Shoulder Instability Surgery

The shoulder joint is the most mobile joint in the body with complex biomechanics. Unfortunately this also leads to it being the most prone to dislocation (the shoulder “popping out”).It most frequently dislocates anteriorly, although posterior dislocation can also occur. Injuries can be associated with nerve damage and related fractures. To dislocate traumatically, damage to an anatomic structure must occur. This is most frequently the labrum, a ring of cartilage that runs around the glenoid.

Traumatic shoulder dislocation frequently leads to recurrent shoulder instability (dislocations and subluxations) that impairs people’s ability to play sport, perform manual tasks including work and over time causes damage to the shoulder joint leading to early osteoarthritis. Unstable shoulder joints can be particularly dangerous in many environments such as swimming in surf conditions, where at least 15% of drowning are thought to be related to dislocated shoulder joints. The likelihood of a shoulder dislocation leading to recurrent instability is dependent on multiple factors including age (younger patients are much more likely to get recurrent instability), higher risk sports (contact and overhead sports such as all codes of football, martial arts, basketball, volleyball, tennis), bone loss, and generalized ligamentous laxity. Physiotherapy can help with return to function but it will not reduce the chance of redislocation in cases of traumatic dislocation. Dedicated shoulder physiotherapy is essential treatment in cases involving generalized ligamentous laxity whether or not surgery is also indicated.

The initial investigation of someone with shoulder instability symptoms usually involves an xray series of the shoulder and an MRI arthrogram. This allows Dr Rae to define the nature of your injury and thereby plan the most appropriate operation. Surgery can usually be performed arthroscopically through small incisions where we are able to visualize and repair the avulsed labrum using advanced minimally invasive techniques. In some situations where a patient is at high risk of redislocation such as having significant bone loss, an open stabilization, normally a Laterjet procedure, may be indicated. This involves the transfer of a block of bone, called the coracoid, with its tendons attached onto the deficient anterior glenoid. This operation is more invasive but provides a higher degree of stability in these patients.

This is general information only and if you would like to talk to Dr Hamish Rae more about your shoulder pain and options for treatment please call 80055111 to make an appointment. He is an experienced orthopaedic surgeon who will provide you with all the information you need about your treatment in Sydney.