Performed by – Ankit Desai, Gareth Hill, Philip Rosell

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 injury, often in sport. This can cause damage to the rim of the joint, which does not 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. This can help to guide the treatment and if surgery is indicated, what operation will be required.

Generally surgery is offered or considered after more than 2 or 3 dislocations but is recommended sometimes after just 1 dislocation if the damage is more severe. In addition, you are at a higher risk of re-dislocation if your first dislocation is at a young age and all these factors will be discussed to decide on a tailored management strategy for you.

In some patients the main problem is laxity of the joint rather than damage caused during the dislocation. 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.

Operative management
Stabilisation can be performed arthroscopically and involves fixing the rim of the joint and the torn or damaged tissues with sutures drilled into the bone and secured with anchors. These are devices like screws or pegs which lock into the bone to hold the sutures and tissues in place while they heal.

In some cases open surgery may be required. This is typically when there is more severe bone damage, and this can be discussed with you prior to surgery.

Open surgery is performed through a 5-10 cm incision on the front of the shoulder. A bone block is typically transferred from the front of the shoulder (the coracoid bone) to replace damaged bone at the front of the joint. This bone block will be held in place with screws. The torn labrum and capsule can also be repaired at the front of the joint to help stability.

Shoulder stabilisation procedures are routinely performed as a day case but occasional overnight stay may be required.

Post-operative management
After surgery your arm will be placed on a special sling, which holds your arm close to your body. You will need this for 4 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 4-6 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 12 weeks the repair is strong enough to allow strengthening exercises. These are continued until 6 months after surgery. Most sports can be restarted after 6 months but for revision procedures or certain high-risk sports this may need to be delayed further.

Success and complications
About 90% of people will have complete resolution of their symptoms and will be able to return to the sports that they were doing prior to surgery without further feelings of instability. 80% will return to the same level of sport or activity as before injury.

As with all surgery there is a risk of infection, but this is about 1% and can generally be treated with antibiotics. There is also a small risk of nerve injury and a 5% risk of developing a frozen shoulder after surgery which will leave the shoulder stiff and painful for up to a year, but it will resolve with time.