Shoulder instability is a problem of loose shoulder joint that occurs when the structures that surround the shoulder joint such as the ligaments, capsule and cartilage become overstretched or injured. When this occurs you may have shoulder joint dislocation. A dislocation occurs when the head of the upper arm bone (humerus) is forced out of the shoulder socket (glenoid). Shoulder dislocation can be partial or complete. A partial dislocation occurs when the ball of the upper arm comes partially out of the socket. It is referred to as a subluxation. A complete dislocation occurs when the ball comes all the way out of the socket.
Shoulder instability most commonly occurs as a result of a Bankart injury or tear. Bankart tear is a specific injury to a part of the shoulder joint called the labrum. Labrum is a ring of fibrous cartilage that surrounds the glenoid and stabilises the shoulder joint. Bankart tear leads to recurrent dislocations, feeling of looseness, lack of strength, pain or clicking and arthritis of the shoulder. Shoulder instability may be caused by injury, falling on outstretched hand, repetitive overhead sports such as basket ball, volley ball or weight lifting. Patients with shoulder instability may have severe pain, swelling, popping or grinding sound, partial or complete dislocation, loss of sensation or partial paralysis and loss of function.
If conservative treatment such as immobilisation, prescription medicines, physical therapy, closed reduction or manipulation and occupational therapy fails to relieve the shoulder instability, your surgeon may recommend reconstruction surgery.
Shoulder reconstruction surgery involves repair of the torn or stretched ligaments so that they are better able to hold the shoulder joint in place. During the surgery the torn labrum is reattached back to the shoulder socket with the help of special anchors and the overstretched capsules and ligaments are tightened.
Trauma may cause a fracture of the humerus (ball) or the glenoid (socket) of the shoulder joint. The majority of these injuries can be treated without surgery with a good, long-term result.Some fractures are better treated with surgery because they may carry a high risk of arthritis if left alone. Some are unlikely to heal, or may heal in the wrong position if not treated surgically.
Fractures are either described as being displaced or non-displaced. Fortunately, nearly 80 percent of all shoulder fractures are non-displaced. This implies that the broken pieces remain near their anatomic position and treatment merely requires immobilization in a sling until the bone fragments heal. Most shoulder fractures heal in about six weeks. About 20 percent of shoulder fractures are displaced and may require some type of manipulation to restore normal anatomy.
Occasionally the rotator cuff muscles are injured or torn at the same time as the fracture. This can further complicate the treatment.
Joint replacement involves surgery to replace the ends of bones in a damaged joint. This surgery creates new joint surfaces. In shoulder replacement surgery, doctors replace the ends of the damaged upper arm bone (humerus) and usually the shoulder bone (scapula) or cap them with artificial surfaces lined with plastic or metal and plastic. Shoulder joint components may be held in place with cement. Or they may be made with material that allows new bone to grow into the joint component over time to hold it in place without cement. The top end of your upper arm bone is shaped like a ball. Muscles and ligaments hold this ball against a cup-shaped part of the shoulder bone. Surgeons usually replace the top of the upper arm bone with a long metal piece, inserted into your upper arm bone, that has a rounded head. If the cup-shaped surface of your shoulder bone that cradles your upper arm bone is also damaged, doctors smooth it and then cap it with a plastic or metal and plastic piece. Surgeons are now trying a newer procedure called a reverse total shoulder replacement for people who have painful arthritis in their shoulder and also have damage to the muscles around the shoulder. In this procedure, after the surgeon removes the damaged bone and smooths the ends, he or she attaches the rounded joint piece to the shoulder bone and uses the cup-shaped piece to replace the top of the upper arm bone. Early results are encouraging.1 This surgery is not right for everyone. And not all surgeons have done it. Success depends not only on careful evaluation to be sure it's the right surgery for you but also on having a surgeon with experience in reverse shoulder replacement.
After surgery, you will be moved into the recovery room where you will stay for approximately two hours. During this time, you will be monitored until you awaken from anesthesia, at which time you will be taken to your hospital room. Your operated arm will be numb from the regional anesthesia, which also can provide good pain relief for the next day. Another side effect of the anesthesia is that you will not be able to move the fingers or wrist on the operated arm.
Typically, you will stay in the hospital for two to three days, but this depends on each individual and how quickly he or she progresses. After surgery, you may feel some pain that will be managed with medication to make you feel as comfortable as possible. This will be given either by injection or pump and should be used as needed. To avoid lung congestion after surgery, you should breathe deeply and cough frequently to clear your lungs.
A Cryocyff, an icing device that will help control pain and swelling, will be placed on your shoulder in the recovery room. You will be able to bring this device home with you and should use it frequently to minimize any discomfort you experience. In some instances, the insurance company may not approve the use of a Cryocyff, in which case we will use ice packs instead.