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MRI arthrogram confirms evidence of generalized shoulder laxity and anterior inferior labrum tear. We again reviewed our protocol for unstable shoulder and global arthroscopic repair and she and her parents wanted to proceed with an arthroscopic repair. Maya was noted to have a "global" labrum tear at surgery, meaning that over time she had torn the labrum completely around the entire glenoid (socket). She also had created a chondral defect (gouge or trough) in the humeral head (ball) during one of her previous episodes of shoulder dislocation. A successful repair for Maya included not only repairing the torn labrum (cartilage) globally, but also tightening up her capsule and ligaments globally to rebalance the shoulder in all directions. This would have been impossible to do with a traditional open (incision) surgery. Modern arthroscopic techniques allow us to evaluate and treat the entire spectrum of pathology involving the entire shoulder joint.
Just as with ACL injuries in the knee, the risk of cartilage damage and further damage to the shoulder joint increases as the number of episodes of shoulder dislocation and subluxation increase. According to one study, "Patients with a history of previous shoulder dislocation were found to have a 19 times greater risk of developing severe shoulder arthrosis than patients who did not have such a history." Another article by Brems notes that inappropriate diagnosis of the direction and degree of instability can lead to a surgical procedure that may not be ideal for a given patient's (true) pathology. Not all instabilities are necessarily anterior or unidirectional. Even with the correct diagnosis, selection of a less optimal procedure perhaps due to surgeon preference, what Brems terms ''The Standard Procedure for All,'' may factor in the subsequent development of arthrosis. Performing the procedure on the wrong side of the joint predisposes to excessive tightness and ultimately arthritis.
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