The shoulder joint is a ball and socket joint surrounded by supporting tissue - ligaments and muscles - which hold the joint in place.
Shoulder instability refers to conditions where the head of humerus (ball part of the upper arm bone) comes out of its socket completely (a shoulder “dislocation”) or partially (called a 'subluxation').
Most of shoulder dislocations are anterior (towards the front). Posterior (towards the back) are uncommon and usually encountered following seizures, electric shocks or some sports injuries.
Shoulder instability can be caused in a number of ways:
Injury or trauma
A severe fall involving a blow to the shoulder can result in dislocation. This is not an uncommon sports injury, particularly in sports such as rugby, skiing, snowboarding and skateboarding.
Any regular activity that involves the arms working overhead can result in ligaments around the shoulder loosening over time and a greater likelihood of shoulder instability. Some sports where the arms are held up a lot, such as swimming, basketball and water polo, can make players prone to shoulder instability (leading to pain or/and subluxation episodes)
Some people are naturally born with more flexible joints and looser ligaments, and some are 'double jointed'. This extra flexibility makes these people more prone to shoulder instability.
Dr Reddy performs most of shoulder stabilisation surgery arthroscopically (key-hole) using the latest evidence-based guidelines and techniques. But bony procedure like the Latarjet procedure would be indicated in some situations. Dr Reddy will discuss the same with you at the initial consultation.
Arthroscopic Anterior Stabilisation or Bankart repair surgery
The labrum is the medical name for a section of the cartilage in the shoulder joint along its rim. It can become damaged, sustaining small or large tears. These tears, referred to as 'Bankart lesions' can be repaired using suture anchors to fix the labrum to the socket.
As a part of the procedure, the capsule and ligamentous structures are incorporated in the repair, thereby tightening them.
Postoperative recovery and rehabilitation
Dr Reddy as well as the Physiotherapist will see you on day 1 following surgery and demonstrate exercises to be performed at home as well as advise on things to do and not to do.
It is important that you follow the advice and rehabilitation guidelines to give yourself the best chance of recovery and an optimal outcome.
- You would likely have a regional/nerve block for pain management apart from a general anaesthetic.
- You would usually stay in the hospital overnight.
- Please take regular pain medication as advised.
- Apply Ice packs 3-5 times, for 10 min each time for the first two weeks.
- You will need to wear the sling full time for 4 weeks, but remove it thrice daily for 15-20 minutes each time to perform exercises. Specifically avoid external rotation beyond neutral and active abduction for the first 6 weeks.
- Please remove the sling for a shower, resting your arm by the side. The dressings are waterproof.
- After 4 weeks – You can cease the use of sling. Progress with exercises as advised by your therapist.
- Strengthening exercises usually start only after 3 months following surgery.
- Avoid lifting weights and push-pull movements for 3 months following surgery. The goal is to gradually achieve normal range of movement and strength of the shoulder over a 3-month period.
- Driving is permitted only once you come out of the sling and have achieved good control of the arm and a pain-free status. This is usually by the 6-week postoperative period.
- Following an arthroscopic shoulder stabilisation, return to sport is discouraged till 6 months post-operatively.
- Please follow your therapist’s advice regarding exercises and follow the rehabilitation guidelines that you can view/download below.