What is Shoulder Stabilisation?
Shoulder Stabilisation is a surgical procedure designed to restore stability to the shoulder joint. Shoulder stabilisation surgery is also commonly referred to as a Shoulder Reconstruction. It is a surgery that may be required to address the ongoing or recurring instability symptoms that commonly follow a traumatic subluxation or dislocation of the shoulder joint. It may also be required on occasions to resolve troublesome instability symptoms due to inherent ligament laxity.
Indications for Shoulder Stabilisation
The need for a shoulder stabilisation surgery is not always clear cut. Many factors need to be weighed up in reaching an informed decision. Factors to be considered include:
How unstable is the shoulder?
Minor cases of shoulder instability may cause a slight sense of apprehension when taking the shoulder in to vulnerable positions. Other may experience a definite sense of the shoulder slipping with some activities ranging from minor subluxation through to complete dislocation requiring reduction of the shoulder at hospital.
How often is the shoulder unstable?
Even if there is evidence of ligament tearing it is not always predictable as to whether the shoulder will continue to be unstable and if so, how much and how often. There may be a series of instability episodes within a short space of time. This makes the case for a surgery stronger. Yet at other times the shoulder might reveal its vulnerability only occasionally, perhaps as infrequently as every few years. This phenomenon may relate to lifestyle issues or luck. Infrequent episodes do make it more difficult for patients to commit to a surgery when in between the instability incidents they have little trouble with their shoulder.
How readily is the shoulder unstable?
Some patients might only have occasional recurrent instability but with a definite trigger for the instability such as making a sudden, extreme shoulder movement. Others might have the shoulder dislocate as readily as rolling over in bed or sneezing resulting in a trip to hospital for the joint to be relocated.
Age, sporting pursuits, leisure activities, occupational demands and handedness need to be evaluated.
The initial dislocation may fracture the bony edge of the glenoid. The bone fragment may be of sufficient size to make the shoulder inherently unstable. This is a situation that requires a reconstruction as a matter of relative urgency. Investigations such as an MRI Scan may have demonstrated a very extensive detachment of the glenoid labrum from the front of the bony glenoid. This is termed a Bankart Lesion . This type of tearing does not in itself make recurring instability a certainty. But the risk is higher and thus the case for surgery stronger.
Labral Tear / Bankart Lesion
Glenoid Rim Fracture
Shoulder Stabilisation Surgery
The goal of shoulder stabilisation surgery is to address the underlying structural issue that is causing the shoulder to subluxate or dislocate. Stabilisation or reconstruction are generic terms that refer to this principle. Thorough pre-operative evaluation of the instability will help to plan the most effective surgical strategy to stabilise the shoulder joint.
If the capsule and labrum have torn away from the glenoid then these structures need to be repaired and tightened. This can be achieved by using soft tissue anchors and sutures to repair the torn capsule and labrum back to the glenoid rim. This type of reconstruction is called a Bankart Repair.
If the glenoid rim has broken away it may need fixation back to its correct position. If the bony rim of the glenoid cannot be repair a bone graft may need to be fixed to the front of the glenoid to prevent the ball falling over the edge of the socket. An example of this type of surgical reconstruction is called a Latarjet Procedure.
If the capsule is stretched and excessively lax it may need to be tightened. Imagine this as a “double breasting” of the loose capsule. This type of reconstruction is referred to as a Capsulorrhaphy.
Arthroscopic or Open Shoulder Stabilisation?
Although an arthroscopic reconstruction using multiple small incisions rather than a single larger incision seems a lesser surgery, the repaired tissue must heal and repair through a biologic process that the surgery technique in itself cannot hasten. The rehabilitation process after surgery can be just as important. Regardless of the precise technique recommended by your surgeon the goal is always the same. The point of the surgery is to regain shoulder stability and to return as close to normal shoulder function and lifestyle as possible. Mr Lyons believes that in his experience over many years that an open surgical stabilisation allows him to confidently produce a stable shoulder.
Postoperative Care for Shoulder Stabilisation
When Mr Lyons performs a surgical stabilisation you will need to be in hospital for approximately two days. During this time the surgery pain will start to ease. His physiotherapist will show you how to start some very gentle exercises in order to minimise shoulder stiffness. You will be advised to use a sling when up and about and especially if outdoors or travelling in a car. This will be required for 3 weeks following your surgery. It is recommended that you do not drive during these 3 weeks and certainly not drive while wearing a sling. When you leave hospital you will have band-aid type strips on the surgical wound. You will be able to get these wet briefly in the shower and pat them dry afterwards.
The dressing will not need replacing after you go home.
You will meet with Mr Lyons at his office about 2 to 3 weeks after surgery. Stitches will be removed. He will then encourage you to ease your arm out of the sling for light below shoulder level tasks as any soreness allows. You will then continue your home based exercises.
A further consultation will take place about 6 weeks after surgery. This is usually about the time that he usually recommends commencing supervised physiotherapy. You may have a preferred physio. Mr Lyons will give them written guidance concerning your rehab program. If you do not have a preferred physio he will be able to recommend someone. The shoulder will feel quite stiff at this point. So the primary focus will be on gentle stretching to restore mobility. This will be followed by muscle strengthening exercises to restore muscle bulk around your shoulder.
Although your shoulder is likely to feel comfortable, stable, and strong at about the 3 month mark after surgery, it is recommended that you avoid contact type sport or activities for to 6 months from the time of surgery. No matter how good your shoulder feels it takes the repaired tissue as long as 6 months to reach peak strength and maturity. No amount of rehab can hasten that biological maturing process.
Risks and Complications of Shoulder Stabilisation
All surgical procedure carries some risk with respect to the need for a general anaesthetic. Risks specific to the shoulder surgery include the potential for infection, nerve and blood vessel injury, shoulder stiffness and muscle weakness. A shoulder that has suffered multiple dislocations prior to shoulder stabilisation surgery may be at risk of arthritis in later life regardless of the surgery having stabilised the joint. It would be unusual for a surgery not to achieve joint stability. However patients need to be mindful that if they return to contact sports after a successful reconstruction, new injuries can occur. Returning to such sports is a calculated personal decision.