Shoulder Reconstruction Surgery
Shoulder reconstruction surgery is a surgical procedure performed on patients with shoulder instability to restore the function, improve stability and stop repeated dislocations of the shoulder joint.
Shoulder reconstruction surgery involves repair of the torn or stretched ligaments so they are better able to hold the shoulder joint in place. Surgery may be recommended if conservative treatments have failed. Surgeries can range from minimally invasive arthroscopic procedures (keyhole surgery with a scope) to more traditional open surgery. The type of surgery you receive will be discussed between you and your doctor as each method has its advantages and disadvantages.
The joint that connects your upper arm to your body is called a ball-and-socket joint which enables you to move your arm up and down, backwards and forwards and in a circle. The bone in your upper arm is called the humerus and has a round end that sits in the curved structure on the outside of your shoulder blade.
Ligaments connect the bones and tendons connect the muscles to the bone holding it together. A layer of tissue (cartilage) separates the bones so they do not rub against each other.
Why do I need Shoulder Reconstruction Surgery?
Shoulder instability is a problem that occurs when the structures that surround the shoulder joint such as the ligaments, capsule and cartilage do not work to keep the ball tightly within its socket. If this occurs, you may have shoulder joint dislocation (where the joint has come completely out of the socket) or subluxation (partially out of the socket). A dislocation occurs when the humerus (upper arm bone) is forced out of the glenoid (shoulder socket).
Shoulder instability commonly occurs because of a Bankart injury or tear. A Bankart tear is a specific injury to part of the shoulder joint called the labrum. The labrum is a ring of fibrous cartilage that stabilises the shoulder joint and surrounds the glenoid. A Bankart tear can result in regular dislocations, weakness, pain or clicking and arthritis of the shoulder.
Shoulder instability can also be caused by injury such as falling on an outstretched hand or repetitive overhead sports such as netball or weight lifting.
If you have previously experienced a shoulder dislocation, you may develop chronic instability. During the original dislocation, the ligaments that support the shoulder are torn. If the ligaments heal too loosely, your shoulder will be prone to repeat dislocations and instability.
Symptoms and Diagnosis
You may need surgery to reconstruct the shoulder joint if you experience any of the following symptoms:
- Severe pain
- Swelling and bruising
- A popping or grinding sensation
- Complete or partial dislocation
- Loss of function or movement
- Numbness or weakness
To determine the extent of your injury or condition your doctor will begin by carrying out a physical examination. They will discuss your medical history and current symptoms to help determine the best course of action. Your doctor may also check for general looseness in your ligaments by asking you to try to touch your thumb to the underside of your forearm.
To further understand the location, and the extent of damage or disease in the shoulder joint and determine whether surgery is the next step your doctor will order further tests such as:
A Computed Tomography (CT) Scan
A CT scan uses computers and rotating X-ray machines to create cross-sectional images of the body. CT scans provide more detailed images compared to standard X-rays as they can also show blood vessels, soft tissues, organs and bones.
Magnetic Resonance Imaging (MRI) Scan
An MRI scan uses a strong magnetic field and radio waves to produce a detailed picture of the tissue and organs inside of your body, such as ligaments, cartilage and tendons.
Most commonly associated with joint or bone problems, an X-ray is a painless diagnostic tool that checks for fractures and signs of wear and tear or injury.
Chronic shoulder instability is often initially treated with nonsurgical treatments. In most cases, you are immobilised in a sling for 2 weeks and then started on a rehabilitation plan.
If you suffer a dislocation between the ages of 15 – 25, you may be prone to recurring dislocations. If you are over the age of 40, you may suffer from a rotator cuff tear with a dislocation rather than repetitive dislocations.
Strong rotator cuff muscles are the best protection against shoulder dislocation, subluxation and instability. A sufficient warm up and certain exercises that build up muscles around the shoulder are helpful.
If conservative treatments such as physical therapy, immobilisation and medication fail to stabilise the shoulder, your doctor may recommend shoulder reconstruction surgery. The surgical options include both open and arthroscopic techniques.
