Saving the Shoulder: Minimally Invasive Shoulder Repair
Keith, an active 18-year-old from Amherstburg, Ontario, is preparing for surgery on his shoulder at DMC Michigan Orthopaedic Specialty Hospital. The surgery will repair an injury he got moving a boat trailer onto a truck hitch.
“It just came dislocated and dropped, and then my shoulder came out like it was dislocated. It was very painful. I passed out.”
DMC Orthopaedic Surgeon Stephen Lemos is a vice chair at the hospital, and a team physician for the Detroit tigers. According to Lemos, a shoulder dislocation in a young patient like Keith is very likely to happen again, if left untreated.
“What happens is this – the risk for dislocation in younger patients after a primary dislocation is around 85 percent, if treated with conservative means – just putting the arm in a sling.”
Keith’s shoulder was no different: it continued to dislocate, even in his sleep. According to Dr. Lemos, “The cup of the shoulder is really quite shallow, and to double the depth of the socket, there’s actually a bushing that surrounds the shoulder. It’s called the labrum, and it’s made out of gristle, like the meniscus in the knee. And when the shoulder moves, it tears on the rim and it doesn’t heal, causing repeat dislocation.”
To repair the tear in Keith’s labrum, also known as a Bankart lesion, Dr. Lemos will use minimally invasive arthroscopic surgery. Traditional open surgery employs a much parger incision and results in considerable muscle trauma. Recovery can be long and painful. In contrast, the arthroscopic procedure involved just three tiny incisions, and Keith will go home the same day.
Keith’s procedure will include new pain management technology. In the Operating room, Dr. Lemos inserts the arthroscope, a thin rod with a tiny camera, through a small incision. This allows the surgeon to see the joint and confirm his surgical plan. He repositions an secures the labrum by anchoring it to the adjacent bone. Then he pulls it gently back into place. Before concluding, he moves Keith’s arm to ensure that Keith will have a full range of motion.
The recovery period includes six weeks in a sling, and at three months the patient is usually back to a full range of motion and is able to participate in most activities. When Keith was interviewed a month later, he was well ahead of schedule. He was out of the sling, and into serious rehab, and considered himself generally pain-free.
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