Shoulder & Elbow : Shoulder Stabilisation

David Potter explains "What is a Shoulder Stabilisation?"

The shoulder joint is a ball and socket joint, which is held together by a combination of ligaments and muscles. There is also a rim of cartilage around the socket called the labrum. The labrum acts to deepen the socket to make the shoulder even more stable.

When a shoulder is dislocated, sometimes the rim of cartilage is pulled away from the socket damaging the labrum. This often does not heal and therefore the shoulder can remain unstable. Once your shoulder has been damaged in this way, you may find that your shoulder dislocates again fairly easily. This damage to the labrum is often called a ’Bankart lesion’; named after the doctor who first described this injury.

Sometimes, if enough force is present during a dislocation, a small part of bone from the shoulder socket (glenoid fossa) may break off with the labrum. This is often called a ’Bony Bankart lesion’.

Shoulder stabilisation surgery is an operation to repair the damage to the labrum and therefore re-stabilise the shoulder joint. This type of repair may also be called a Bankart repair or a Latarjet procedure by your surgeon.

What is a ’Bankart Repair’?

A ’Bankart repair’ is the name of the operation often used to repair the damage to the labrum.

What is a ’Latarjet procedure’?

If the bone has been damaged as well as the labrum (a Bony Bankart lesion), a small bone graft may be used to repair the socket - this is sometimes called a ’Latarjet procedure’. Often the small bone graft is taken from another part of your shoulder blade called the ’corocoid process’.

What is a ‘Hill Sachs Lesion’?

You may also be told by your doctor that you have sustained a Hill Sachs lesion following your dislocation. A Hill Sachs lesion is the term used to describe a compression fracture to the humeral head. As your shoulder dislocates, the humeral head is forced out of the shoulder socket (glenoid fossa) and as it does so it hits the hard edge of the socket. This can cause an indentation of the humeral head. If this indentation (Hill Sachs lesion) is fairly small, it may not cause you any problems. Occasionally a large Hill Sachs lesion may cause your shoulder to dislocate again, and if this happens your surgeon may recommend another procedure to correct this defect. This is sometimes called a Remplissage procedure.

What is a ‘Remplissage Procedure’?

’Remplissage’ is French for ’to fill in’. It is often done at the same time as a ’Bankart Repair’. The Hill Sachs lesion is ’filled in’ by stitching part of the rotator cuff muscle and shoulder capsule into the defect. This can then usually prevent further dislocations as the shape of the humeral head is restored to a more normal shape.

How are these operations carried out?

Shoulder stabilisation surgery is carried out under a general anaesthetic.

Repair work to the labrum (Bankart Repair) and the humeral head (Remplissage Procedure) is usually carried out as key-hole (arthroscopic) surgery. Very occasionally there are technical reasons why we cannot carry out the operation arthroscopically. In this case it will be done in the traditional way - called an open procedure.

A Latarjet procedure is usually carried out by an open procedure.

What are the benefits of having shoulder stabilisation surgery?

The aim of shoulder stabilisation surgery is to restore the stability of the shoulder joint and therefore reduce the chance of it dislocating again. It is normal to feel discomfort following the operation but this will usually settle as your wounds heal.

It can take up to three months for the repair to fully heal, and you may still be seeing improvements in your shoulder up to 12 months post surgery.

Are there any complications of having shoulder stabilisation surgery?

As with most types of surgery there are risks involved and complications can occur unrelated to the shoulder surgery. Some other complications, which can occur specifically following this type of shoulder surgery, are:

1. Re-dislocation
2. Infection
3. Ongoing pain and stiffness in the shoulder
4. Nerve damage

These risks are very small but if any occur, further treatment or an operation may be necessary.

1. Re-dislocation can occur if the repair fails. This can occur if high levels of activity are undertaken before the repair has healed fully - your physiotherapist or surgeon will guide you on when it is safe to start using your arm more. It may also occur if you have another injury to your arm.

2. Infection can be a serious complication. Some infections show up immediately whilst you are still in hospital, others are not apparent until you have gone home. If you are at particular risk your surgeon may recommend that you take antibiotics.

3. Ongoing pain and stiffness of your shoulder is possible especially if you do not continue with your individual home exercise plan. To minimise this risk you will be given exercises by a physiotherapist before you leave hospital

4. Nerve damage can occur as many of the large nerves and blood vessels that enter the arm pass close to the site of the operation; but it is very rare for any permanent damage to occur.

What will happen if I decide not to have surgery?

If you decide not to have this surgery, other treatment options are:

Physiotherapy: exercises can strengthen up your shoulder muscles to help improve the muscle control of your shoulder - you may have already tried this if you have reached the stage of discussing surgery.

Activity modification: changing the way you do activities or stopping activities which involve stretching your arm into end of range positions may reduce the number of times you dislocate.

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