Shoulder dislocation is where the humeral head comes out of the 'glenoid' socket in the shoulder blade. Shoulder instability is very closely connected to dislocation of the shoulder – once the shoulder has been dislocated it is then more prone to instability
There are four surgical approaches to the shoulder stabilisation procedure described below, depending on the exact nature of the shoulder dislocation and instability.
- Existing medication(s) – some medications can impact surgery, especially any anti-coagulant medication and medicine for diabetes; we will advise if any of your medication needs to be stopped (and when) well ahead of the day of surgery. Any other medication should be taken the morning of surgery with a little water (half a cup maximum).
- You should not shave (or wax) skin near where any surgical incisions will be made.
- No solid foods (cow's milk and drinks containing cow's milk are considered food) should be consumed within 6 hours of surgery; clear fluids (e.g. water, cordial) may be consumed until 3 hours before surgery and then nil by mouth from that point.
- Please advise us if you have a cold or fever, a cough or any other injuries or infections (e.g. urinary tract infection or cuts/tears to the skin) – your procedure may need to be postponed as any of these may make anaesthesia or surgery unsafe.
- Please bring all imaging (e.g. x-rays / CT scans / MRI scans) with you to hospital.
- Please come to hospital at least one hour before your planned surgery, unless we advise you otherwise.
In very general terms make sure you follow a healthy and balanced diet before surgery and continue any regular physical activity up until the day of the procedure. If you smoke, you should ideally stop smoking at least four weeks before the procedure and otherwise as a minimum at least one week before.
There are four different surgical approaches to shoulder stabilisation:
Anterior Capsular Shift
Also called 'capsular shift surgery', this procedure – generally conducted using arthroscopic (minimally invasive) surgery - involves tightening the ligaments in the shoulder to achieve stabilisation of the shoulder joint. A 'T'-shaped incision is made to the shoulder joint capsule and then the edges are made to form an overlap and sutured into place. This has the effect of making the ligaments tighter. A similar approach, known as 'capsular shrinkage', also an arthroscopic technique, uses the application of heat to the ligaments to shrink the ligament fibres.
Also known as 'Bankart repair surgery', this approach is specifically to repair damage to the labrum, a section of cartilage in the joint which can develop tears called 'Bankart lesions'. During the procedure these lesions are 'debrided' (a process of removing the damaged edges of the labrum) or suture anchors are used to fix the labrum in place (where there are larger tears present). Labral repair can normally be completed arthroscopically, however large tears may need to be repaired using conventional surgical techniques.
Sometimes repeated dislocation of the shoulder can damage the bone of the socket itself. The Latarjet procedure is a bone graft, where a small section of bone from another bone in the shoulder is grafted into the damaged socket. Screws are used to fix the graft in place. This procedure can only be completed using conventional surgery.
Superior Labrum Anterior Posterior ('SLAP') Lesion Repair
In rare cases where the labrum has come completely away from the bone, this arthroscopic approach uses a suture anchor or a biodegradable tac to reattach the labrum to the bone.
After the procedure the ligaments and muscles in the shoulder are strengthened by following a rehabilitation physiotherapy program, which will also increase the range of motion of the joint over time.
Immediately after surgery the arm must be kept in a sling for 2-4 days. More details on the rehabilitation program will be given to you after surgery.
As with any surgery, there is always a risk of:
- Infection (of the incision site, or in the chest).
- Blood clot (leg or lung).
- Heart attack.
Some specific risks of a shoulder stabilisation surgery are:
- Temporary or permanent loss of some movement in the shoulder joint.
- Continued dislocations.
- Pain when lifting the arm above head height.
- Breakage of internal fixing components, which may require further surgery.