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Abstract
The shoulder plays an important role in most activities of daily life and in most sports. Some of these sports require a range of motion more than usual thus making the individual more prone to shoulder instability.
Glenohumeral instability is the inability to maintain the humeral head centered in the glenoid fossa. (Matsen et al 1994).
A complex interaction between static and dynamic factors maintains GHJ stability. Both factors function to allow maximum GH rotation while limiting excessive translation of the humeral head on the glenoid (Carr 1996, Warner and Boardman 1999).
The pathoanatomy that can contribute to anterior shoulder instability includes Bankart lesions, bony Bankart lesions, capsular injury, excessive capsular laxity, Hill-Sachs lesions, rotator cuff and subscapularis muscle injuries, glenoid fractures,and glenoid dysplasia. (Gill and Zarins 2003).
The most common complication following anterior glenohumeral dislocation and instability is the recurrence of the instability Diagnosis of traumatic glenohumeral instability entails a detailed history taking,careful clinical examination (Protzman 1980, Rowe and Zarins 1981, Silliman and Hawkins 1993, Warme et al 1999) and radiological examination including CT and MRI (Rockwood et al 1996, Bradely et al 2003, Young et al 2005).
Successful treatment of anterior instability of the shoulder requires a balance between restoring joint stability and minimizing loss of glenohumeral motion. The choice of treatment should be individualized on the basis of the patient’s occupation and level of participation in sports, as well as on the degree of instability of the shoulder. (Paxinos et al 2001,Gill and Zarins 2003).
In this study results of arthroscopic vs open techniques in management of recurrent shoulder dislocation published in the literature between 1997 – 2007 were reviewed. No significant difference between the two methods were found , These results were compared with other meta-analysis studies ,these studies supported that open technique is better than arthroscopic regarding to post operative recurrence, Rowe scores and return to work or sports ,,,but our study revealed that the arthroscopic technique is improving by time.
The degree of shoulder stability achieved by the arthroscopic technique was greatly evident, compared to the marked instability encountered preoperatively in all patients.
The range of shoulder motion also showed remarkable improvement post operatively and this can be explained by the improved stability and the decreased postoperative pain.
Using the arthroscopic procedure in treatment of recurrent traumatic anterior shoulder instability have many advantages as the procedure is biomechanically sound, less time consuming with minimal blood loss, but it needs special instrumentation and special surgical experience and the last but not the least advantage is that it allows almost immediate resumption of shoulder motion and doesn’t lead to residual loss of shoulder motion on the long run.