Recurrent shoulder dislocation, also known as shoulder instability, occurs when the shoulder joint repeatedly slips out of its normal position. Several factors can contribute to an increased risk of recurrent shoulder dislocation. These risk factors include:
Previous Shoulder Dislocation: Once an individual has experienced a shoulder dislocation, the risk of recurrence is higher compared to someone who has not had a previous dislocation. The risk increases further if the initial dislocation occurred at a younger age.
Ligamentous Laxity: Some individuals naturally have looser or more lax ligaments, which can contribute to increased shoulder joint mobility and instability. Ligamentous laxity can be genetic or acquired through repetitive overhead activities or trauma.
Trauma or Injury: High-impact injuries or trauma to the shoulder joint, such as a fall, sports-related injury, or motor vehicle accident, can damage the stabilizing structures of the shoulder, making it more prone to recurrent dislocations.
Structural Abnormalities: Certain anatomical variations or structural abnormalities can predispose individuals to shoulder instability. The “Bankart” lesion or anterior labral tear is the structural damage that results from a dislocation. When the labrum/ligament remains displaced there is a loss of restraint that keeps the shoulder in place. Bone loss from an initial and more commonly repeated dislocations or subluxations increase the risk of recurrent dislocations and may need to be corrected at the time of surgery in addition to repairing torn ligaments. Other abnormalities, such as a loose joint capsule or abnormal bone shapes, can also contribute to instability.
Muscle Weakness or Imbalance: Weakness or imbalances in the muscles surrounding the shoulder joint, particularly the rotator cuff and scapular stabilizers, can disrupt the dynamic stability of the shoulder and increase the risk of dislocation.
Participation in Contact Sports or Overhead Activities: Engaging in sports or activities that involve repetitive overhead motions, forceful throwing, or contact can put stress on the shoulder joint and increase the risk of dislocation. Sports such as rugby, football, basketball, volleyball, and swimming are commonly associated with recurrent shoulder dislocation.
Poor Rehabilitation or Noncompliance with Treatment: Inadequate rehabilitation following an initial shoulder dislocation or noncompliance with treatment protocols can lead to persistent muscle weakness, decreased joint stability, and an increased likelihood of subsequent dislocations.
It’s important to note that while these factors increase the risk of recurrent shoulder dislocation, not everyone with these risk factors will experience dislocations. Treatment options for recurrent shoulder dislocation may include physical therapy, strengthening exercises, bracing, and in some cases, surgical intervention to repair or stabilize the shoulder joint and reduce the risk of future dislocations. Consulting with a healthcare professional, such as an orthopedic specialist or sports medicine physician, can help assess individual risk factors and develop an appropriate treatment plan.
Surgical options I utilize include minimally invasive arthroscopic repairs and open repairs that address that pathology. Treatments are individualized based on the patients activity level, type of sports, age, hand dominance and lesions present.
This procedure repairs the injured ACL (Anterior Cruciate Ligament) and avoids the taking a graft from another pert of the knee or use of donor tissue. The procedure is best for acute tears (recent). I am available for consultation to determine which procedure is best for each patients injury.
See my recently featured article on ACL repair and a new FDA approved implant. I have been performing this procedure and was the first in Northern New Jersey to perform the operation. I hope you enjoy the article.
ACL repair has long been considered an operation that will fail. In recent years there has been a renewed interest in repairing the ACL. Based upon new information, a revisiting of old research articles and newer devices has identified tears that may be amenable for repair. Success with repair in the proper patient can be achieved reliably and the native ACL can be saved.
The BEAR technique utilizes a recently FDA approved device to “bridge” the gap in the repair and enhance healing by promoting healing through the use of the patients own blood and growth factors, providing a scaffold for repair and blocking the synovial (joint) fluid from disrupting the repair process. This now allows for an even wider array of tear patterns to be amenable to repair.
This is particularly exciting for younger, pediatric patients that are still growing. This technique avoids the need to use the patient own tissue and allows for safe repair without as much risk to the growth plate. Dr. Rizio is accepting new patients interested in this technique and also many other sports related injuries. Dr. Rizio sees sports injuries in adult and pediatric patients.
To learn more about the actual device, clink the link below for the company website:
ACL tears are a common injury and being seen with greater frequency and at younger ages. Tears lead to loss of time from sport and activities and can lead to further joint deterioration without prompt recognition and treatment. The standard treatment is a reconstruction with autograft (patients tissue) or allograft (donor, cadaveric tissue). The choice of graft depends on several factors including age of patient and sports activity level. Currently, the time to return to sport has been shown to effect re-injury rates. Historically, 6 months after surgical reconstruction was considered an appropriate time to return to sports without restrictions. This notion has been challenged by recent studies noting lower re-injury rates by waiting 9 months or more to return to sports.
Newer surgical instruments and a retrospective look at studies from decades ago regarding primary repair have lead to resurgence in interest in primary repair instead of reconstruction. Failure rates have been high with this technique in previous studies that lead to the abandonment of this procedure. However, when evaluating the results or success of repair in specific tears, the results can approach that of a reconstruction. Specifically, proximal tears (from the femur) have better success when repaired. The advantage of a repair is that the ACL can be saved, less invasiveness and potentially faster return to sports. If the repair were to fail the standard options for reconstruction still exist. This is particularly attractive in pediatric patients where reconstruction techniques can injure growth plates.
Not every patient is a candidate but the option should be available for those patients inclined to have a repair over a reconstruction. I offer this to my patients who are appropriate candidates based on MRI appearance and surgical evaluation. Below is a short video demonstrating a repair I performed and the technique utilized.
Breaking the clavicle or “collarbone” occurs from a fall or direct blow to the area. Contact sports like football, rugby and ice hockey are common high risk sports. Falls while cycling, skiing and motor vehicle accidents are other common ways to fracture the clavicle. Immediately following the injury patients experience pain, swelling and limited use of the arm. X-rays are usually sufficient to make the diagnosis and initial treatment involves immobilization in a sling and use of ice and over the counter pain medications.
Treatment can be surgical or non- surgical. Non-surgical management simply lets the fracture heal in the position it is in and includes a period of immobilization. The immobilization period is typically 3-4 weeks until sufficient healing occurs so therapy can begin and pain is decreased. Non-surgical management has been the norm for a long time, however, surgical fixation or repair is gaining popularity for certain injuries.
Surgical repair can be accomplished with a variety of devices, but usually a plate and screws has some advantages. Repair can align very displaced fractures. When the fracture is very displaced and when fragments shorten or ride over each other patients who are active tend to complain of shoulder pain and sometimes weakness or dysfunction. This can be alleviated with surgical repair. In addition, fracture healing time is shortened with surgical repair and risk of fracture not healing is lessened by surgical fixation. Use of the upper extremity is allowed much sooner following surgical repair.
In summary, clavicle fractures can be managed with or without surgery. Treatment decision is made based on fracture type, displacement and shortening. Patients activity level, age and other risk factors are taken into consideration as well. Below is a short presentation on a clavicle fracture I treated utilizing sutures and a plate to restore the anatomy and fix the fracture anatomically.
Tennis elbow is a common problem for patients who play tennis or not. The #Tenex device offers a minimally invasive solution for patients not improving with typical treatments and those who do not want to wait any longer to return to activity. I combine this with PRP at time of the procedure.