Types of recurrent dislocation:

1. Traumatic dislocations: In dislocations in one direction (forward or backward), where the first dislocation is caused by a significant trauma (fall, impact, traffic accident, etc.), the structure called labrum, which participates in the joint structure of the scapula, which acts as a barrier to the arm bone, is damaged and separated from the place where it adheres to the scapula, and since the barrier structure is damaged (Bankart lesion), the possibility of dislocation of the shoulder increases and in recurrent dislocations, only surgical treatment is effective. 90% of recurrent shoulder dislocations are classic traumatic dislocations. In advanced cases, dislocations can be very easy and patients usually start to dislocate the shoulder themselves. The only treatment option is surgery.
2. Atraumatic dislocations: The first dislocation is a type of dislocation that occurs without significant trauma, with excessive strain during daily activity (such as turning the arm, throwing, making a reverse movement), both posterior and anterior, usually seen in both shoulders, where the priority in treatment is physical therapy and capsule operations are performed in the operation. In these patients, the shoulder dislocates and reinserts very easily. With physical therapy performed in good and experienced hands, 80% of them are cured. Those who do not respond to physical therapy can be treated with surgical methods.
3. Voluntary dislocations: Patients voluntarily dislocate and reposition their shoulders forward and backward. These patients first need to give up voluntary dislocation. Psychological treatment may sometimes be needed for this. In patients who completely give up voluntary dislocation, treatment is continued as in atraumatic dislocation. If dislocation occurs in certain movements despite physical therapy, surgical treatment can be tried, but the success of surgical treatment is very low.

Surgical Treatment : These are the characteristics expected from a surgeon;

1. Low recurrence rate
2. Low complication rate
3. Low reoperation rate
4. Low probability of arthritis in the joint in the future
5. Should not cause restriction of movement in the shoulder joint
6. It should be applicable to the vast majority of cases. In general, arthroscopic surgery is around 80% successful and open operations are around 85% successful. Arthroscopic surgery is technically very difficult and requires special training. The success rate is 90% in good hands.

ARTHROSCOPIC SURGERY:

Advantages : Additional pathologies can be treated. Less postoperative scarring Less risk of limitation in joint movements Less scarring on the skin Shorter duration of surgery

Disadvantages: Recurrent dislocations due to bone deficiency cannot be cured Surgical technique takes time to perfect There is not enough supportive tissue The risk of recurrence is higher, albeit at a very small rate.

There are different arthroscopic surgery methods for different types of shoulder dislocations.

1. Arthroscopic bankart repair; The cartilage support in the front part of the shoulder socket called labrum is one of the most important causes of recurrent shoulder dislocations. In this surgery, which is performed through 1 small hole in the back and 2 small holes in the front, the labrum is sewn to its original place. In order to fix this cartilage piece to the bone, a 3-5 mm screw with a thread at the end is inserted into the bone and the labrum is sewn to the bone using the thread.
2. Narrowing of the joint capsule; It is performed in recurrent shoulder dislocations in which the labrum is not torn, the labrum is completely degenerated or in addition to labrum repair. The aim is to tighten the joint capsule that is loose with recurrent dislocations. For tightening, the abundance is tightened by starting from the lower part of the loose capsule and suturing upwards..
3. Etching: It is a treatment method that can be summarized by arthroscopically heating the loose joint capsule using radiofrequency current through the joint and then shrinking the capsule. It can be performed alone or in addition to bankart repair. It is less commonly used due to its complications. In the postoperative period, the arm remains suspended for 4 weeks. As long as it is in suspension, shoulder shaking exercises are performed 3 times a day. The patient can take a bath from the 5th day. During the time the arm is in the sling, the sling can be removed and the patient can eat, use the computer and write while the shoulder remains fixed. Passive and limited active movements are allowed between 4-6 weeks. Between weeks 6-10, active movements and their variety are increased. During this period, patients can do most of their daily work, and movements other than opening the arm to the side above the shoulder level are allowed. Between weeks 10 and 12, movements other than throwing movements are allowed from shoulder movements. At weeks 12-16, all movements are started to be allowed. In the 16th week, sports are allowed. Sports in which the arm is used intensively in the overhead position (tennis, basketball, volleyball, etc.) are allowed after the 6th month. Postoperative physical therapy and rehabilitation is as important as surgery.