Surgical stabilization of the shoulder joint. Results of five years’ experience

Relevance: Damages of the tendon-ligamentous apparatus of the shoulder joint are the most common manifestations of injuries. This is because of complex biomechanics and large range of motion. The main complication of shoulder joint injuries is chronic instability, which is difficult to eliminate due to the need for high-tech surgical procedure and a carefully planned rehabilitation protocol. Purpose of the study: to conduct a retrospective analysis of the early and late postoperative period of patients, who underwent various surgical procedures to stabilize the shoulder. Aim is to assess our treatment and rehabilitation. Materials and methods: On the basis of the Department of Traumatology and Orthopaedics of «National Medical and Surgical Center named after N.I. Pirogov» conducted a study of the postoperative period of patients, which operated on for various causes of instability of the shoulder joint in the period 2015-2020. The operating journals were researched, the postoperative condition of the range of motion of the shoulder joint was assessed against the background of the surgical treatment and the developed personalized rehabilitation protocols for each of the identified pathologies using questionnaires and physical examination. Results: The study included 476 patients, of whom there were 361 men (75.8%), women - 115 (24.2%), the average age was 40.5±15.1 years. Surgical procedures for clearly localized injuries (142) and multiple injuries (334) of the structures of the shoulder joint. The largest number of surgeries were performed for instability - 192 surgeries (29.9±8.8 years) and 151 surgeries for rotator cuff ruptures (54.2±12.1 years). In each clinical case, we drew up an individual plan of not only surgical treatment, but also postoperative rehabilitation, which varied in terms of the timing of the inclusion of new stages of physical activity, depending on the intraoperative surgical situation and the patient’s history. Conclusions: Young patients are more likely to recurrence instability after primary dislocations. In contrast, older patients are less likely to suffer from instability, but more often complain of shoulder pain. At the present stage of development of shoulder surgery, early activation of the limb is especially important as a measure of combating postoperative contractures and atrophy of muscle groups.