Arthroscopic Shoulder Stabilisation

What is a Arthroscopic Shoulder Stabilisation?

The shoulder is a very mobile joint. It consists of a ball (from the long arm bone, the humerus) and a socket (formed out of the shoulder blade). Whilst it is able to move freely in every direction, this does make it vulnerable to ‘pop out of place’, or dislocate. In healthy shoulder joints, there are soft-tissue structures, such as ligaments, tendons and muscles, that help hold the ball inside the socket.

For various reasons, the soft tissue supporting structures of the shoulder can become damaged. This may be due to dislocating the shoulder (eg. on the football field), or it may be due to more long term damage. Once these structures are damaged, the shoulder is more likely to dislocate. (See shoulder instability).

An arthroscopic shoulder stabilisation is a procedure whereby small cuts are made around the shoulder in order to place a camera and specialised instruments inside the shoulder joint. Surgeons use these special instruments to tighten the shoulder joint, to make it less prone to dislocating in the future.

Who is this operation for?

This procedure is for people with:

Shoulder instability: This means that the shoulder is too loose and may pop out or dislocate even when performing normal tasks. In some cases, the shoulder is not loose enough to dislocate but may move too far and almost dislocate. This is known as a subluxation. An unstable shoulder is often very painful and more prone to wearing out.

Shoulder dislocation: If you have dislocated your shoulder you may have torn cartilage or ligaments surrounding the shoulder joint which will need to be repaired.

What are the benefits of the operation?

This operation aims to improve the pain for people suffering with shoulder instability. It should also improve the feeling of shoulder looseness that these people get.

Complications

The complication rate following shoulder stabilisation arthroscopy is very low. However like all surgery, there are risks that need to be considered when deciding to have shoulder stabilisation arthroscopy surgery.

Side effects
Side effects are symptoms that occur due to the surgery and are a normal part of the recovery from the operation. The main side effects of shoulder stabilisation arthroscopy are:

  • A sore shoulder which may last for several weeks after the operation.
  • Swelling of the shoulder which may last for several days.

Complications
Complications are problems that occur during or after the operation. Most people having knee arthroscopy surgery aren’t affected. There are some complications that may occur for any operation. These include:

  • A reaction to the anaesthetic
  • Infection of the wound or joint
  • Excessive blood loss
  • A blood clot, usually in a vein of the leg (known as a deep vein thrombosis or DVT)

Specific complications of shoulder stabilisation arthroscopy are very uncommon, but can include the following:

  • Shoulder stiffness: Occasionally you shoulder may be stiff after this operation. It is important to complete the physiotherapy exercises
  • Damage to nerves: This occurs very rarely in roughly 0.3% of cases.
  • Re-dislocation: After the operation, you shoulder may dislocate again. This is a rare complication occurring in roughly 0.4% of cases.

Before the operation

Preadmission Clinic | Preparing for Surgery

Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.

During the visit, you will be seen by a

  • doctor
  • nurse
  • anaesthetist (if necessary)

Tests

Tests that may be ordered for you include:

  • Blood tests
  • Xray of your Chest (if necessary)
  • ECG (if necessary)

Preparing Your Skin

Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.

Tip

Carry a list of your medications with you including the name, dosage and how often you take it.

Medications

Our doctors will advise you which medications you should stop or can continue taking before surgery.

Get some help from your friends and family

Whilst recovery from this operation is generally quite fast, you will not be able to use that arm very well during the healing process. You may wish to organise some help from family or friends in daily tasks, such as cooking and driving in the first week or so after the operation.

About the Operation

Admission

Most people are admitted to hospital on the day of their surgery. For a knee arthroscopy you can usually go home on the day of your surgery but some people will need to stay overnight.

Anaesthesia

The anaesthetic team will see you and decide the type of anaesthetic that’s best for you.

The different types of anaesthesia include:

  • General Anaesthetic. This type of anaesthetic puts you asleep during the whole procedure and a machine controls your breathing.
  • Spinal Anaesthetic. An injection is placed into your back to numb your hip and legs. You will be awake during the procedure, however a sedative can be given to you to help you doze off.
  • Nerve Blocks. This special injection is used to help with your pain after the operation and often used  in conjunction with a general anaesthetic.

The operation

The operation is done via keyhole surgery. This involves making several small cuts around the shoulder, to allow a camera and specialised instruments to be introduced into the joint. By doing this, the surgeon can inspect the soft tissue structures in and around the shoulder joint, in order to assess what needs to be done. 

The loose or torn soft tissues around the shoulder joint can then be tightened or reattached with the instruments. 

The small cuts are then stitched up with sutures and a dressing is placed over the wounds.

The whole operation usually takes 1 – 2 hours to complete.  

Recovery Room 

After the operation, you will be resting in the recovery room, where specially trained nurses will closely monitor you. This usually takes 1 to 2 hours. After which, you will be taken to your hospital room.

After the Operation

After the operation, you are cared for in the Theatre Recovery room. You will usually only spend 1-2 hours in the recovery room.

Most people wake up fully when back in their rooms on the ward. Whilst on the ward, the nurses will take care of your every need. It usually takes a few hours to recover fully from the anaesthetic, and the nurse with regularly check on your recovery. You may be required to stay 1 night in hospital.

You will need to go home with some pain relief to help with the pain for the first few days.

Recovery and Rehabilitation 

For the first 4-6 weeks after the operation, the arm needs to be in a sling to protect it from regular use. During this time, a physiotherapist can outline appropriate exercises that encourage increasing the range of motion of the shoulder. It is important to follow the advice of your surgeon and physiotherapist as your shoulder is vulnerable to re-injury in the first 6 weeks following the operation.

After 6 weeks, exercises that promote strengthening of the muscles around the shoulder are encouraged. Your physiotherapist will give you an exercise program in order to help build up the strength in the shoulder. 

It is important to complete the required physiotherapy exercises in order to get the best outcome after the operation. 

If you participate in competitive sport it may take 6 months to return to these activities.

F.A.Q.s | Frequently Asked Questions 

Are there important things I need to tell my doctors?

  • Redness, swelling or warmth around the cut 
  • Leakage from the cut 
  • Fever and chills. 
  • Severe pain that is not relieved by prescribed painkillers. 

References

  • Wall MS, Warren RF. Complications of shoulder instability surgery. Clin Sports Med. 1995 Oct;14(4):973-1000.
  • Cole BJ, Warner JJ. Arthroscopic versus open Bankart repair for traumatic anterior shoulder instability. Clin Sports Med. 2000 Jan;19(1):19-48.
  • Kang RW, Frank RM, Nho SJ, Ghodadra NS, Verma NN, Romeo AA, Provencher MT. Complications associated with anterior shoulder instability repair. Arthroscopy. 2009 Aug;25(8):909-20
  • Gilmore CJ, Ma R, Hogan MV, Thompson SR, Miller MD. What’s new in sports medicine. J Bone Joint Surg Am. 2013 Apr 17;95(8):756-66