The treatment of shoulder instability begins with a well-designed physical therapy program if the patient is above 25 years of age. The two major parts to stability of the shoulder are the muscles and the ligaments about the shoulder. If the ligaments have been weakened by injury, the muscles can be strengthened to replace them to some extent. This therapy only works for subluxation and does not have a role with recurrent dislocation.
If rehabilitation fails to stabilise your shoulder, surgery may be suggested. There are many different types of shoulder operations designed to stabilise the shoulder. Nearly all of these operations attempt to tighten the ligaments that are loose, usually the ligaments at the front of the shoulder.
Probably the most popular method for surgically stabilising the shoulder that dislocates anteriorly (out the front) is a procedure known as a Bankart repair. This procedure was developed based on the idea that the primary reason the shoulder is dislocating is that the ligaments in the front of the joint have been torn from their attachment on the front end of the socket (glenoid) of the shoulder joint. In this type of operation the ligaments and the labrum are anchored back into their original position, and allowed to heal so that the shoulder is once again stable.
While Bankart repair is sometimes done through an open incision at the front of the shoulder, most surgeons now prefer to perform a similar operation arthroscopically (key hole surgery).
Alternatively, a Capsular Shift may be performed. This involves tightening of the loose tissues at the front and underneath.
A Capsular Shift is often performed in combination with a Bankart repair because the tissues are both torn from the attachment, and stretched.
95% of people can expect no further dislocations. There is sometimes a slight (10%) reduction in the range of movement as a result of the operation.
There are risks involved with any surgery. The possible complications with regard to shoulder reconstruction include Infection, Scarring, Nerve damage and Stiffness. If surgery is to be recommended, Dr Duke will discuss these complications with you in full during the consultation.