Dislocated shoulder stabilisation

Ouch! If you’ve ever experienced a dislocated shoulder, you know the intense pain and instability that comes with it. The shoulder joint, being the most mobile joint in the body, is unfortunately prone to dislocation – where the head of the upper arm bone (humerus) pops out of the shallow socket (glenoid) of the shoulder blade. While a first-time dislocation might be treated conservatively, recurrent dislocations often lead to chronic shoulder instability, significantly impacting daily life and activities. This is where dislocated shoulder stabilisation becomes crucial.

Stabilisation aims to restore the shoulder’s normal function and prevent future dislocations. This often involves shoulder stabilisation surgery, a procedure designed to repair the damaged structures within the shoulder joint. Understanding this process, from causes and diagnosis to surgical options and recovery, is key to making informed decisions about your shoulder health. Let’s dive into what dislocated shoulder stabilisation entails.

Understanding Shoulder Dislocation and Instability

A shoulder dislocation happens when the humerus forcefully separates from the glenoid. This typically occurs due to:

  • Trauma: A fall onto an outstretched arm, a direct blow to the shoulder (common in contact sports), or a sudden, forceful twisting motion.
  • Overuse: Repetitive overhead movements (like in swimming, tennis, or baseball) can gradually stretch the shoulder ligaments, leading to instability.
  • Loose Ligaments: Some individuals naturally have looser ligaments (joint hypermobility), making their joints, including the shoulder, more susceptible to dislocation even with minor force.

When a shoulder dislocates, several structures can be damaged:

  • Ligaments: These strong bands connect bones and provide stability. They often get stretched or torn during a dislocation.
  • Labrum: This rim of cartilage deepens the shoulder socket, enhancing stability. A common injury during dislocation is a tear in the labrum, often called a Bankart lesion.
  • Bones: In some cases, fractures of the humerus or glenoid can occur simultaneously. A Bony Bankart involves a fracture of the glenoid rim along with the labral tear.

Shoulder instability refers to the condition where the shoulder joint feels loose, slips partially out of place (subluxation), or dislocates repeatedly. Symptoms include:

  • Recurrent dislocations or subluxations.
  • A feeling of the shoulder “giving way” or feeling unstable.
  • Pain, especially during certain movements or activities.
  • Clicking, popping, or grinding sensations.
  • Reduced range of motion or apprehension about moving the arm in certain directions.

Diagnosing shoulder instability involves a thorough physical examination by an orthopaedic surgeon or specialist, reviewing your medical history, and imaging tests like X-rays (to check bone alignment and fractures) and MRI scans (to visualize soft tissues like ligaments and the labrum).

When is Dislocated Shoulder Stabilisation Necessary?

Not every dislocated shoulder requires surgery. For first-time dislocations without significant structural damage, non-surgical treatment is often the initial approach. This typically includes:

  1. Reduction: A doctor will carefully maneuver the humerus back into the socket.
  2. Immobilisation: Wearing a sling for a period (often 3-6 weeks, as suggested by sources like the Royal Orthopaedic Hospital NHS Foundation Trust and South Tees Hospitals NHS Foundation Trust resources) to allow initial healing and reduce pain.
  3. Pain Management: Using ice packs and pain relief medication.
  4. Physiotherapy: A structured rehabilitation program is crucial. A physiotherapist guides patients through exercises to gradually restore range of motion, strengthen the surrounding muscles (especially the rotator cuff), and improve shoulder stability.

However, shoulder stabilisation surgery is often recommended in cases of:

  • Recurrent shoulder instability: If the shoulder continues to dislocate or feel unstable despite physiotherapy.
  • Significant structural damage: Such as large Bankart tears, bony Bankart lesions, or significant ligament damage visible on MRI.
  • Young, active individuals: Especially athletes involved in high-risk sports, as they have a higher risk of re-dislocation after non-surgical treatment.
  • Failed conservative treatment: When physiotherapy and activity modification haven’t resolved the instability and symptoms.

The goal of surgical treatment is to repair the damaged structures, tighten the joint capsule, and restore stability to prevent further dislocations.

