- Home
- Centre Locations
- SOS Facilities
- SOS Services
- Contact Us
- Imaging
- Conditions
- The Head and Neck
- The Shoulder and Elbow
- Shoulder Arthritis
- Reverse Geometry Shoulder Replacement
- Frozen Shoulder
- Clavicle Fractures
- Clavicle Fractures - Pin v Plate
- How I Pin a Clavicle (Graphic Scenes)
- Tennis Elbow
- Rotator Cuff Tendonitis
- Acromioclavicular Joint
- Dislocated Shoulder
- Steroid Injections
- Operations and Complications 2006
- How Bad Is My Shoulder?
- Brachial Plexus Block
- The Hand
- The Spine
- The Hip and Groin
- The Knee and Shin
- The Foot and Ankle
- Payment
- Articles
- Education
- Products
- Testimonials
- News
- Careers
- Media Centre
- Links
| Dislocated Shoulder |
Shoulder Dislocation/Instability
I dislocated my shoulder. What damage have I done?
The shoulder is a naturally unstable joint and it sacrifices stability in order to achieve the huge range of mobility that it demonstrates. Although it is technically a ‘ball and socket’ joint, the ball (humeral head) is very big and the socket (glenoid) is very small. In fact on these MRI pictures it looks a bit like a golf-ball sitting on a golf-tee.In order to make it a bit more stable there is a lip of gristle (the labrum) running round the edge of the glenoid. This make the socket a bit deeper and a bit wider so it is more like a shallow bowl than a saucer.
If you sustain a traumatic dislocation (sports, heavy fall etc) then the humeral head is pulled violently forwards and can rip the labrum away from the glenoid. When the head goes back in (often the relocation has to be done in Casualty) the labrum may or may not go back to the right place and it may or may not reattach itself there.
Do I need an MRI scan?
An MRI scan is not essential but it does help me to plan the surgery. After a traumatic dislocation there will almost certainly be a labral tear which will show up on the scan.
My shoulder didn’t seem to come all the way out - it clunked back in.
This is probably a ‘subluxation’. The ball slides or gets pulled forwards but not far enough to pull off the labrum and come right out of the socket. Before it’s too late your muscles realise what is going on and pull the head back into the socket. Often this situation occurs if you are double-jointed (ligamentous hyper-laxity).
This is probably a ‘subluxation’. The ball slides or gets pulled forwards but not far enough to pull off the labrum and come right out of the socket. Before it’s too late your muscles realise what is going on and pull the head back into the socket. Often this situation occurs if you are double-jointed (ligamentous hyper-laxity).
Do I need an operation? I am very sporty.
In my opinion, and that of most specialist shoulder surgeons, the best way to treat a dislocated shoulder in a young (under 30) active person is an operation. This may contradict what you have been told by others - the Casualty doctor or your GP - because the traditional view was that, as 80% of dislocations are one-off events, you don’t need surgery after just one dislocation.
In fact if you are young then there is about an 80% chance of your shoulder dislocating again - and then again and again. And after each dislocation the next one ocurs more easily until the shoulder will pop out just rolling over in bed! And as well as that, you lose confidence in your shoulder which can make the recovery from surgery longer.
If you are over 30 or not sporty then it is reasonable to see how you do with physiotherapy and rehabilitation but if the shoulder comes out again then surgery would be the best idea.
Will I have a big scar down the front of my shoulder?
No. These days the shoulder is stabilised using a keyhole (arthroscopic) technique. So the only evidence of the surgery are three 1cm scars around the shoulder which are barely visible.
Tell me about the operation - what does it entail?
I do a procedure called a Bankart Stabilisation. The basis of this operation is to put your shoulder back the way it was without having to move tendons or tighten tissues. What I do is to manouvre the labrum back into its original position and then suture it in place while it bonds back onto the bone. The diagram shows what I mean.
If you have had a number of dislocations then the layers of tissues and ligaments in the front of the shoulder will have stretched out so they need to be tightened up at the same time.
Let me walk you through it.
