If you dislocate your shoulder, you are at increased risk of it happening again. As the most flexible joint in your body, the shoulder can perform a wide range of different movements including lifting and rotating your arm and turning it in many different directions.
Unfortunately, this range of motion makes the joint particularly prone to dislocating, which occurs when the head of the upper arm bone is forced out of the shoulder socket, normally as the result of a fall or heavy blow.
Having dislocated your shoulder once, the connective tissues can become loose, leading to recurrent dislocations. This is referred to as chronic shoulder instability.
Treating a dislocated shoulder – will I need surgery?
It is normally a simple procedure to realign a dislocated shoulder, however, you may require surgery to prevent future dislocations. Or, if you develop sense the shoulder is too loose or have repeat dislocations following the initial dislocation, surgery may be needed further down the line.
Your orthopaedic surgeon will make an assessment and diagnosis following a shoulder dislocation and advise you whether surgical repair is recommended. They will take a range of factors into account, including the extent of injuries to the ligaments, tendons, cartilage and bone, the direction in which the shoulder dislocated and your age and lifestyle. If you have developed chronic shoulder instability with damage to the joint on scans, it is likely that you will need surgery.
Surgical options for a dislocated shoulder
There are different surgical options depending on the type and extent of your shoulder dislocation. They include:
(1) Bankart repair
When a shoulder dislocates the labrum (a ring of cartilage that surrounds the socket) may be torn away. This is referred to as a Bankart lesion. A Bankart repair is a surgical procedure to repair the tear and reattach the labrum to the socket. It can be performed arthroscopically or using open surgery, but the arthroscopic technique is much more common as it is quicker with smaller scars and does not require detachment of muscle during surgery.
(2) Remplissage procedure
If the humeral head (the ball at the top of your upper arm bone) is damaged by the dislocation, it can cause a Hill-Sachs lesion. This is treated using the remplissage procedure, which is an arthroscopic keyhole procedure that involves filling the bone defect by fixing it to part of the neighbouring rotator cuff, which is a group of muscles and tendons that keep the head of the upper arm bone within the shoulder socket. A remplissage procedure is normally carried out alongside a Bankart repair and latest research suggests that this increases the chance of success of surgery.
(3) Latarjet procedure
This type of surgery is used when bone at the edge of the shoulder socket becomes significantly damaged during a dislocation. Combined with a Hill-Sachs defect, this can mean that a soft tissue repair alone, such as a Bankart or Remplissage procedure is not likely to be successful. During the procedure, bone with an attached tendon is taken from a different part of the shoulder blade and grafted to the damaged area on the socket. The Latarjet procedure helps to restore lost socket bone and reinforce the soft tissues of the shoulder joint. It is usually performed open, rather than keyhole, as this is the quickest and most reliable way to perform the surgery currently, and does not involve detachment of muscles.
(4) Shoulder replacement
In some cases, damage to the shoulder following a dislocation is so extensive that a shoulder replacement is needed. This may involve replacing just the humeral head (hemiarthroplasty) or both the humeral head and shoulder socket (total shoulder arthroplasty). Some older patients may be given a reverse shoulder replacement, which involves placing the ball inside the socket and attaching a plastic socket to the ball using a stem. This is more often used to treat large rotator cuff tears that cannot be repaired, or severe types of arthritis.
Recovering from surgery for a dislocated shoulder
Depending on the type of surgery and whether it is performed arthroscopically or as open surgery, you may be treated as an outpatient or need to stay in hospital overnight. You will normally need to wear a sling for two to four weeks after surgery.
A physiotherapist will recommend elbow, hand and wrist exercises that can help to support healing and prevent stiffness. A cold compress can help to relieve post-surgical pain and swelling, alongside painkilling medication.
If you have sustained a dislocated shoulder or are experiencing recurrent dislocations, talk to Thames Shoulder and Elbow about the range of treatment options available.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
Our Locations
Hospital of St John and St Elizabeth, St John’s Wood – Directions
BMI The Syon Clinic, Brentford – Directions
HCA Chiswick Medical Centre, Chiswick – Directions
West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, Isleworth – Directions
