Shoulder Instability Repair

Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint. A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder. A partial dislocation is referred to as a subluxation whereas a complete separation is referred to as a dislocation. The common symptoms of shoulder instability include pain with certain movements of the shoulder; popping or grinding sound may be heard or felt, swelling and bruising of the shoulder may be seen immediately following subluxation or dislocation. Visible deformity and loss of function of the shoulder occurs after subluxation or sensation changes such as numbness or even partial paralysis can occur below the dislocation as a result of pressure on nerves and blood vessels.

The risk factors that increase the chances of developing shoulder instability include:

• Injury or trauma to the shoulder
• Falling on an outstretched hand
• Repetitive overhead sports such as baseball, swimming, volleyball, or weightlifting
• Loose shoulder ligaments or an enlarged capsule

Surgical Repair

When conservative treatment options fail to relieve shoulder instability your orthopaedic surgeon may recommend Shoulder Stabilization surgery. The goal of Shoulder Stabilization surgery is to improve stability and function to the shoulder joint and prevent recurrent dislocations. Shoulder stabilization surgery has traditionally been performed as open surgery, with large incisions and a long recovery process.

Shoulder Stabilization surgery can now be performed arthroscopically, depending on your particular situation, with much smaller incisions.

Occasionally, however, arthroscopic surgery may need to be converted to open surgery to properly repair the damage to internal structures.

Arthroscopy is a surgical procedure in which an arthroscope, a small, soft, flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat a variety of conditions.

The benefits of arthroscopy compared to the alternative, open shoulder surgery, include:

• Smaller incisions
• Minimal soft tissue trauma
• Less pain
• Faster healing time
• Lower infection rate
• Less scarring
• Earlier mobilization
• Usually performed as outpatient day surgery

Procedure in Detail

Shoulder Stabilization surgery is performed in a hospital operating room under general anesthesia.

Your surgeon will perform shoulder arthroscopy to assess the shoulder joint and develop the surgical plan. The arthroscope is a small fiberoptic viewing instrument made up of a tiny lens, light source and video camera.

The surgical instruments used in arthroscopic surgery are very small (only 3 or 4 mm in diameter) but appear much larger when viewed through an arthroscope.

The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the shoulder joint at cartilage, ligaments, and bone. The surgeon can determine the amount or type of injury, and then repair or correct the problem as necessary.

The surgeon makes a few small incisions (about 1/4 of an inch), around the joint area. Each incision is called a portal. These incisions result in very small scars, which in many cases are unnoticeable.

In one portal, the arthroscope is inserted to view the shoulder joint. Along with the arthroscope, a sterile solution is pumped to the joint which expands the shoulder joint, giving the surgeon a clear view and room to work.

With the images from the arthroscope as a guide, the surgeon can look for any pathology or anomaly. The other portals are used for the insertion of surgical instruments. If your surgeon can stabilize the shoulder without reverting to an open, much larger incision, they will perform the necessary repair to the supporting structures.

This may involve repairing a tear in the labrum as well as tightening the capsule and ligaments. After stabilizing the shoulder, the portals (incisions) are closed by suturing or by tape.

Post-Operative Care

• You will wake up in the recovery room and then be transferred back to your hospital room
• Pain medication will be provided to keep you comfortable
• A bandage will be around the operated shoulder and your arm will be in a sling or brace. The sling will be worn for about 4-6 weeks to facilitate healing
• Your surgeon will see you prior to discharge and explain the findings of the operation and what was done during Surgery
• You can remove the bandage usually in 48 hours and place dressings provided by your surgeon over the area
• It is NORMAL for the shoulder to swell after the surgery. Placing Ice-Packs on the shoulder will help to reduce swelling. Apply ice packs to the area for 20 min 3-4 times a day until swelling has reduced
• You should keep a pillow under your elbow while lying in bed
• You will not be allowed to lift anything over your head or anything greater than 1-2 pounds for the first 6 weeks
• You will make an appointment with your surgeon 7-10 days after surgery to monitor your progress and have your sutures removed
• It is recommended that you not drive during the first 6 weeks while wearing a sling due to safety reasons and the risk of injury to the surgical site
• You will be given specific instructions regarding activity and a rehabilitation program of exercise and strengthening
• Eating a healthy diet and not smoking will promote healing

Risks and Complications

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or specific to Shoulder Resurfacing surgery. Medical complications include those of the anesthetic and your general well-being. Almost any medical condition can occur so this list is not complete.

Complications include:

• Allergic reactions to medications
• Blood loss requiring transfusion with its low risk of disease transmission
• Heart attacks, strokes, kidney failure, pneumonia, bladder infections
• Complications from nerve blocks such as infection or nerve damage

Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death.

Specific complications for Shoulder Stabilization surgery are rare but may include:

• Infection
• Shoulder stiffness
• Dislocations
• Damage to the nerves or blood vessels
• Damage to the joint
• Blood clots
• Hemarthrosis

Summary

A good knowledge of this procedure will make the stress of undertaking the procedure easier for you to bear. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery.