Options for Recurrent Shoulder Dislocations

Surgery for shoulder dislocation is typically considered in cases of recurrent shoulder instability, significant structural damage, or failed conservative treatment. The primary goal of surgery is to stabilize the shoulder joint, reduce the risk of future dislocations, and restore function. There are several surgical procedures commonly used to address shoulder dislocation, including:

1. Arthroscopic Bankart Repair: This procedure is commonly performed for anterior shoulder instability. It involves reattaching or tightening the torn labrum (a ring of cartilage around the socket of the shoulder joint) and repairing any damaged ligaments using sutures and anchors inserted arthroscopically through small incisions.

2. Open Bankart Repair: In some cases, particularly with large or complex labral tears, an open surgical approach may be necessary to access and repair the damaged structures. This involves making a larger incision to directly visualize and repair the torn labrum and ligaments.

3. Capsular Shift: In cases of significant capsular laxity or soft tissue stretching, a capsular shift procedure may be performed. This involves tightening and reinforcing the joint capsule surrounding the shoulder joint to improve stability.

4. Latarjet Procedure: This procedure is indicated for cases of anterior shoulder instability with significant bone loss, such as recurrent dislocations associated with a glenoid bone defect. It involves transferring a portion of the coracoid process of the scapula to the front of the glenoid to create a bony block, which helps stabilize the shoulder joint.

5. Remplissage Procedure: In cases of anterior shoulder instability with associated Hill-Sachs lesions (compression fractures of the humeral head), a remplissage procedure may be performed. This involves filling the defect in the humeral head with soft tissue (typically the posterior capsule or infraspinatus tendon) to prevent engagement of the lesion with the glenoid during shoulder movement.

6. Bankart Repair with Remplissage: In some cases, a combination of Bankart repair and remplissage procedures may be performed to address both labral tears and Hill-Sachs lesions simultaneously.

The choice of surgical procedure depends on various factors, including the underlying cause of shoulder instability, the extent of soft tissue and bone damage, the presence of associated injuries, and the patient's activity level and functional goals. It's essential to consult with an orthopedic surgeon or shoulder specialist to determine the most appropriate surgical approach based on individual circumstances.

Following shoulder dislocation surgery, a structured rehabilitation program supervised by a physical therapist is essential to optimize recovery, restore shoulder function, and prevent complications. Rehabilitation typically focuses on regaining range of motion, strengthening the shoulder muscles, improving proprioception and neuromuscular control, and gradually reintroducing functional activities. Compliance with the prescribed rehabilitation program and close follow-up with the healthcare team are critical for achieving successful outcomes after shoulder dislocation surgery.

Author

Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.