An arthroscopic shoulder stabilisation is a minimally invasive technique, performed under a general or regional anaesthetic. The surgeon will start by making 3 small incisions in the shoulder to insert the arthroscope (a tiny camera) that will send images to a monitor in the operating theatre, in order for the surgeon to examine. Fluid (saline) is passed in to the shoulder to enable the doctor to look at the structures within it. The damaged structures are then repaired and tightened to help restore the joints’ stability, usually by using small anchors in the socket of the shoulder and stitching the separated tissue back to the bone.
Shoulder reconstruction surgery involves the repair of the stretched or torn ligaments, enabling them to hold the shoulder joint in place. During surgery, the torn labrum is reattached to the shoulder socket and the overstretched ligaments are tightened.
In some cases, open surgery may be necessary. A larger incision is made over the shoulder joint and the repair is carried out under direct visualisation. Open shoulder stabilisation is usually carried out under general anaesthetic and possibly a nerve block injection to numb the affected arm. A 10cm incision is made at the front of your shoulder and a portion of your coracoid bone (a bony hook-like structure at the front of the shoulder) is relocated to the front of the glenoid (the socket part of your shoulder joint) and held in position with a screw. This substitutes any bone loss, deepens the socket, and moves some tendons that act like a sling at the front of the shoulder. Post-operative pain is common and you will receive a combination of painkillers to help reduce it.
Following shoulder reconstruction surgery, you will be taken to recovery where you will be observed for the initial post-operative period. When you go home depends on your individual situation and the time of your procedure; this will be discussed with you prior to your operation. You will have to keep your arm in a sling for 4- 6 weeks to encourage the healing process, minimise movement and protect the repair work. A physiotherapist can show you use of the sling and teach you simple exercises that you should continue once you return home. They may also provide advice on how to carry out everyday tasks after surgery and organise follow-up outpatient physiotherapy sessions.
You can remove the outer layer of your dressing a couple of days after your operation. The plaster that is underneath this dressing needs to be left in place and kept dry. Your wound will be checked and the stitches removed (if necessary) at your follow-up appointment around 2 weeks following your operation. You may experience minor pain after surgery; it is important that you take your painkillers as advised on discharge from the hospital. If your pain does not decrease, contact your doctor.
Risks and Complications
Complications following shoulder reconstruction surgery are rare; however, as with all invasive surgery, there are some risks involved. The most common complications may include:
- Stiffness or restricted movement
- Nerve damage
- Increased pain
- Swelling or oozing around the wound
- Side effects of general anaesthesia
Outlook Following Shoulder Reconstruction Surgery
Shoulder reconstruction surgery is a good treatment option for shoulder stabilisation, but in some cases, a course of physiotherapy may be trialled first to help strengthen the shoulder. Eventually, an operation may be essential to help repair the structural faults caused by the dislocation.
Shoulder Reconstruction Surgery is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire. We also offer a number of other procedures for shoulder and elbow conditions, including shoulder replacement surgery, SLAP repair and elbow release surgery. We can book you in to see a specialist Orthopaedic shoulder surgeon for an initial consultation, usually within 48 hours.
You can use your private medical insurance or pay for your Shoulder Reconstruction Surgery treatment. We offer competitive, fixed price packages as well as the ability to spread your cost with the option of 0% finance. If you are using your health insurance please do contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.
Why One Healthcare
- Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
- Fast access to diagnostics including MRI, Xray and Ultrasound
- Private, spacious, en-suite rooms
- Specialist Physiotherapy and nursing teams
- Little or no waiting time
- ‘Ultra clean air’ theatres
- Freshly prepared food
- Calm, dignified experience
Mr Jai Relwani
Consultant Orthopaedic Surgeon; Clinical Lead - Shoulder & Elbow Service
One Ashford Hospital
Mr Rajeev Sharma
Consultant Orthopaedic Surgeon - Upper Limb Surgery (Shoulder, Elbow, Wrist and Hand)
One Hatfield Hospital