Shoulder Stabilisation Surgery

What is shoulder instability?

The shoulder joint is a ball-and-socket joint that allows for a wide range of motion, but this mobility also makes it more prone to instability compared to other joints. A shoulder dislocation is when your shoulder joint comes out of its socket. A shoulder subluxation is when your shoulder joint comes out partially out of its socket and usually pops back in.
After a shoulder dislocation, the structures that hold the shoulder joint together may become stretched, weakened or damaged. Shoulder dislocation and instability are frequently used interchangeably. After a shoulder dislocation your shoulder may feel unstable, in that certain movements of your shoulder can make your shoulder not feel quite right and give you a sense of wanting to dislocate again. There are two main types of shoulder instability:

1. Traumatic Instability: The most common reason for a shoulder to dislocation is from trauma or an injury. The exact mechanism can vary, but usually results from your shoulder being rotated outwards (external rotation) and moved away from your body (abduction). It can occur during sports, after a fall or while lifting an objected above your head. This will result in your shoulder dislocating anteriorly (at the front of the socket). Your shoulder can also dislocate posteriorly (at the back of the socket). This is much less common. Posterior dislocation frequently results from your shoulder being forced backwards, such as during a footy tackle.
2. Atraumatic Instability: You shoulder may also dislocate without an injury and is also known as voluntary or multi-directional instability. It typically associated with inherent loose ligaments leading to unstable joints (hypermobility). Patients with atraumatic instability may frequently experience a sense of shoulder instability during normal day-to-day movements or activities. Other joints of your body may also be affected by this.

What does shoulder instability feel like?

After a shoulder dislocation, your shoulder will feel painful and swollen. This will settle over 1-2 weeks with rest, immobilisation using a sling and icing of your shoulder.  Other symptoms you may feel include:

• Recurrent episodes of shoulder dislocation or subluxation, where the shoulder feels like it slips out of place and then comes back to its normal position. You shoulder may not necessary dislocation, but you may have a feeling “looseness” or a sense of your shoulder wanting to dislocation in certain positions.
• Pain and discomfort in the shoulder, especially during movements or activities that involve overhead motion or stress on the shoulder joint. This may be due to a tear within your shoulder. If you had a dislocation a while ago, the pain may only be subtle and is frequently at the back of your shoulder.
• Your shoulder may have limited range of motion or a feeling of stiffness. This usually starts to resolve 1-2 weeks after your dislocation.
• You may also experience muscle weakness or imbalance around the shoulder joint. Your shoulder blade may feel like it is sitting out of position, particularly when moving your arm above your head.

Can surgery fix shoulder instability?

When is surgery needed after a shoulder dislocation needed? Not all patients need surgery after a shoulder dislocation. In fact, most patient will be able to have a largely normal shoulder with a dedicated rehabilitation program. In some cases, however, surgery may be needed. This can be the case if you have recurrent instability. Recurrent instability is when your shoulder dislocates despite maximal non-operative treatment. Recurrent instability can be present without your shoulder completely dislocating. Sometimes, you may find that you simply cannot do certain tasks anymore, you cannot return back to your chosen sport or you have persistent shoulder pain. Sometimes, your shoulder may just not quite “feel right”. If that is the case, it is best to get your shoulder properly assessed.

The aim of surgery is to repair any damaged cartilage (labrum) inside your shoulder so that you can return back to what you love doing.  The specific surgery depends on various factors, such as the underlying cause of instability, whether you have associated cartilage or bone damage and your specific functional needs.

What surgery can be done for shoulder instability?

Below are some common surgical options for shoulder instability:

• Arthroscopic (keyhole) Stabilisation: Shoulder arthroscopy is a minimally invasive surgery using small incisions. Through those incisions a specialised camera (arthroscope) and surgical instruments are used to view and to repair any damaged  cartilage (labrum) inside your shoulder. The cartilage is repaired back to bone using strong bone anchors. The anchors have several sutures inside them which are used to tie down the cartilage and to compress it against your bone, allowing it to heal.
• Open Stabilisation: Open stabilisation surgery involves making a larger incision at the front of your shoulder to directly view the shoulder joint. It may be needed in cases where there is extensive cartilage damage, bone loss, or when additional tightening of your shoulder joint is necessary.
• Latarjet Procedure: The Latarjet procedure is another open procedure. It is done in cases of recurrent anterior shoulder instability with significant bone loss of the glenoid (shoulder socket). It involves transferring a piece of bone, along with the attached tendons, from the shoulder blade (scapula) to the front of the glenoid (shoulder socket), providing stability and filling in the bone defect.