Remember To Stretch Before Bone Breaking - Page #4
 

Working Diagnosis:
Chronic shoulder instability secondary to anterior labral lesion (Bankart lesion)

Treatment:
The patient's report of intermittent paresthesias during shoulder dislocations raised concern that frequent shoulder dislocations were causing traction neuropathy. He did not want to proceed with surgical labral repair or formal physical therapy secondary to work and financial considerations. He was advised to avoid dance routines and positions that result in shoulder dislocation and was given a home exercise program.

Outcome:
At a 6-month follow up he reported resolution of paresthesias and cessation of dislocations with avoidance of bone breaking techniques. He was able to return to work without shoulder dysfunction and continued dancing with modified techniques.

Author's Comments:
Breakdancing is debuting at the 2024 Olympics. An understanding of the biomechanics and specific injuries associated with breakdancing is essential for this growing sport.

Editor's Comments:
The majority of shoulder dislocations are anterior dislocations, impacting the anterior and inferior glenohumeral ligaments. A Bankart lesion typically refers to an anteroinferior glenoid labrum tear, which results in detachment of the capsule from the anterior glenoid. Patients can also have posteroinferior tears of the labrum, although these are much less common. Individuals who sustain shoulder dislocations may also have bony lesions. The term "bony Bankart" describes a fracture of the adjacent anteroinferior glenoid rim. Bankart lesions are also often associated with a Hill-Sachs defect, which is an impaction depression fracture to the posterolateral humeral head. Studies have shown that Bankart lesions are seen more commonly in patients with recurrent shoulder dislocations.

Primary arthroscopic repair of Bankart lesions allows for reinsertion of the detached anterior capsule and labrum. This may often be recommended for younger patients and athletes, and repair helps to improve shoulder stability and reduce the risk and rate of recurrent dislocations. Non-operative approaches to treatment involve rest, immobilization, and physical therapy (which involves stretches, strengthening, and stabilization exercises). Ultimately, the decision of whether to pursue a surgical or non-surgical approach should be a shared decision between the patient and physician based on the patient's age, level of activity, lifestyle, and goals.

As the author notes, breakdancing (also known as breaking) will debut at the 2024 Summer Olympics. As this sport continues to grow, it is important for sports medicine physicians to recognize common musculoskeletal injuries and overuse syndromes associated with these individuals. Injuries are reported more frequently in professional breakdancing compared to amateur breakdancing, and common sites of pain include the wrist, spine, shoulder, and ankle. Common injuries include sprains, strains, and tendinitis, although fractures and dislocations are also seen.

References:
1. Clavert P. Glenoid labrum pathology. Orthop Traumatol Surg Res. 2015 Feb;101(1 Suppl):S19-24. doi: 10.1016/j.otsr.2014.06.028. Epub 2015 Jan 14. PMID: 25596985.

2. Rutgers C, Verweij LPE, Priester-Vink S, van Deurzen DFP, Maas M, van den Bekerom MPJ. Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill-Sachs and Bankart lesions: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022 Jun;30(6):2130-2140. doi: 10.1007/s00167-021-06847-7. Epub 2022 Jan 6. PMID: 34988633; PMCID: PMC9165262.

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