Tear of the anterior labrum
The shoulder joint is the commonest joint to dislocate. The first dislocation usually needs a great force to push or pull the joint out of place. Treatment should always be to reduce the joint as quickly as possible. Often this requires an anaesthetic. Once a shoulder has dislocate once it can happen again often with less force. This is because at the first injury, ligaments are often damaged and these sometimes don't heal. The ligaments attach to the shoulder socket via a structure called the labrum and it is this structure that normally tears.
Instability anchor insertion
If you have dislocated your shoulder and your surgeon has recommended surgery it is likely they think you have a ligament injury. Mr Hughes prefers to perform this repair by key-hole surgery. The aim of the surgery is to reattach the torn ligaments back to where they were pulled off. To do this, strong stitches are attached to the bone at the edge of the shoulder socket.
Repair of the labrum using knots
The damaged ligaments are then stitched back to this bone. Surgery for dislocation has been performed successfully for many years through a large incision. This "open" procedure involves making a cut through one of the major tendons across the front of the shoulder. Using a key-hole technique avoids this potential damage.
After the surgery you will be placed in sling to prevent shoulder movement. This is kept in place for usually 3 weeks. It is important to keep the elbow, wrist and hand moving during this stage to stop them getting stiff. Your physiotherapist will advise you on this. After 3 weeks, the sling is discarded and shoulder exercises are started but some extreme movements are still avoided for a further 3 weeks. Again your physiotherapist will advise you on this. From 6 weeks, full movement is allowed and strengthening exercises are started. Normally recovery occurs over about 10 to 12 weeks with return to work at about this time. If you play contact sports such as rugby it often takes 9 to 12 months before you are safe to start playing again.
Completed repair
The surgery is not without risks. There is a small risk of infection. There is also a very small risk of damaging either nerves or blood vessels during the operation. There is a risk of excessive stiffness following the operation which is normally successfully treated by the physiotherapist. The patient needs to be aware that even in key-hole surgery there are scars and some scarring is unavoidable. The biggest risk is of failure with patients going on to have further dislocations. Sometimes the repaired ligaments do not heal sufficiently well. Normally dislocations occurring after surgery happen with a further severe injury. Further attempts at key-hole surgery can be made but this is a situation where Mr Hughes does sometimes consider an open operation.
This advice is very general and you should receive advice tailored for your particular needs from both your surgeon and physiotherapist.
