From the Guidelines
To treat a sprain of the anterior glenohumeral joint (GHJ) ligament, it is crucial to prioritize a comprehensive approach that addresses both the acute injury and the potential for long-term instability, considering the high likelihood of labroligamentous injury and persistent instability, especially in younger patients 1. When managing a sprain of the anterior GHJ ligament, the initial steps should focus on reducing pain and inflammation. This can be achieved through the application of ice for 15-20 minutes every 2-3 hours, along with the use of over-the-counter pain medications such as ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) as needed.
Key Considerations
- The importance of assessing both osseous and labroligamentous pathology in patients with shoulder dislocation or instability, as coexisting humeral avulsion of the glenohumeral ligament and significant glenoid bone loss can occur in up to 10% of patients with recurrent shoulder instability 1.
- Glenoid morphology and bone loss can significantly impact the likelihood of recurrent shoulder dislocations, potentially necessitating bone grafting to restore stability 1.
- The role of age in determining the likelihood of certain complications, with younger patients being more prone to labroligamentous injury and persistent instability, and older patients more likely to have rotator cuff tears in association with shoulder dislocation 1.
Rehabilitation Approach
After the acute phase, rehabilitation should progress to gentle range of motion exercises, followed by strengthening exercises that focus on the rotator cuff muscles. These exercises can include internal and external rotation with light resistance bands, starting with 2 sets of 10 repetitions daily and increasing as tolerated. Physical therapy is highly recommended for proper guidance and to ensure a comprehensive rehabilitation program.
Immobilization and Support
Initially, wearing a sling can provide comfort and protection, but it is essential to avoid prolonged immobilization to prevent stiffness. The goal is to balance rest with gradual mobilization and strengthening to support the healing of the anterior GHJ ligament and prevent long-term instability.
Given the potential complexity of shoulder injuries and the importance of addressing both the immediate injury and the risk of future instability, a thorough evaluation and personalized treatment plan are essential for optimal recovery and to minimize the risk of recurrent problems.
From the Research
Anterior Glenohumeral Joint Ligament Sprain
- The glenohumeral joint is the most dislocated articulation, accounting for more than 50% of all joint dislocations 2.
- Anterior dislocations comprise 90% to 98% of all glenohumeral dislocations, and a systematic approach to management is paramount 3.
- Detailed assessment of existing soft tissue injury to the labrum, capsule, glenohumeral ligaments, and rotator cuff is mandatory as their presence influences the surgical outcome 2.
- Treatment options for shoulder instability include rehabilitation, arthroscopic repair techniques, open Bankart procedure, capsular plication, remplissage, Latarjet technique, iliac crest, and other bone grafts 2.
Diagnosis and Treatment
- A physical exam is mandatory for diagnosing glenohumeral instability, and the treatment plan should be individualized for all patients 2.
- The glenoid track concept was clinically adopted, and the measurement of the glenoid track for surgical decision-making is recommended 2.
- Three-dimensional (3D) technologies can help to evaluate glenoid and humeral defects, and patient-specific guides are low-cost surgical instruments that can be used in shoulder instability surgery 2.
Related Conditions
- Glenohumeral osteoarthritis (OA) is one of the most common causes of shoulder pain, and conservative treatment options include physical therapy, pharmacological therapy, and biological therapy 4.
- Glenohumeral OA presents shoulder pain and decreased shoulder range of motion (ROM), and abnormal scapular motion is also seen in patients as adaptation to the restricted glenohumeral motion 4.