What is anterior shoulder instability?
The shoulder joint is one of the largest and most complex joints in the body. It has the greatest range of movement of any joint, but this leaves it unstable and with the highest chance of dislocation of all the body’s joints. The shoulder is a ball-and-socket type of joint that permits a wide range of movement. Its bony structures include the upper arm bone (the humerus) and the shallow cavity (the glenoid) of the shoulder blade. The shoulder joint is formed where the head of the upper arm bone fits into the shallow cavity (glenoid fossa). The joint is surrounded by numerous ligaments and muscles such as the subscapularis, which give it stability.
- Shoulder instability refers to a condition in which an injury that allows the head of the upper arm to dislocate from the shallow cavity. This type of dislocation is also called anterior (near) shoulder instability.
- In anterior shoulder instability, the subscapularis muscle plays an important role.
What is the subscapularis muscle?
The subscapularis is a triangular-shaped shoulder muscle located in the shoulder bone. This muscle attaches the shoulder bone to the upper arm bone called the humerus. The function of this muscle is to stabilize and rotate the shoulder joint. It allows the shoulder to allow the arm to turn inward. When the arm is extended, it draws the humerus forward and downward. It also prevents the dislocation of the head of the humerus (upper arm bone). The subscapularis is the most used muscle in the shoulder. It is the primary muscle used in pitching, hitting, swimming, and all types of sports. As a result, injuries to the shoulder muscle are common among athletes.
What are the symptoms of anterior shoulder instability?
People with anterior instability of the shoulder joint can sometimes feel the ball of the shoulder come out of its socket or “give way.” Often, the episodes of giving way occur with specific activities or positions of the arm, such as throwing a ball or reaching behind the body.
What is the Putti-Platt procedure?
Putti-Platt is one of the surgical treatment options for anterior shoulder instability. In this procedure, the flexible cord (tendon) of the subscapularis muscle is cut and then reattached to the head of the upper arm bone (humerus). This procedure makes the head of the upper arm bone tighter to the shoulder blade allowing better stability of the shoulder joint. This type of procedure is rarely indicated.
When is the Putti-Platt procedure not recommended?
Putti-Platt is a rare procedure and done only for anterior shoulder instability. Below are conditions in which the Putti-Platt procedure is not recommended:
- Any other shoulder instability (posterior or multidirectional).
- Glenohumeral arthritis (swelling of the shoulder joint).
- Restricted external rotation of the shoulder.
SLIDESHOW
Pain Management: Surprising Causes of Pain See SlideshowHow is the Putti-Platt procedure done?
The Putti-Platt procedure is done under general anesthesia. Usually, the procedure is completed within 180 minutes. During this procedure:
- The surgeon monitors the patient vitals throughout the procedure after administering general anesthesia.
- The patient is positioned in a beach-chair position. The room is arranged to allow the arm to be raised (the relaxing position) fully abducted (away from the body) and externally rotated throughout the procedure.
- The skin is incised along the shoulder bone and curved at the tip of the upper arm bone.
- The flexible cord (the tendon) of the subscapularis muscle is detached from the shoulder bone and then reattached to the head of the upper arm bone (humerus).
- After the upper bone is tightened with the flexible cord, the surgical opening is sutured, and the patient is monitored in an intensive care unit
What are the complications of the Putti-Platt procedure?
This procedure has promising initial outcomes but disappointing long-term follow-up.
- The main drawback of this procedure is the loss of external rotation of the shoulder to increase the stability of the shoulder.
- This cannot be performed on athletes because it reduces the shoulder range of motion.
- Pain and recovery periods are more in this procedure.
- Sometimes, late osteoarthritis (degeneration of the joints) is observed after this procedure.
What is the recovery period after the Putti-Platt procedure?
- After surgery, the patient’s shoulder may be immobilized for three to six weeks.
- Rehabilitation with exercises is recommended for the next two months after the immobilization period.
- Usually, patients regain full motion and strength of the shoulder joint after one year of the procedure.
