If a shoulder dislocates, it can cause a permanent structural abnormality which may make your shoulder unstable. This is more likely to occur if you have experienced a traumatic dislocation and you are young (<40yrs old). Most shoulders dislocate anteriorly, which means your shoulder ‘pops out to the front’. More rarely this can happen posteriorly or ‘out to the back’. If your shoulder dislocates more than once it is likely to keep happening unless it is repaired, particularly if the cause is due to a structural problem within the shoulder.
Unstable shoulders are diagnosed by taking a detailed history of your symptoms including how it dislocated, where the pain is and what makes it worse. A thorough clinical examination is then performed, which involves finding out what movements reproduce your pain and whether you have any weakness. The nerves that control your shoulder will also be assessed. You will also have an X-ray taken to confirm the shape of your bones and to ensure that your shoulder did not suffer a fracture to the socket area when it dislocated.
Most patients will need further imaging (scans) to assess the structures that support the shoulder. Dye may be injected into your shoulder before the scan, which can be uncomfortable. The dye improves the quality of the scan to more accurately diagnose your problem.
Not all shoulders that dislocate become unstable. It is more likely that if your shoulder dislocated when you are young or if it happens more than once it will become unstable. This means that your shoulder feels like it may ‘pop out’ during certain activities like throwing a ball.
Physiotherapy can improve the control of your shoulder so that you don’t need an operation.
Even if your shoulder still feels unstable after a course of physiotherapy and surgery is still indicated, the physiotherapy will help your recovery after your operation.
If your shoulder continues to feel unstable and your scan shows a structural abnormality you will be offered surgery to repair the damage.
Firstly your shoulder will be assessed whilst you are under anaesthetic to check your range of movement and the stability of your shoulder.
Then through key-hole incisions your shoulder will be reassessed internally and the operation performed. Your damaged tissue and bone will be prepared. The tissue is secured to your bone using bone anchors. The different surgical procedures will be thoroughly discussed with you as they may change your post-operative rehabilitation.
Surgery is a successful method of treating patients with unstable shoulders. How well you do from surgery is affected by many factors including general health, age, extent of damage and quality of the tissue. Surgery will only be performed if your shoulder is unstable.
Some of the possible complications of arthroscopic stabilisation surgery are listed below:
Infection: Infection can complicate any surgery. It may be possible to treat this with antibiotics alone, but further surgery may be required, the chance of this happening is about 1%
Stiffness: Post-operative stiffness can occur. It is important that you work with the physiotherapist to try and avoid this.
Reoccurrence: Unfortunately a proportion of repairs fail if the tissue does not heal to the bone, the rate of recurrence is approximately 10%
Nerve and blood vessel injury: There is a very small risk of damage to nerves or blood vessels around the shoulder.
Cardiovascular problems such as heart attack and stroke, and also blood clot formation, can very occasionally be caused by anaesthesia and surgery. The anaesthetist will assess you and if there are any reasons why you would have an increased risk of these occurring, they will discuss this with you, and take steps to minimise the risks.
Arthroscopic stabilisation surgery can usually be undertaken as a day case. You may need to stay overnight if you are not operated on until late in the day, or if you have other medical illnesses that need monitoring after your operation.
Initially you will be required to wear a sling to protect your repair. You will be assessed by a physiotherapist on the ward who will ensure you are able to correctly undertake your post-operative exercises to maximize the benefit of the operation. You should continue these exercises as directed until you are assessed again by an outpatient physiotherapist within two weeks of your discharge.
Please keep the wounds dry to decrease the chance of infection. The wounds will be reviewed at your two week post-op out-patient clinic visit. The sutures will also be removed. Range of movement will also be assessed at this visit to ensure you have not developed any post-operative stiffness.
If you feel concerned or unwell after the operation you should seek medical attention via your GP.
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