Shoulder Stabilisation Surgery
Shoulder stabilisation surgery, also referred to as a Bankart repair is a minimally invasive surgical procedure to correct instability in the shoulder joint, often caused by a shoulder dislocation.
The shoulder joint is a ball and socket joint with the largest movement of any joint within the body. Movement of the shoulder occurs between the ball (head of the humerus) and socket (glenoid), but also between the shoulder blade and the chest wall (scapulothoracic joint). Although the ball and socket joint allows a large range of movement, the disadvantage is that the shoulder can become unstable.
The shoulder is stabilised by the muscles around it, which when in perfect balance greatly help to maintain stability of the ball and socket joint, preventing dislocation. The important static factors are:
- The rim of the cartilage which helps deepen the socket, called the glenoid labrum
- The bones of the ball and socket joint
- The ligaments around the shoulder that help hold the bones together
Shoulder dislocation is a common injury following trauma to the shoulder. The dislocation results in the ball coming completely out of the socket. Sometimes the ball may only partially dislocate; this is known as a subluxation. Dislocation of the shoulder may involve damage to the static factors that control shoulder stability. Stretching or tearing of the ligaments and damage to the rim of the cartilage on the socket is common. This may lead to persistent symptoms of instability, particularly when the arm is raised upwards and outwards.
A Bankart lesion is a tear specific to the anterior portion of the labrum, where the labrum is torn off the glenoid, caused through dislocation of the shoulder. It is very common to cause a Bankart lesion, resulting in an unstable shoulder which could also lead to further dislocation.
Some people experience shoulder dislocation with minimal force, usually because their joints are very loose. More severe force from a fall or sporting injury often causes a labrum tear.
Before your procedure, an anaesthetist will review your fitness for surgery and finalise the planned anaesthetic regime. If you are given a general anaesthetic, you will be asleep throughout the procedure. If you are given a local anaesthetic with a regional nerve block, you will be awake but will not feel any pain.
Shoulder stabilisation surgery is usually carried out arthroscopically (keyhole surgery). The surgeon will make small incisions in the shoulder joint, usually no more than 1cm in diameter. A thin small tube with a camera and light on one end (arthroscope) is then inserted to look inside the joint and the images are projected onto a monitor in the operating theatre. Saline (sterile water) is passed into the shoulder to allow the surgeon to look at the structures and repair the stabilisers of the shoulder. This involves repair of the damaged rim of the cartilage and tightening or repairing the overstretched ligaments.
Your procedure may be carried out with open surgery where a small cut is made over the shoulder with the necessary repairs then being carried out.
Following your surgery, your incisions will be sutured (stitched) and dressed, and your arm placed in a sling. The procedure generally takes no more than 1 hour, after which you will be taken to the recovery room where you will be monitored for the initial post-operative period.
You will be taken onto the ward once you have left the recovery room where you will continue to be monitored until you are fit to be discharged. Shoulder stabilisation surgery is generally carried out as a day case procedure, meaning you can go home the same day, provided there are no complications. You will need someone to drive you home and stay with you as your arm will be in a sling for 1-4 weeks. The sling will need to remain on 24 hours a day, including at night. You can only remove it to have a shower, get dressed and perform any arm movements as advised by your doctor.
It is important that you wear your sling during this period as it is essential for minimising any movement at the shoulder joint and protect the work that has been carried out. Moving your shoulder unnecessarily during this period will delay the healing process and reduce the potential benefits of the operation.
You are likely to experience some post-operative pain or discomfort, and you will be advised to take painkillers to help alleviate it. These may be prescribed for you, or you can take over the counter medication. If your pain does not settle, this will be reviewed at your follow-up appointment, usually 1-2 weeks after your procedure when your stitches are removed.
Physical therapy plays a vital role in the recovery process and you will be shown a set of exercises by a member of the Physiotherapy team that you can continue at home. It is important that you carry them out as directed as this will help improve your range of motion, whilst building strength and flexibility.
After 4 weeks, you should be able to remove your sling at the recommendation of your doctor and continue with your physical therapy to keep gaining strength and mobility.
Depending on your job, are will likely need to take 1-6 weeks off work. You may be able to return after 4 weeks if you job is office based, but for more strenuous roles, you will likely need longer. You will not be able to drive for 4-8 weeks, depending on your recovery process.
You will not be able to return to any strenuous sports for at least 4-6 months as doing so before then could compromise the result of your surgery. You can maintain your fitness by gentle walking or using a stationary bike with care. Swimming can be resumed after 10-12 weeks with sports such as tennis, football and weight training after 6 months, provided you have sufficient muscle control.
You may still experience some stiffness in the shoulder for up to 9 months, but full range of motion should return by 12 months, provided you have kept up with your physical therapy.
Risks and Complications
Shoulder stabilisation surgery is a common procedure and is considered safe. However, as with all invasive surgery, there are associated risks. These include:
- Infection at the wound site
- Allergic reaction to the anaesthetic
- Damage to the nerve or blood vessels
- Increased pain, although this will usually disappear within a few weeks
- Stiffness in the shoulder
If you experience any of the below symptoms, you should contact your doctor:
- Increasing pain, even when taking painkillers
- Pus oozing from the wound site
- Fever and chills
- Increasing redness and swelling around the wound site
Outlook after Shoulder Stabilisation Surgery
The success rate of shoulder stabilisation surgery is approximately 90%, although a small number of patients may have further instability and require another surgery in the future.
Shoulder stabilisation surgery is available at One Ashford Hospital. We also offer a number of other procedures for shoulder and elbow conditions, including 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.
One Ashford Hospital is well placed to see patients from Ashford, Canterbury, Maidstone, Dover, Folkestone and all surrounding areas. Call us on 01233 428 336 to find out more.
You can use your private medical insurance or pay for your Shoulder Stabilisation 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