In cases of old dislocation of the shoulder, operation is indicated for restoration of function and relief of discomfort.
Operation is advised in all early cases. In the older cases, in which the shoulder has been dislocated for several months and there is painless adaptation with 50 degrees of free movement, operation is not advisable. Experience has shown that the end result in these cases is seldom perfect function of the shoulder with a free range of motion. In most instances the free movement obtained is in proportion to the duration of the dislocation. The early cases are much more successful.
Weakness of the deltoid is present in a large percentage of cases following operation. This may be due either to the original injury or to operation, as the nerve supply to the deltoid may be easily damaged by the division of the subscapularis muscle.
The first step in the operation, in the author's opinion, is the clearance of the glenoid fossa and the division of the subscapularis muscle, but the most difficult step is the reconstruction of the anterior portion of the capsule. This may be accomplished by utilizing the long head of the biceps, as described by Nicolai in his treatment for recurrent dislocation of the shoulder, or by reenforcing the anterior part of the capsule with fascial sutures. In one or two instances the writer has transferred the tendon of the coracobrachialis and the long head of the biceps and attached them to the short superior portion of the capsule, thus reenforcing the anterior part of the joint. While operation for an old dislocation of the shoulder may not result in 100 per cent. function, it is much more satisfactory than a resection of the head of the humerus for the same condition.
(C) 1936 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.