The shoulder is the most mobile joint in the body and enables us to position our hands effectively in space. This ball and relatively small and shallow socket joint (similar to a golf ball on a golf tee) is unfortunately prone to dislocation and relies heavily on the intact ligaments, capsule and tendons around it to remain enlocated. Shoulder dislocation is a common sporting injury and once it has occurred can unfortunately have long lasting implications.
The vast majority of first episode dislocations occur with a major injury (collision sports, motor vehicle accidents) however once a dislocation has occurred, the affected shoulder is left prone to subsequent dislocation episodes in the future. What has been clearly demonstrated is the clear relationship between a patient’s age at the time of the first dislocation and the risk of subsequent shoulder instability. The younger a patient is at the time of dislocation, the higher the chance of problematic subsequent dislocations – in fact, for dislocations occurring in patients under the age of 20, the risk of ongoing instability is up to 90%.
The first priority in treatment of shoulder dislocations is the relocate the shoulder, also called a closed reduction. This will give immediate relief from pain and relive pressure on neighbouring structures such as nerves and blood vessels. Once your shoulder is enlocated you will usually be placed into a sling to give the shoulder some rest, you will however be able to start some gentle exercises to get the shoulder moving again once it is comfortable to do so.
Referral to a specialist shoulder surgeon is important so that your shoulder injury can be comprehensively assessed, and a treatment plan discussed. Investigation may include an MRI scan to evaluate the ligamentous damage around the shoulder or a CT scan if injury to the bone damage of the shoulder joint is suspected. Your individual treatment plan will depend on the extent of injury and your risk of recurrent shoulder instability.
Surgery for Shoulder Instability
Surgical treatment for shoulder instability can address the soft tissue and ligamentous elements around the shoulder or bone loss due to recurrent shoulder dislocation.
The most common procedure performed to stabilise a shoulder joint is a repair of the labrum and ligaments at the front of the shoulder back onto the rim of the glenoid (shoulder socket). This is known as a Bankart repair and can be performed either as an open procedure or arthroscopically. The arthroscopic (key-hole) technique has evolved considerably over the last decade to become the modern gold standard of repair and avoids having to operate through or around the rotator cuff muscles and tendons.
In more severe cases where there is associated bone loss of either the humeral head or glenoid or in cases of dislocation despite a soft tissue reconstruction a bone transfer procedure may be recommended. This procedure, known as the Latarjet procedure, involves transferring a section of bone onto the front of the shoudler socket to replace missing bone and increase the restraints to recurrent dislocation.
Recovery after shoulder stabilisation surgery is a delicate balance of protecting the reconstruction to allow healing but also maintaining shoulder movement to prevent stiffness. Your arm will usually be placed in a sling for four to six weeks with instructions given regarding some gentle exercises that should be performed during this time. Rehabilitation will then progressively focus on regaling movement and then strength and condition in the shoulder. Return to manual labour or contact sports is usually 4-6 months following surgery.