The shoulder joint is extremely mobile, allowing patients to rotate, lift and reach the arm up over the head. This wide range of motion can cause patients also heightens susceptibility to a shoulder dislocation and, ultimately, shoulder instability. Shoulder instability affects patients when the ball (humeral head) is forced out of the socket (glenoid bone) on a regular basis. Once a shoulder dislocates, it is at greater risk for additional dislocations and overall instability. With recurrent shoulder instability, patients have exhibited bone loss of the ball (humeral head) and socket (glenoid bone) of the shoulder joint. The basis of shoulder stability is formed by the bony makeup of the joint. If this is bony makeup is compromised, then the risk of dislocation heightens dramatically. In cases of severe bone loss, bony augmentation through use of an autograft (from self) or allograft (from cadaveric source) is the recommended treatment option. This treatment option, offered by Dr. Matthew Provencher, Vail, Aspen, and Denver, Colorado orthopedic shoulder surgeon and sports medicine specialist, will reconstitute the bony makeup of the joint and resolve shoulder instability.
Shoulder instability with severe bone loss is particularly difficult to treat given that the bony foundation of the joint has been placed in jeopardy. In cases of severe bone loss, research has shown that soft tissue repair including arthroscopic stabilization surgery does not always reestablish shoulder stability. Instead, bone graft surgery has proven to be much more effective in these cases. A coracoid process graft, iliac crest autograft, and distal tibia allograft placed at the area of bone loss of the socket (glenoid bone) have been proven effective for treatment of severe bone loss.
Glenoid bone loss after a single dislocation has been found in up to 22 percent of patients and is a leading cause of arthroscopic instability repair failure. In order to determine the amount of the socket (glenoid bone) and bone loss of the ball (humeral head), Dr. Provencher uses traditional imaging including x-rays as well as the latest imaging technology to acquire a 3-D CT scan. The amount and characteristics of the patient’s bone loss will be assessed through this imaging in order to arrive at an individualized and proven treatment method.
Then, in order to provide his patients with the most individualized treatment plan, Dr. Provencher will also do a thorough physical examination of the injured shoulder aside from the acquired imaging. In general, arthroscopic techniques are commonly reserved for patients with bony defects of the shoulder joint, while open surgery techniques with application of a bone graft are reserved for cases of severe bone loss.
To each patient with severe bone loss of the shoulder joint, Dr. Provencher will explain the various treatment and bone graft options. Ultimately, Dr. Provencher will provide his recommendation for ideal treatment to reestablish shoulder stability in great detail at the first consultation following physical examination and review of imaging studies.
Recovery and Rehabilitation Following Bone Graft Surgery for Shoulder Instability
Dr. Provencher will prescribe a detailed post-operative physical therapy program to all patients with severe bone loss following shoulder instability surgery with a bone graft. The program generally begins with gentle passive range of motion followed by active motion with caution to allow for union of the bone graft with the native bone, strengthening of the repaired joint and a return to normal activities.
For more information on severe bone loss of the shoulder, or to learn more about bone graft options and bone graft surgery for shoulder instability, please contact the office of Dr. Matthew Provencher, Vail, Aspen, and Denver, Colorado orthopedic shoulder surgeon.