Shoulder Instability

The shoulder is the most commonly dislocated joint in the body. Some people develop recurrent problems with either repeated dislocations or the feeling that the shoulder is about to dislocate. This commonly occurs in people in their late teens or early twenties and may also cause pain in the shoulder.

The initial dislocation is usually related to an accident, commonly in sport, and causes damage to the rim of the joint, which does heal properly and leads to a long-term weakness. Physiotherapy may make the shoulder more stable but may not prevent further dislocation. If the symptoms interfere with everyday activities or sport reconstructive surgery can be indicated.

Prior to reconstructive surgery an MRI scan may be carried out, but commonly surgeons will recommend arthroscopy to determine how unstable the joint is and whether there is any damage to the joint. Stabilisation can be performed under the same anaesthetic as the arthroscopy.

Operative management

Stabilisation can be performed arthroscopically and involves fixing the rim of the joint with absorbable tacks. But for more unstable shoulders open surgery is required.

Open surgery is performed through a 5-10 cm incision on the front of the shoulder and the rim can be reattached as well as tightening the loose tissue at the front of the joint, which has been stretched by the recurrent dislocations.

Arthroscopic stabilisation can be performed as a day case or overnight stay, whereas open surgery will require a 1-2 night stay in hospital.

After surgery your arm will be placed on a special sling, which holds your arm close to your body. You will need this for 6 weeks.

Post Operative Management

You will need to wear a sling for up to 6 weeks, during this time you will not be able to lift, drive or perform any activities that may damage the repair. However you will be able to start to move your arm under the supervision of a physiotherapist.

After 6 weeks you will be able to discard the sling and start to regain movement in your shoulder, avoiding strengthening exercises as the repair is not strong enough at this stage.

After 6 weeks the repair is strong enough to allow strengthening exercises. These are continued until 12 weeks after surgery.

Most sports can be restarted after 6 months, but contact sports, such as rugby and motocross, should be avoided for 12 months after surgery.

Success and Complications

About 90-95% of people with damage to the rim of the joint will have complete resolution of their symptoms and will be able to return to sports at their previous level. Failure is related to amount of damage to the joint detected at the time of surgery. As with all surgery there is a risk of infection, but this is about 1% and can generally be treated with antibiotics.

In some patients the main problem is laxity of the joint rather than damage to the rim. Although an operation may be indicated the success rate is lower.

In a few patients the problem is related to abnormal muscle activity. This is not suitable for surgery but is treated by specialised physiotherapy.

Clare Park Hospital | Crondall Lane | Crondall | Farnham | Surrey | GU10 5XX

© Joint Reaction 2008