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 rotator cuff and ligament tear in the front of the shoulder (a Bankart lesion) may lead to repeated shoulder dislocations.
When the 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. It can be performed arthroscopically, depending on your particular situation, with much smaller incisions. Arthroscopic stabilization is a surgical procedure to treat chronic instability of the shoulder joint.
Arthroscopy is a minimally invasive surgery and is performed through tiny incisions (portals), about half-inch in length made around the joint area. Through one of the incisions, an arthroscope (small fiber-optic viewing instrument) is passed. A television camera attached to the arthroscope displays the images of the inside of the joint on the television monitor, which allows your surgeon to look at the cartilage, ligaments and the rotator cuff while performing the procedure. A sterile saline solution is pumped into the joint which expands it and gives a clearer view to the surgeon. Bone spurs, defects or tissue tears will be identified.
Your surgeon makes use of tiny surgical instruments which are passed through the other incision to treat the condition. Any tear in the rotator cuff will be sutured or stapled. The sutures will be held in place with the help of a small anchor which is drilled into the upper part of the humerus. The labrum can be re-attached, and the capsule tightened to prevent instability.
Following the procedure, a shoulder sling can be worn for 4-6 weeks to immobilize and facilitate healing. Pain medications will be prescribed to keep you comfortable. A post-operative rehabilitation program including strengthening exercises will be advised for 6-9 months. You will be able to participate in sports in between 18 and 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.
Some unstable shoulders, particularly those with loss of bone from the glenoid (cup) are actually better treated with open surgery and bone transfer.
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.