Shoulder Instability – Arthroscopic / Open Stabilisation

Our shoulder surgeons at Schoen Clinic have many years of experience in treating shoulder instablility. Your shoulders are in the best hands with us.

Overview

The shoulder is a ball and socket joint. The socket of the shoulder is like a flat saucer, while the ball is a hemisphere. This arrangement of a shallow socket and a hemispherical ball allows for a large range of movement, but makes the joint prone to instability. To increase the stability of the joint without compromising the movement, the socket is deepened by the attachment of a cartilage along its circumference called the 'Labrum' which resembles a ring of gristle around the socket. Several ligaments are attached to the labrum and these together with muscles surrounding the joint enhance the shoulder stability. When the shoulder dislocates the ligaments can be torn or stretched and in some cases need to be repaired.

Causes & Symptoms

There are three main causes of shoulder instability:

  • Post-traumatic tear: of the labrum and the ligaments that occurs more often during an injury with the arm far from the body and in external rotation.
  • Atraumatic instability: this is often a combination of hypermobility of the tissues of the body that can be associated with an abnormal pattern of movement of the shoulder girdle.
  • Overuse syndrome: this is a condition often associated to overhead sports or works where the ligamentous structure are overstretched and overused for years, generating a  micro instability of the joint with symptoms of mechanical conflict of the soft tissues around the shoulder against the bony surfaces that surround it.

Diagnostics

The diagnosis is made from the history and findings at examination. The patient can present with pain or mechanical symptoms in the joint like recurrent dislocations. Special imaging study such as an MR-Arthrogram help in confirming the diagnosis, however, in the absence of findings on examination or MR, a diagnostic arthroscopy may sometimes be performed.

 

 

Treatment

The operation is done by 'keyhole surgery’ usually through two or three 5mm incisions. The operation involves repairing the over-stretched or torn ligaments deep around the shoulder joint. The repair involves stitching the torn or stretched ligaments back onto the attachment to the socket of the shoulder blade (Glenoid). This is done using tiny anchors with sutures attached to them. The repair should be protected until healing take place (four weeks for initial healing).

If keyhole surgery is not suitable, your surgeon may perform an open stabilisation. 

As with all surgery there is a risk of complications. These are rare, but you should be aware of them before your operation. They include:

 

•  Complications relating to the anaesthetic

•  Infection

•  Failure to achieve successful result with a further dislocation of the shoulder

•  A need to redo the surgery

•  Injury to the nerves or blood vessels around the shoulder

•  Fracture

•  Prolonged stiffness and or pain

•  Implant failure

Aftercare

You will usually be in hospital either for a day or overnight. The operation is performed under general anaesthetic and a nerve block in your neck or upper chest that will make your arm 'dead' for 8-12 hours after surgery. This is for post-operative pain relief. After this your shoulder may well be sore and you will be given painkillers to help this. Ice packs may also help reduce pain. Wrap crushed ice or frozen peas in a damp, cold cloth and place on the shoulder for up to 20 minutes.

You will return from theatre wearing a sling. Your arm will remain in a special sling for four weeks. This means that you will be unable to use your arm throughout this time and will be unable to return to work. You will not be allowed to drive for 5-6 weeks after surgery.

The shoulder must remain immobilised with a sling and a body belt for four weeks. You should remove the sling for exercises only.

Your consultant or physiotherapist will see you prior to discharge and you will be taught exercises to do and given further advice to guide you through your recovery.

For keyhole surgery, there may be no stitches (or only one absorbable stitch in the front wound) and only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5-7 days.

With open stabilisation there is an incision at the front of the armpit within the natural skin crease. The stitch is dissolvable but is usually removed at 2-3 weeks. The wound should be kept dry until it is well healed.

The length of time that you will be off work will depend on your job but expect a minimum of six weeks for active job.

Your physiotherapist and surgeon will advise you when it is safe to resume your leisure activities. However, you will NOT be able to return to contact sports before six months after surgery.

Treatments are available at the following locations

Schoen Clinic London

Our Address
Schoen Clinic
Orthopaedic and Spinal Hospital London
66 Wigmore Street
London W1U 2SB
General Telephone Enquiries
+44 (0)203 929 0801
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