The shoulder is a ball-and-socket joint. The ball is the head of the upper arm bone (humeral head). The end of the scapula (glenoid) meets the humeral head to form a shallow and flat cavity. It is rimmed with soft tissue called the labrum, which makes a deeper socket that molds to fit the humeral head. Ligaments, strong tendons, and muscles contribute to shoulder stability.
When the ‘ball” (head of the upper arm bone) is forced out of the shoulder socket, typically due to a sudden injury such as a fall or accident, the structures surrounding the shoulder joint become stretched and can tear. Once the ligaments and surrounding tissues are torn, the shoulder becomes more prone to slipping out of place. If the tissues are persistently unable to keep the humeral head centered in the socket, this is known as chronic shoulder instability.
Some people have loose ligaments in the shoulder due to hyperlaxity or playing sports that require repetitive overhead motion. Shoulder instability may involve the front of the shoulder (anterior instability) or the back of the shoulder (posterior instability). If genetic or acquired looseness affects the shoulder in more than one direction, it is called multi-directional instability.
When nonoperative approaches such as physical rehabilitation are unsuccessful and instability continues, surgical correction may be indicated.
What is Shoulder Stabilization Surgery?
Surgery to stabilize the shoulder may be recommended to patients who have chronic shoulder instability. It may also be recommended to patients who have had a shoulder dislocation and are at risk of repeating the injury, such as professional sports players.
There are several different types of shoulder surgery that stabilize the shoulder. Depending on your injury and the type of surgery necessary, the surgery may be done using an arthroscope or through open stabilization surgery, which requires a larger incision.
Shoulder arthroscopy uses small incisions (portals) that allow the surgeon to insert a tiny camera (arthroscope) into the shoulder joint. It is minimally invasive and allows your surgeon to evaluate and, in some cases, treat the cause of instability.
Types of Shoulder Stabilization Surgery
The following are some of the more commonly performed types of shoulder stabilization surgeries.
This procedure most commonly uses an arthroscope to tighten the joint capsule and ligamentous tissue to reduce the “looseness” or size of the capsule. The surgeon takes “tucks” in the capsule, like the way a tailor tucks in loose fabric and sews the overlapping fabric together. By tightening the joint capsule and ligaments, they are once again able to perform their stabilizing function.
Labral repair (Bankart repair)
This procedure repairs tears to the ring of cartilage attached to the rim of your shoulder socket (labrum). It is commonly performed using an arthroscope. Arthroscopic labral repairs can be performed at both the front of the shoulder (anterior instability) and back of the shoulder (posterior instability), as necessary.
If the tear is small yet the edge is frayed (macerated), a labral debridement may be performed instead of a labral repair. A debridement smooths the edges of the labrum, so they do not get caught in the joint when the shoulder moves.
An open Bankart repair may be necessary if the bone of the socket is involved in the injury, or if the patient is at high risk for recurrence of shoulder dislocation. This requires a longer incision at the front of the shoulder, which is closed with suture and steri-strips once the repair is complete.
In some cases, a dislocated shoulder results in a dent in the ball part of the joint. This can put the patient at risk for repeat injuries. This technique, which is sometimes done in combination with a Bankart repair, uses an arthroscope to bring part of the attachment of the rotator cuff forward to fill in the dent in the back of the ball part of the joint.
In cases where repeated dislocations have caused the bone of the socket to chip or wear away, a bone graft may be necessary to stabilize the shoulder. Your surgeon may use this technique, which is done as open surgery, to transfer a piece of bone (the coracoid) from another part of your shoulder and attach it to the area of the socket with bone loss.
Bone grafts can also be done using donor bone, or bone taken from the end of your collarbone or your pelvis.
No matter which type of surgery is used to stabilize the shoulder, sling immobilization and physical therapy plays a major role in protecting healing tissues and the surgical repair, as well as maximizing the patient’s functional outcome.