Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint. A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder. A partial dislocation is referred to as a subluxation whereas a complete separation is referred to as a dislocation. The repeated dislocation of the humerus out of its socket is called chronic shoulder instability. A tear in the labrum or rim fracture in the front of the glenoid (a Bankart lesion) may lead to repeated shoulder dislocations.
When conservative treatment options such as medications, rest, and ice application fail to relieve shoulder instability, your surgeon may recommend shoulder stabilization surgery.
Shoulder stabilization surgery is done to improve stability and function to the shoulder joint and prevent recurrent dislocations. There are several types of shoulder operations that stabilize the shoulder. The surgery may be done using an arthroscope or through an incision made in your skin depending on the type of injury you have and the type of surgery needed. Shoulder arthroscopy is a minimally invasive surgical technique that allows your surgeon to evaluate your shoulder and in some cases treat the cause of instability. During the procedure your surgeon will make small incisions in your shoulder called portals. A tiny camera is then placed in the portals and the interior space of the shoulder can be visualized. The following are among the other commonly performed surgeries.
Labral repair (Bankart repair)-
This procedure is performed to repair a tear to the labrum and is done by Dr Savadekar using the arthroscope. A labral tear is repaired using suture anchors and heavy suture to reattach the labrum to the socket.
Remplissage Procedure-
This procedure is another arthroscopic procedure done by Dr Savadekar sometimes in addition to Bankart repair procedure when there is deep impaction fracture on the ball (Hill Sachs lesion) due impact of socket rim.
Latarjet/Bone block procedure-
This procedure is done when there is bone loss from the socket due to repeated dislocations. It is also done by Dr Savadekar as an arthroscopic procedure. A small piece of bone is taken from another part of the shoulder and is placed into the worn away area of the shoulder socket. This is called a bone graft. It is attached using screws.
Capsular shift- this procedure is performed to tighten the joint capsule. A capsular shift is commonly performed using an arthroscope. In this procedure your surgeon tightens the capsule, including the ligaments that stabilize the shoulder. This is similar to when a tailor tucks loose fabric by overlapping and sewing the two parts. By tightening the ligaments, they are then able to perform their stabilizing function.
Following the procedure, your surgeon may advise the use of a continuous passive motion machine to prevent stiffness and improve range of motion of the shoulder joint. Pain medications will be prescribed to keep you comfortable. A shoulder sling can be worn for 4-6 weeks to immobilize and facilitate healing. Postoperative rehabilitation program including strengthening exercises will be advised for 6-9 months. You will be able to participate in sports in about 18 to 36 weeks after the surgery.
The major benefits of arthroscopic stabilization as compared to open repair of instability are that it gives a chance to identify and treat coexisting diseases, lesser pain and complications, combined with shorter hospital stay.
As with any surgical procedure, there may be certain risks and complications involved and include infection of the surgical wound, post-operative stiffness, risk of arthritis, muscle weakness and injury to the nerves and blood vessels.
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