Shoulder
Shoulder Instability Surgery
The shoulder gives up stability in exchange for range of movement, and that is why it dislocates more often than any other joint. 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 needs 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 usually considered when:
- The shoulder has dislocated more than once
- It slips, or feels as if 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. This restores the bumper that keeps the ball centred.
If repeated dislocations have worn away a significant amount of bone from the front of the socket, a soft-tissue repair alone is likely to fail. Those shoulders need a bone-block procedure, most commonly a Latarjet, in which a piece of bone with its attached tendon is moved across to rebuild the front of the socket. A CT scan and the history of your dislocations decide which of the two you need.
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 step by step, 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 testing shows strength and control are 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 use will still feel unreliable.
Risks
The main risk is the shoulder dislocating again despite surgery. That risk is much higher if there was significant bone loss and only the soft tissue was repaired. Some permanent loss of external rotation is common after stabilisation, and it 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 is likely enough to dislocate again that early repair is worth discussing. An older patient with a first dislocation is generally treated without surgery, and the rotator cuff is 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, at six to nine months, once strength and control testing allow it. Going back 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. A CT scan settles this.
Not sure this is your problem?
These pages start from the symptom. They cover what else can cause it and what is usually tried first.
Not sure whether you need this?
Ask it at a consultation, and bring your imaging and any plan you have already been given. Second opinions on surgery advised elsewhere are routine. He sees patients by appointment only, in Kharar, Mohali, and on set days each month in Solan.