordination.

Arthroscopic stabilization of shoulder joint is a encouraging method in atraumatic instability of the shoulder. In case of any failure, the method doesn't exclude the option of open-surgery methods.