Surgery for Traumatic Instability of the Shoulder.
Last updated Thursday, February 10, 2005
About surgery for traumatic instability
Here is some patient information typically given to a patient before a
repair for traumatic instability. However, this will vary with the
surgeon, the patient and the repair. If you have are going to have such
a repair, only your surgeon can give you specific information relative
to your procedure.Traumatic instability When a major force is applied to the arm, the supporting ligaments
of the shoulder joint may be torn. Sometimes these ligaments heal
spontaneously in the proper location so that the stability of the
shoulder is regained. On other occasions, strong healing to the
appropriate location does not occur, leaving the shoulder unstable when
it is put in certain specific positions. We refer to this as traumatic
instability of the shoulder.
These injuries most commonly arise from situations in which the
elevated arm is forced violently backward such as in a fall while
skiing. If this is the situation, one may elect to avoid the positions
in which the shoulder feels unstable, recognizing that this may require
giving up certain activities. Alternatively, one may seek a surgical
repair of the torn structures with a goal to regain some of the
functional abilities that were lost.
Who should consider this surgery We consider surgical treatment for informed patients who are unwilling
to accept the functional limitations imposed by recurrent traumatic
instability.Goals of surgery The ligaments are almost always torn from the front bottom part of the
socket of the shoulder. We can often repair this injury by sewing the
ligaments back to the bone from which they were torn. We make an
incision in the lower front skin creases of the shoulder and gain
access to the joint between two of its major muscles: the deltoid and
the pectoralis major. The ligaments are reattached by roughening up the
edge of the bony socket and placing small drill holes in the lip of
this socket. Sutures are passed through these drill holes and through
the ligaments so that when the sutures are tied the ligaments are held
in the appropriate place for healing.Risks of surgery The risks of this surgery include, but are not limited, to:
- infection,
- injury to nerves and blood vessels around the shoulder,
- unwanted shoulder stiffness,
- persistent instability of the shoulder,
- pain,
- complications of anesthesia,
- and the need for revision surgery.
Post-surgery limitations For three to four weeks after the surgery one must protect the
shoulder from elevation above the horizontal and from rotation away
from the body. It is important to carry out isometric strengthening
exercises which are done with the arm in a sling. After this first
period of protection, gentle range of motion and additional
strengthening exercises are added.
During the second six weeks we emphasize shoulder range of motion,
strength, endurance, and coordination. Usually patients can resume
rigorous physical activities three months after the operation provided
they have regained excellent strength, coordination, endurance, and a
near-normal range of motion of the shoulder.
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