Surgical Options for Shoulder Stabilisation

The type of shoulder stabilisation surgery performed depends on the specific damage, the chronicity of the instability, patient factors (age, activity level), and the surgeon’s preference. Common procedures include:

  • Arthroscopic Bankart Repair: This is the most common stabilisation surgery, particularly for anterior shoulder instability caused by a Bankart lesion. Performed using keyhole surgery (arthroscopic shoulder stabilization), the surgeon inserts a tiny camera and instruments through small incisions. They reattach the torn labrum and tighten the stretched ligaments back to the glenoid rim using suture anchors. Benefits include smaller scars, potentially less pain, and faster initial recovery compared to open surgery.
  • Open Bankart Repair: Similar to the arthroscopic approach but performed through a larger incision. This might be chosen for complex tears, revision surgeries, or surgeon preference.
  • Latarjet Procedure (Bone Graft): This open procedure is often used for recurrent instability, especially when there is significant bone loss from the glenoid socket or if previous soft tissue repairs have failed. It involves transferring a piece of bone (the coracoid process) along with its attached tendons to the front of the glenoid socket. This bone graft provides a bony block, preventing the humeral head from dislocating forward, and the transferred tendons add dynamic stability. Resources like Nuffield Health and South Tees mention this procedure.
  • Capsular Shift/Plication: This procedure involves tightening the stretched joint capsule, often performed arthroscopically alongside a Bankart repair, to reduce overall joint laxity.
  • SLAP Lesion Repair: If the instability involves a tear of the superior labrum (where the biceps tendon attaches), a SLAP lesion repair might be performed, typically arthroscopically.

Your orthopaedic surgeon will discuss the most appropriate surgical procedure based on your individual diagnosis. Most shoulder stabilisation surgeries are performed under general anaesthetic, often combined with a nerve block for post-operative pain control.

Recovery and Rehabilitation After Stabilisation Surgery

Recovery after shoulder stabilisation surgery is a gradual process requiring commitment to a rehabilitation program. Here’s a general outline:

  • Immobilisation: You will wear a sling for several weeks (typically 3-6 weeks) to protect the repair and allow tissues to heal. Your surgeon will advise on when and how to remove the sling, usually only for specific exercises initially. Resources from South Tees Hospitals and ROH NHS Trust highlight this period.
  • Pain Management: Pain is expected after surgery. Your surgeon will prescribe pain medication, and nerve blocks administered during surgery provide initial relief. Using ice packs as directed can also help manage pain and swelling.
  • Physiotherapy: This is arguably the most critical part of recovery. You will work closely with a physiotherapist, starting with gentle passive and active-assisted range of motion exercises while still in the sling. As healing progresses, the program will focus on:
    • Regaining full range of motion.
    • Strengthening exercises for the rotator cuff and surrounding shoulder muscles.
    • Improving shoulder stability and control.
    • Gradual return to functional activities.
  • Returning to Activities: Timelines vary depending on the surgery type and individual progress:
    • Driving: Usually possible after coming out of the sling and regaining sufficient control (typically 6-8 weeks, check with your surgeon and insurance).
    • Work: Depends on job demands. Desk jobs might be possible sooner, while physically demanding roles require longer recovery (3-6 months).
    • Sports: Return to non-contact sports may start around 3-4 months, while contact sports or heavy overhead activities often require 6 months or more to allow full healing and strength recovery.

It’s crucial to follow your surgeon’s and physiotherapist’s instructions carefully to optimise healing and minimise the risk of complications like stiffness, re-injury, or nerve damage. Full recovery and return to peak performance can take 6-12 months.

Takeaway and Next Steps

Dislocated shoulder stabilisation is a vital treatment for individuals suffering from recurrent shoulder instability. While non-surgical treatment like physiotherapy can be effective for some, stabilisation surgery offers a reliable solution for repairing structural damage and preventing future dislocations, allowing a return to an active lifestyle. Procedures like arthroscopic Bankart repair and the Latarjet procedure are common surgical options tailored to individual needs.

Successful outcomes rely heavily on accurate diagnosis, appropriate surgical treatment, and dedicated adherence to a post-operative rehabilitation program.

If you are experiencing symptoms of shoulder instability or have suffered a dislocated shoulder, seeking expert medical advice is essential.

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