Recurrent Dislocations

If you’re tired of living with shoulder pain and are looking for alternatives to steroid injections or joint replacement, then minimally invasive regenerative treatments could help get your life back on track.

Your shoulder isn’t just one joint, it’s a complex combination of several working together with muscles, tendons and ligaments to give your arms an incredible range of movement, whether you’re combing your hair or playing sport.

Shoulder dislocations can occur at all three joints within the shoulder. The large ball and socket joint, called the glenohumeral joint, is more prone to dislocating. It is less common at the smaller joint at the top of your shoulder – the acromioclavicular or ‘AC’ joint and dislocations are more rare at the sternoclavicular joint or ‘SC’ joint.

What causes a shoulder dislocation?

Usually, there must be some element of trauma to result in shoulder dislocations- also known as traumatic shoulder instability. However, there is also a small group of patients who can dislocate their shoulder without trauma called atraumatic shoulder instability. Very rarely there are patients who can dislocate their shoulder due to abnormal muscle movements – also known as muscle patterning instability. But, over 95% of patients with shoulder dislocation are as result of an injury e.g. during a road traffic accident, a fall or sporting event.

What causes a recurrent shoulder dislocation?

Certain joints, like the ‘AC’ joint and ‘SC’ joint may be dislocated permanently and reasonably well tolerated. When the glenohumeral joint is dislocated it is usually reduced back, which is a procedure to return the shoulder to its usual position.

But sometimes a glenohumeral dislocation is acutely painful and needs urgent reduction. In some cases, when it is reduced, it stays in joint and stays stable. However, in other cases, if there has been significant damage to the ligaments (labrum), the bone (glenoid or humerus) or the muscles around the shoulder (the rotator cuff) then these shoulder dislocations can happen repeatedly on certain movements or become recurrent.

Recurrent shoulder instability of the glenohumeral joint can be quite painful when it dislocates but the bigger concern is that the abnormal movement in the long term can result in further damage to the shoulder, including osteoarthritis. It is therefore important for the shoulder to regain stability. In some cases, rehabilitation alone can achieve this, but in other cases surgical intervention may be required.

In the cases of ‘AC’ joint dislocation or the rarer but riskier dislocations of the ‘SC’ joint, the ideal management is to reduce the joints through surgical means.

Who is at greater risk of shoulder dislocations?

Playing contact sports, especially rugby, puts you at a higher risk of joint dislocation. However, a traumatic shoulder dislocation can also happen through trauma from other sports as well as a road traffic accident or a simple fall.

Dislocations of the ‘AC’ joint are commonly seen when someone lands directly on the tip of the shoulder. For example, when coming off a bicycle or when being tackled in rugby. A main shoulder dislocation (glenohumeral) usually happens when the arm is outstretched and there is an indirect force to the shoulder.

There is a small group of patients where the shoulder dislocations happen without any significant trauma but because of muscle imbalance. In these patients there is usually a hyperlaxity and poor muscle control to predispose them to shoulder dislocations.

Why have a consultation at the Regenerative Clinic?

Shoulder instability management requires a multidisciplinary team approach, which involves not only a surgical input, but more importantly input from radiology and dedicated shoulder physiotherapists. Most patients respond well to physical therapy to manage their shoulder dislocations but in some groups surgical treatment to repair the ligament is necessary.

At the Regenerative Clinic we see many patients with shoulder dislocations. Mr. Ali Noorani and colleagues are the leading experts in shoulders and have written several papers including guidelines for the British Elbow and Shoulder Society and the British Orthopaedic association on how to manage shoulder instability. 

What are the current treatment options?

Our expert clinicians will be able to assess your shoulder from accurate history and clinical examination as well as imaging (including an MRI scan) and offer further management. In some cases, they will offer you an expert physiotherapist to rehab your shoulder. In others, surgical intervention or the use of regenerative treatments or a combination may be offered to help with your shoulder. 

The range of regenerative treatments include:

Platelet-Rich Plasma (PRP) Therapy

This is an effective and well-researched procedure that’s a potential alternative to surgery. It takes advantage of the blood’s natural healing properties to reduce pain and improve joint function. It uses a specially concentrated dosage of platelets prepared from your own blood to repair damaged cartilage, tendons, ligaments, muscle and bone. Treatment is administered via an injection and, depending on the injury, two to six injections may be required, performed at weekly intervals. Patients usually see their symptoms improve within four to six weeks of having the injections. PRP is a safe treatment option which, because your own blood is used, carries no risk of allergic reaction. Read more clinical evidence supporting PRP here.

This day case treatment is exclusively offered to our patients. It combines the benefits of Platelet-Rich Plasma (PRP) therapy with Lipogems®, a pioneering procedure that uses your body’s own adipose (fat) cells to treat pain and inflammation. AMPP injections are minimally invasive and are carried out under ultrasound guidance. Altogether the procedure takes about an hour to perform with a minimal recovery time of around three hours. As well as being a potential alternative to surgery, AMPP can also aid post-surgery recovery.

Who will my consultation be with and what can I expect?

You will see one of our upper limb orthopaedic consultants, Mr. Ali Noorani or Mr. Matt Smith for around 30 minutes. During this consultation, our specialist will:

  • discuss your medical history to find out more about your symptoms
  • carry out a clinical examination to look at the joint and identify the source of the pain and mobility issues
  • arrange for a diagnostic investigation, for example using an x-ray and/or MRI scan to assess the issue
  • discuss all the treatment options with you, along with their potential benefits and any risks.

Our experienced team works as part of a collaborative partnership of surgeons, sports medicine doctors and physiotherapists to provide the perfect patient pathway to get you quickly on the road to recovery. Whether you need conventional treatment or if you are a candidate for our regenerative treatments, you can be sure that you will get the best advice.

What is the autologous biological approach and when should it be considered?

Autologous means ‘from the same person’ rather than from a donor. Essentially, your own cells are used to encourage healing. With this type of treatment, there’s a dramatic reduction in the risks of the rejection, infection or contamination that come with using material from someone else. The innovative therapies we offer are based on this idea. If you’ve found traditional treatments aren’t helping your pain, or if you’re looking for a possible alternative to surgery, then this approach is one to consider.

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