A dislocated shoulder for Andy Robertson has dealt Liverpool with a serious blow, with Dr Rajpal Brar explaining the difficulty, his surgical procedure and when he might return.
Robertson injured his left shoulder whereas on worldwide obligation with Scotland final month, falling after a collision with Spain goalkeeper Unai Simon.
The left-back needed to go away the pitch along with his shoulder in a makeshift sling.
Robertson left the Scotland camp for additional analysis with the Liverpool medical group and a number of shoulder specialists, with the eventual determination being that he would require surgical procedure and be out for an unsure period of time.
The membership have given no specifics – aside from it’s a shoulder damage and Robertson underwent surgical procedure – and haven’t supplied a return timeline both.
Nonetheless, primarily based on the data we do have, it’s doable to attach the dots and make an informed guess on Robertson’s prognosis, surgical procedure and the way lengthy he could also be out.
What’s the damage?
Based mostly on how Robertson was injured – medically often called the ‘mechanism of damage’ – with him hitting the bottom along with his arm out to the aspect and hand upwards (‘abduction’ and ‘exterior rotation’) together with the physio makeshift splinting his arm into the opposition (hung throughout his physique into ‘adduction’ and ‘inner rotation’), that is almost definitely a dislocation of the glenohumeral joint.
‘Gleno’ refers the glenoid fossa which is a socket that the ‘humeus’, or higher arm bone, suits into to kind the shoulder joint.
Glenohumeral dislocation is the commonest joint dislocation within the physique, accounting for practically 50 p.c of all main joint dislocations.
Particularly, that is almost definitely an ‘anterior’ dislocation which means the humerus (higher arm bone) popped out in a ahead course.
Anterior glenohumeral dislocations account for practically 97 p.c of all shoulder dislocations.
When the shoulder is dislocated, there may be potential injury to a number of issues.
Initially are the glenohumeral joint ligaments, which stabilise the joint.
Along with ligament injury, 40 p.c of circumstances concerned additional related injury.
These embrace tears to the labrum, which is a rim of this fibrous cartilage that surrounds the glenohumeral joint to supply further stability and cushioning.
Labral tears that solely contain tender tissue and no fractures are referred to as ‘bankart lesions’.
These happen in roughly 90 p.c of circumstances the place the affected person is youthful than 30 years outdated and suffered an anterior dislocation. For reference, Robertson is 29.
There’s additionally the chance for related fractures (injury to bone).
Associated to the ‘bankart lesion’ is the ‘bony bankart lesion’, during which a chunk of bone is pulled (avulsed) off together with the labral tear.
‘Hill-Sachs deformity’ is a small despair within the humeral head, occurring in 35 to 40 p.c of anterior dislocations.
Final however not least, we have now ‘higher tuberosity fractures’, which can be injury to the humerus – however these solely happen in roughly 10 p.c of circumstances.
There’s additionally risk for the shoulder capsule, which surrounds the joint and consists of sure ligaments that mix into it, such because the ‘coracohumeral ligament’.
Final and positively not least, there are possibilities for nerve injury (particularly, the ‘axillary nerve’).
On this state of affairs, most nerve-related signs and dysfunction are solely short-term and most circumstances resolve with none wanted intervention.
What does the surgical procedure entail?
Surgical procedure will rely upon the specifics of the damage, however usually the surgeon will look to restore ligaments which might be unstable and different vital tender tissue injury, just like the labrum.
Within the case of a ‘bankart lesion’ – which is extremely doubtless in Robertson’s case if he had an anterior dislocation – it is vitally extensively really useful that the surgeon restore the injury for younger (underneath 35) people who’re first-time dislocators and have interaction in extremely demanding bodily actions.
I’d say Andy suits the invoice!
The surgical procedure is often accomplished ‘arthroscopically’, which means by way of tiny incisions (termed ‘portals’) within the pores and skin and small devices, to be as much less invasive as doable.
Surgical procedure can be indicated when there are vital fractures, however the truth that Robertson noticed a number of specialists and it took a while to resolve on surgical procedure hints to me that these vital fractures weren’t current in his case.
How lengthy will he be out?
Although Klopp himself speculated that “my expertise tells me round about three months,” the membership have but to provide a timeline on Robertson’s restoration.
I imagine that to be the best transfer, as a result of it may be troublesome to undertaking a timeline out that far with out seeing how Robertson responds to physio – and it additionally takes stress off him to return again earlier than a sure time.
If he certainly has an anterior shoulder dislocation with labral injury, then you definately’re usually taking a look at three-plus months to return following the surgical procedure.
The shoulder might be immobilised for a set time frame after which methodically progressed by way of a step-wise physio program that improves mobility, power and neuromuscular management, whereas shifting from fundamental actions in direction of extra sports-specific actions.
Some excellent news is that Robertson ought to be capable to return to cardiovascular coaching faster – and thus much less of a dent in his health – than an damage of comparable severity to the decrease physique.
Any long-term repercussions?
Typically, when you’ve dislocated the shoulder, there’s the next threat of doing it once more.
Nonetheless, within the case of anterior dislocation with surgical procedure to restore the ligaments and labrum, analysis reveals considerably decreased dangers of subsequent dislocation.
That’s round a six p.c probability versus 47 p.c if no surgical procedure is carried out.
Clearly, the damage just isn’t best for the membership or participant, however outcomes are usually fairly good, supplied it’s not far more extreme than the clues point out.
Robertson is in glorious arms with the medical employees and as soon as he’s cleared to return for coaching, he might be ramped up methodically and with bounce matches to assist construct his health and shield towards different tender tissue accidents within the buildup to his return.
