A shoulder dislocation, when the upper arm’s humeral head is forced out of the shoulder’s socket, can usually be realigned fairly easily. To help prevent shoulder instability and future dislocations, either surgical or nonsurgical treatment is recommended.
- In some cases, surgery is recommended right away.
- In other cases, surgery is recommended only if shoulder instability persists after nonsurgical treatments, such as rest, ice and physical therapy, have failed.
It is worth noting that not all doctors agree on when to recommend surgery, particularly in younger athletes with first-time shoulder dislocations. Experts are currently researching how factors such as the age and severity of the injury affect surgical outcomes.
Common Surgical Procedures to Treat Shoulder Dislocation
The procedure(s) that surgeons will recommend to treat shoulder instability depends on factors such as:
- The direction of the dislocation
- The injuries to the shoulder’s tendons, ligaments, cartilage, or bone
- The age and activity level of the patient
Among the many surgical options available are Bankart repair; capsular shift; Latarjet procedure; remplissage procedure; and shoulder replacement.
When a shoulder dislocates toward the front of the body, a ring of cartilage (the labrum) that surrounds the socket may be torn away from the socket. This is known as a Bankart lesion. The goal of Bankart repair is to repair the labral tear and reattach it to the socket. Bankart repairs can be done using a traditional open surgical approach or a less invasive arthroscopic approach.
Especially after multiple dislocations, the ligaments that hold the shoulder joint in place can become stretched out and lax. A capsular shift tightens the ligaments by creating tissue flaps, then shifting and re-suturing them to eliminate the loose tissue.
Latarjet procedure / Bone grafting
The Latarjet procedure (alternately known as Bristow or Bristow-Latarjet procedure) can be used when bone on the edge of the socket has been damaged during a dislocation. The procedure involves transferring bone from the coracoid process (part of the shoulder blade) and the attached conjoint tendon to the front edge of the socket. Latarjet is a procedure that can be done using either the open approach or arthroscopically.
Surgeons can also augment the bone loss on the patient’s shoulder socket by using a cadaver bone (often the end of the cadaver’s tibia bone) or bone from the patient’s pelvis. This bone augmentation helps restore stability to the shoulder. Bone loss sustained on the rounded top of the patient’s humerus can sometimes be replaced using a cadaver bone graft as well (typically the cadaver’s femoral head).
The remplissage procedure may be done in tandem with the Latarjet procedure. It may be recommended if the shoulder’s ball, or humeral head, has been badly damaged by dislocation, causing a condition known as a Hill-Sachs lesion. The procedure involves resurfacing the head and/or filling in the defect by fixing it to part of the rotator cuff.
Replacement of the ball (hemiarthroplasty) or both the ball and socket (total shoulder arthroplasty) is sometimes required in the treatment of shoulder instability. Hemiarthroplasty is sometimes necessary to reconstruct bone defects on the ball side that are too big to fix with a bone graft.
In elderly patients, shoulder instability can be associated with large rotator cuff tears that are sometimes not repairable. These patients often are best treated with a reverse shoulder replacement, when a ball is placed on the socket, and a plastic socket is attached to the ball with a stem in the humerus.
How the Surgical Approach Is Determined
As mentioned above, many of the surgical procedures used to treat shoulder instability can be performed using an open approach or an arthroscopic approach.
In addition to the open and arthroscopic approaches, a combination of open and arthroscopic approach is sometimes used. This is known as a “mini-open” approach.
Each approach option has its own advantages and drawbacks. Patients should discuss with their surgeon the best option for their individual situation.
It is important for individuals to inquire about their surgeon’s experience. A surgeon’s level of experience performing a certain procedure or approach is one of the most important factors in having a successful surgery.