Shoulder Stabilisation for Dislocation
Shoulder stabilisation is a procedure intended to prevent further dislocations to your shoulder thereby preventing further damage to the joint.
You will usually be admitted on the day of surgery. The surgery will usually take place under general anaesthetic (asleep) with a nerve block for pain relief afterwards. The surgery takes between 30 and 90 minutes depending on whether you are having a key-hole (arthroscopic) stabilisation or an open operation.
During this operation we have a full look around the shoulder to diagnose the problem. Often there is damage at the front of the joint where your shoulder has previously been coming out of joint. In these cases we free up the scarring and repair the damaged structures (often capsule) back to the socket (glenoid) where is was torn off from. There a small chance that you either don’t have anything to repair back on to the socket or there is significant bone loss within the shoulder such that we can predict the operation will fail if carried out. In these cases you may require an open operation to prevent your shoulder from dislocation or a longer period of physiotherapy to balance your shoulder properly.
Some units around the UK are performing keyhole shoulder surgery with a nerve block ONLY and the patient awake meaning they can watch the surgery taking place on a TV monitor. We are currently in discussion within our unit whether this is a possibility – the obvious benefit is that you do not feel drowsy or sick afterwards and can be discharged very quickly.
Open stabilisation (Latarjet procedure or Sheffield Bone Block procedure)
Sometimes repeated dislocations have damaged the front of the shoulder socket and the back of the ball, leading to significant bone loss. The effect of this that as the shoulder is moved into certain positions the bone defects may touch each other dislocating the shoulder. The aim of open surgery is to address the bone loss at the front of the socket to prevent this. This can be done in one of two ways:
In the Latarjet procedure, we use a piece of bone from the shoulder blade called the coracoid which is attached to the front of the shoulder along with a tendon that attaches to it. This restores the bone and the tendon acts as a sling around the shoulder to prevent dislocation. In these cases, one can expect a slight loss (probably not noticeable to you) of external rotation of the shoulder. It is however a reliable procedure with good results in the literature.
In the Sheffield Bone Block procedure (developed by Mr David Potter), half the coracoid is used as the graft without the tendon attached. This restores the bone loss well and because the tendon is left attached to its original location and not moved, full range of movement including the extremes of external rotation can be expected (good for throwing athletes). It is a relatively new procedure, but the early results are hugely promising.
You will be placed into a shoulder immobilising sling after the surgery and the physiotherapists will tell you what you can and can’t do with your shoulder. Most people are discharged the same day following surgery, unless it is not safe to do so. It is common to have significant swelling because of the surgery and the wounds can leak for a few days afterwards as the swelling reduces.
After 3 days the bulky bandage can be removed / after one week the dressings can be removed. If you have any sutures that need removing we will tell you. In general, the sling is worn for around 3 weeks, full range of movement is achieved by around 3 months and you can return to sporting activities around six months. If you choose to return to sporting activities sooner your risk of dislocation is slightly higher.
Common risks include bleeding, infection, pain and stiffness in the shoulder.
Specific risks with this operation are
- Failure to prevent dislocation / recurrence (5-10%)
- Nerve injury (<1%)
- Further surgery required if re-dislocation
90-95% of those undergoing stabilisation do not have any further dislocations. That said around 15% of patients find they do not trust their shoulder as they used to before it dislocated. Most of these will require no further surgery but some may go on to require an open procedure to enable them to work or return to sports.
Mr Sam Vollans
Consultant Orthopaedic Surgeon
I graduated from the University of Leeds and completed my specialist training in Yorkshire. Following this, I undertook further training in both elective and trauma shoulder & elbow surgery within the UK and Europe with many renowned surgeons.
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