Dr. Garcia presents his complex treatment algorithm for treating patients with shoulder instability and labral tear

This video features orthopedic sports shoulder surgeon Dr. Grant H. Garcia from the Orthopedic Specialists of Seattle discussing shoulder dislocations and labral tears, explaining how treatments range from basic rehab to highly specialized bone reconstruction.

Here is a summary of the main topics discussed:

• Shoulder Anatomy: The shoulder is a ball-and-socket joint consisting of the humerus (ball) and the glenoid (socket). The labrum is a ring of cartilage that acts as a protective bumper around the socket to keep the ball stable. Tearing this cartilage can lead to structural instability and recurrent dislocations.
• First-Time Dislocation Approach: The immediate priority is getting the shoulder safely back into place, followed by X-rays to rule out fractures. Most first-time dislocations are managed non-surgically with a brief period in a sling and prompt physical therapy, allowing a return to sports within four to six weeks.
• Age-Specific Concerns:
  • Under Age 20: Patients in this group face a 90% recurrence rate of re-dislocating their shoulder without surgical intervention, requiring specific clinical counseling.
  • Under Age 40: Dr. Garcia monitors closely for potential hidden fractures or localized nerve injuries.
  • Over Age 40: High-impact dislocations in older patients frequently cause concurrent rotator cuff tears, which require an MRI to evaluate.
• Arthroscopic Labral Repair: If a patient suffers from multiple, recurrent dislocations, surgery is recommended to prevent future arthritis. This minimally invasive arthroscopic procedure involves placing three or four suture anchors into the socket bone to reattach the torn labrum and tighten the joint capsule. This yields a 90% success rate for returning to sports.
• Addressing Complex Bone Defects: For chronic or severe cases (often involving dozens of dislocations or prior failed surgeries), soft tissue repairs alone will fail due to bone damage:
  • Hill-Sachs Lesion: This is a "pothole" dent created on the back of the humeral ball during a dislocation. Dr. Garcia addresses this using a Remplissage technique, which arthroscopically anchors the adjacent rotator cuff tendon directly into the defect to fill the gap, dropping the long-term recurrence rate to under 5%.
  • Glenoid Bone Loss: Severe instability can wear down the front of the socket bone (like a golf tee missing its front edge). If 15% to 25% of the bone is missing, a Latarjet procedure is performed. This open surgery transfers a piece of the coracoid bone from the front of the shoulder to rebuild the socket wall.
  • Distal Tibial Allograft: As a salvage option for previously failed Latarjet surgeries, a piece of cadaver ankle bone (distal tibia) containing natural cartilage can be grafted onto the shoulder socket to preserve joint function.