Putti-Platt Procedure Procedure: (https://emedicine.medscape.com/article/1894455-overview)
Top What Is a Putti-Platt Procedure? Related Articles
Broken Bone
A broken bone is a fracture. There are different types of fractures, such as:- compressed,
- open,
- stress,
- greenstick,
- spiral,
- vertebral compression,
- compound, and
- comminuted.
Symptoms of a broken bone include pain at the site of injury, swelling, and bruising around the area of injury. Treatment of a fracture depends on the type and location of the injury.
Broken Bones
Broken bones are a common type of injury. Bones are some of the hardest tissues in the body, but they can break when they are stressed. Osteoporosis and cancer may cause bone fractures. The broken bone needs immediate medical treatment.
Bursitis Symptoms and Treatments
Diagnosed with bursitis? Learn about treatment and prevention for trochanteric bursitis, as well as hip, knee, shoulder and other bursitis types.
CT Scan (Computerized Tomography)
A CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.
CT Scan vs. MRI
CT scan (computerized tomography) is a procedure that uses X-rays to scan and take images of cross-sections of parts of the body. CT scan can help diagnose broken bones, tumors or lesions in areas of the body, blood clots in the brain, legs, and lung, and lung infections or diseases like pneumonia or emphysema.
MRI (magnetic resonance imaging) is a procedure that uses strong magnetic fields and radiofrequency energy to make images of parts of the body, particularly, the organs and soft tissues like tendons and cartilage.
Both CT and MRI are painless, however, MRI can be more bothersome to some individuals who are claustrophobic, or suffer from anxiety or panic disorders due to the enclosed space and noise, the machine makes.
MRI costs more than CT, while CT is a quicker and more comfortable test for the patient.
First Aid: Why You Need a First Aid Kit and CPR
First aid is providing medical assistance to someone a sick or injured person. The type of first aid depends on their condition. Preparedness is key to first aid, like having basic medical emergency kits in your home, car, boat, or RV. Many minor injuries may require first aid, including cuts, puncture wounds, sprains, strains, and nosebleeds. Examples of more critical first aid emergencies include heart attacks, strokes, seizures, and heatstroke.
First Aid: Wound Care for Cuts and Scrapes
Wound care treatment at home involves performing cuts and scrapes first aid including cleaning the injury and applying antibiotic ointment and a bandage. Use wound care products like adhesive bandages, hypoallergenic bandages, sprays, tape, and gauze. If cuts and scrapes don’t heal, see your doctor.
Hip Bursitis
Bursitis of the hip results when the fluid-filled sac (bursa) near the hip becomes inflamed due to localized soft tissue trauma or strain. Symptoms include stiffness and pain around the hip joint. If the hip bursa is not infected, hip bursitis can be treated with ice compresses, rest, and anti-inflammatory and pain medications.MRI (Magnetic Resonance Imaging Scan)
MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Rotator Cuff Tear and Injury
Rotator cuff injury is damage to any of the four tendons that stabilize the shoulder joint. Shoulder pain and tenderness are common symptoms. Rotator cuff disease treatment depends on the severity of the shoulder injury.
Rotator Cuff Tear: Exercises, Symptoms, Tests, and Surgery
Rotator cuff tears are painful. Learn about rotator cuff tear exercises, symptoms, tests, and surgery.
Shoulder and Neck Pain
Shoulder and neck pain may be caused by bursitis, a pinched nerve, whiplash, tendinitis, a herniated disc, or a rotator cuff injury. Symptoms also include weakness, numbness, coolness, color changes, swelling, and deformity. Treatment at home may incorporate resting, icing, and elevating the injury. A doctor may prescribe pain medications and immobilize the injury.
Trauma/First Aid Quiz
What should be in your first-aid kit? Take this quiz to understand trauma and learn the truth about how to administer first aid.
What Is a Shoulder Subacromial Injection?
Injecting corticosteroids into the subacromial space is one method to treat inflammation and pain. Injections can reduce pain and inflammation and restore the mobility of shoulder joints.