Shoulder
Shoulder Instability Surgery
The shoulder trades stability for range of movement, which is why it is the joint most likely to dislocate. After a first dislocation the structures that hold it in place, the labrum and the capsule, are often left stretched or torn, and the shoulder keeps slipping out. Surgery repairs them.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
Who tends to need it
Age at the first dislocation is the strongest predictor of what happens next. A shoulder that first dislocates in the late teens or early twenties has a high chance of dislocating again; one that first dislocates in the fifties usually does not, and is more likely to have torn the rotator cuff instead.
Surgery is generally considered when:
- The shoulder has dislocated more than once
- It slips or feels like it is about to during ordinary movements
- You have started avoiding positions such as reaching back, throwing, or sleeping on that side
- A first dislocation happened young, in a contact sport, with imaging showing a clear labral tear
- There is bone loss from the socket or the ball from repeated episodes
What the operation involves
For most patients this is an arthroscopic labral repair, called a Bankart repair. Through keyhole incisions, the torn labrum is reattached to the rim of the socket with anchors and the stretched capsule is tightened, restoring the bumper that keeps the ball centred.
Where repeated dislocations have worn away a significant amount of bone from the front of the socket, a soft-tissue repair alone tends to fail. Those shoulders need a bone-block procedure, most commonly a Latarjet, which transfers a piece of bone with its attached tendon to rebuild the front of the socket. Which of the two you need is decided from a CT scan and the history, not from preference.
Acute injuries with an associated fracture may instead need open reduction and plating, the shoulder is stabilised by fixing the broken bone.
Recovery and return to sport
- Week 0 to 4. Sling, with gentle movement out of it as directed. Avoiding the position that dislocates the shoulder, usually arm out and rotated back.
- Week 4 to 12. Range of movement restored progressively, then strengthening of the cuff and the shoulder blade muscles.
- Month 3 to 6. Sport-specific work, throwing progressions where relevant.
- Month 6 to 9. Return to contact and overhead sport, once strength and control are demonstrably back.
Rebuilding control of the shoulder blade matters as much as the repair itself. A shoulder that is stable on the operating table but poorly controlled in the air will still feel unreliable.
Risks worth knowing about
Recurrent dislocation despite surgery is the main risk, and it is much higher if significant bone loss was present and only the soft tissue was repaired. Some permanent loss of external rotation is common after stabilisation and is usually a fair trade for a shoulder that stays in place. Stiffness, infection, nerve injury and problems with the anchors or transferred bone are less common.
Common questions
Should a first dislocation be operated on?
Not usually, but sometimes. A young patient in a contact sport with a clear labral tear on imaging has a high enough chance of it happening again that early repair is worth discussing. An older patient having a first dislocation is generally treated without surgery, with the rotator cuff checked.
Will I lose movement afterwards?
Some external rotation, often. Most people do not notice it in daily life; a competitive thrower might. It is discussed beforehand because it affects which procedure suits you.
Can I go back to contact sport?
Usually yes, generally at six to nine months once strength and control testing allow. Returning early is the most common reason for a repair to fail.
What is bone loss and why does it change the plan?
Repeated dislocations can grind away the front rim of the socket. Past roughly a fifth of it, a soft-tissue repair has nothing solid to anchor against and fails at a high rate, so the socket has to be rebuilt with bone instead. A CT scan is what settles this.
Not sure whether you need this?
That is the right question to bring to a consultation. Second opinions on surgery already advised elsewhere are a routine part of the practice. Bring your imaging and any plan you have been given.
Not sure this is your problem?
These start from the symptom rather than the operation, and cover what else can cause it and what gets tried first.