As the joint with the greatest range of motion in the body, the shoulder is particularly prone to dislocation and instability, which can lead to pain, weakness and anxiety about further dislocations of the shoulder. Stabilisation surgery is used to repair damage to tissues and ligaments and restore stability to the shoulder.
What does shoulder stabilisation surgery involve?
Arthroscopic shoulder stabilisation surgery – This is a keyhole surgery using an arthroscope, which is a tube-like instrument with a camera at one end. Small incisions of around a centimetre are made in the shoulder and the arthroscope is inserted so the orthopaedic surgeon can see inside the shoulder joint. Saline is passed into the shoulder to provide a clearer view and one to two further incisions are made through which miniature surgical instruments are inserted. The camera on the arthroscope allows the surgeon to monitor the surgical procedure on a video screen. Your surgeon can then perform the necessary surgery to repair the damaged tissue in your shoulder. The incisions are closed with sutures. The procedures will help prevent further dislocations and restore a feeling of stability to the shoulder. You will need to wear a sling while the shoulder heals and comply with a physiotherapy rehabilitation programme.
Procedures commonly performed include:
Arthroscopic surgery allows surgeons to perform surgical repairs that would have been impossible to see using traditional open surgery. The glenoid labrum is the fibrous rim of tissue that surrounds the shoulder socket, helping to stabilise the shoulder joint. It helps the humerus (upper arm bone) to fit more securely into the socket and several ligaments are attached to it. It can become torn as a result of injuries. Symptoms of a torn glenoid labrum are similar to other shoulder injuries and include pain, loss of strength and motion, locking or catching, a feeling of instability and being increasingly prone to dislocation. Using an arthroscope, the surgeon will examine the rim of the glenoid and adjacent labrum. If the labrum is torn it will be anchored back to the rim of the glenoid socket.
A bony Bankart lesion is an injury to the bone of the glenoid resulting in it being broken away from the rest of the socket and the labrum torn away with it. Bankart repair is an arthroscopic surgical procedure to reattach the injured bone and labrum to the rest of the socket. Sutures are used to reattach the bone and labrum to their anatomical position.
SLAP stands for Superior Labrum from Anterior to Posterior. A SLAP tear is an injury to the labrum where the biceps tendon attaches. This area has a poor blood supply, so tears may not heal well. Symptoms include a pain deep inside the shoulder or at the back of the shoulder joint and a catching sensation when you are using your arms above your head, for example when throwing. A SLAP tear may occur on its own or with tendonitis of the bicep. A SLAP tear can be the result of repetitive overhead actions, such as throwing, lifting heavy objects or falling onto an outstretched hand. It can be difficult to diagnose as it may not show up on an MRI scan so the consultant may suggest injecting a contrast dye which will help to highlight tears in the normal structure. Non-surgical treatments, such as anti-inflammatories, physiotherapy and pain-relieving injections may be recommended at first but if these do not provide relief, you will be offered arthroscopic surgery to repair the SLAP tear. Surgical options include:
- SLAP repair: An arthroscope is inserted into a small incision on your shoulder so your surgeon can see inside the joint. Miniature surgical instruments, inserted through another incision, are used to reattach the torn labrum to the shoulder socket using suture anchors. The anchors are attached to the bone and the sutures are wrapped around the labrum and tied to the bone.
- Biceps tenodesis: If you also have biceps tendonitis, the biceps tendon will be cut from the labrum and reattached in a different area. The idea is to decrease the forces pulling on the SLAP region to alleviate symptoms. This procedure is called biceps tenodesis.
Shoulder stabilisation surgery
You might need shoulder stabilisation surgery if you have damaged your shoulder joint as a result of:
- Falling onto an outstretched arm or impact to the shoulder
- Trying to lift something very heavy
- Reaching overhead suddenly and violently
- Glenoid labrum repair: You will need to wear a sling for three to six weeks. During that time you surgeon will recommend gentle exercises to increase the range of motion in your shoulder. Once your sling is removed you will need to do other shoulder strengthening exercises. It will be around four to six months before your shoulder is fully healed.
- Bony Bankart repair: You may not recover full use of your shoulder for several months after surgery, but you will see a gradual improvement in pain levels and movement. You will need to follow a programme of gentle exercises to restore movement and strength to the shoulder. You should avoid lifting anything heavier than a cup of coffee or using the arm for any kind of forceful movement for six to twelve weeks after surgery. Gentle stretching is recommended on an ongoing basis.
- SLAP repair: You will need to wear a sling after surgery for two to four weeks, during which time you will be given gentle exercises to increase the range of movement in your shoulder. After four to six weeks you will begin a programme of strengthening exercises. Normally you can resume using your arms above your head three to four months after surgery.
Arthroscopic shoulder stabilisation is a commonly performed, safe and effective procedure that can help to prevent recurrent shoulder instability, alleviate pain and restore lost shoulder function. Using modern suture anchors, more than 90% of patients who have SLAP repair surgery have a good outcome and more than 85% can return to competitive activities.