The end of the shoulder blade, or scapula, that creates the shoulder socket is known as the glenoid. It is surrounded by a small, flexible tissue known as the labrum, which acts like a speed bump to keep the ball in the shoulder socket. A group of four muscles and their respective tendons, known as the rotator cuff, stretches from the humerus to the glenoid and serves two purposes. First, the rotator cuff helps to raise, lower, and swing the arm, giving the shoulder a large range of motion. Secondly, the cuff serves to keep the humerus inside the glenoid socket. The cuff is covered by a pack of tight ligaments, known as the capsule, that attaches the humerus to the glenoid (the ball to the socket).
Repeated dislocation or subluxation of the humerus out of the glenoid is known as instability. Instability is a weakening of the capsule of the shoulder joint, which allows the ball to slip out of the socket, causing pain, frustration and loss of faith in the shoulder as a sturdy joint. Instability is often accompanied by a tear of the labrum or rotator cuff, a Bankart lesion or a Hill-Sachs defect. A process known as stabilization can remedy chronic instability, and it may be done one of two ways: arthroscopically or open. This procedure covers arthroscopic stabilization.
Detailed Description
Specialist
Orthopedic surgeon
Procedure
Before the procedure:
The patient's medical history and any possible allergies to medication are determined. The surgeon may order X Rays, an MRI, CT scan or EMG to look into the joint before the procedure. The patient is dressed in a hospital gown and anesthetized either locally or generally.
During the procedure:
A number of half-inch incisions will be made to allow the arthroscope to enter the shoulder joint. A sterile saline solution will be pumped into the joint both to cleanse it and to expand it for better visualization. The surgical staff may also pump air into the joint to create more room to see inside the joint. While watching a monitor that shows a magnified image of the inside of the shoulder, the surgeon guides the arthroscope to perform a number of procedures within the joint. He or she will first inspect the inside of the shoulder for bone spurs, defects and tissue tears.
The surgeon then identifies any tears in the rotator cuff, and stitches or staples them shut. The sutures are kept in place by a small anchor that is drilled into the upper portion of the humerus. Within the joint, the surgeon may use a thermal shrinkage device to tighten the ligaments and further prevent instability. He or she may also remove any bone spurs and debride any tissue damaged by the dislocation during the operation.
Recovery:
Directly following the procedure, the surgeon may order the patient to use a Continuous Passive Motion machine to prevent atrophy and stiffness within the shoulder joint. Once discharged from the hospital, the patient will likely undergo a demanding strengthening regimen to further tighten the rotator cuff muscles. Rehabilitation will continue for six to nine months for most patients with acute dislocations, with full range of motion returning after about three months.
Complications/Risks:
- Blood clots (very rare)
- Surgical wound infection
- Risk of post-surgical stiffness
- Reaction to anesthesia
- Risk of developing arthritis
- Weakening of muscles
- Neurovascular injury
Medications:
Prescription and non-prescription painkillers, shoulder sling for support.
Tell your doctor if…
You experience increasing pain, prolonged swelling, decreased sensitivity or decreasing joint motion after the procedure. Also, if you experience any symptoms suggestive of infection such as general malaise (tiredness) or fever, notify your doctor.
Last updated: 01-Jan-00