It is a day-case procedure so you are in and out on the same day.
It is done under a combination of a general anaesthetic and an inter-scalene block to minimise pain afterwards (see anaesthetics in shoulder surgery).
The operation takes about 30 minutes but you will be away from your bed on the ward for maybe 2 hours to allow for the anaesthetic and recovery time.
And you will get a DVD of your operation to take home!
You will have to wear a sling for 4 weeks after the surgery and this also has a strap going round your lower chest. This is a bit annoying but very important in order to get the best result. You can come out of the sling to shower and dress but you have to be careful not to let the arm swing out to the side too much.
Go to the ‘looking after your stitches’ section to learn about what to do for showers etc.
How long does it take to get over the operation?
Before you are fully fit and able to play collision sports like rugby, it will be 4 to 5 months. But once you are out of the sling you can quickly start to do more and more things and increase your activity levels.
If you do a clerical type job and you can get there, you could go straight back to work. Working on a computer is a bit tricky but if you put the keyboard on your lap then you will be able to type.
If you do a heavy physical job then it will be 3 months or so before you are back doing that.
Less physical sports, the gym and swimming can all be started after about 2 months but fairly slowly at first and then build up.
Can my shoulder dislocate again?
I’m afraid so. The operation doesn’t create a super-shoulder and if you do something as forceful as you did the first time round you could dislocate it again.
I am double-jointed and my shoulder dislocates very easily. Do I need surgery?
This is one of the problems with people who have ‘ligamentous laxity’ but just having loose joints doesn’t mean your shoulders are also unstable. However if they are subluxing or dislocating very easily on the background of loose ligaments then there is usually a different problem in the joint. The labrum (that was damaged in the traumatic dislocation) remains intact and the humeral head jumps over it and stretches out the lining and ligaments of the front of the shoulder.
Surgery is NOT the first lne of treatment for this condition - atraumatic instability. The best treatment is physiotherapy and rehabilitation working on re-educating all the muscles that hold the ball in the socket. This is quite tricky and needs a specially trained physiotherapost but the results can be very good.
If this doesn’t work then an operation is an option. I do an arthroscopic capsular shift. In this procedure I tighten up the ligaments and capsule in the front of the shoulder to recreate the correct tension and hold the ball in the socket. The rehabiltation is the same as discussed above.
What are your results with the arthroscopic Bankart procedure?
This operation has about a 10% failure rate. Failures are catagorised as re-dislocations, subluxations or continued pain. Bizarrely, if you dislocate your shoulder 5 years after surgery playing top level impact sports, that counts as a failure!
In my opinion, and that of most specialist shoulder surgeons, the best way to treat a dislocated shoulder in a young (under 30) active person is an operation. This may contradict what you have been told by others - the Casualty doctor or your GP - because the traditional view was that, as 80% of dislocations are one-off events, you don’t need surgery after just one dislocation.In fact if you are young then there is about an 80% chance of your shoulder dislocating again - and then again and again. And after each dislocation the next one ocurs more easily until the shoulder will pop out just rolling over in bed! And as well as that, you lose confidence in your shoulder which can make the recovery from surgery longer.
If you are over 30 or not sporty then it is reasonable to see how you do with physiotherapy and rehabilitation but if the shoulder comes out again then surgery would be the best idea.
Will I have a big scar down the front of my shoulder?
No. These days the shoulder is stabilised using a keyhole (arthroscopic) technique. So the only evidence of the surgery are three 1cm scars around the shoulder which are barely visible.
Tell me about the operation - what does it entail?
I do a procedure called a Bankart Stabilisation. The basis of this operation is to put your shoulder back the way it was without having to move tendons or tighten tissues. What I do is to manouvre the labrum back into its original position and then suture it in place while it bonds back onto the bone. The diagram shows what I mean.
If you have had a number of dislocations then the layers of tissues and ligaments in the front of the shoulder will have stretched out so they need to be tightened up at the same time.
Let me walk you through it.
It is a day-case procedure so you are in and out on the same day.
It is done under a combination of a general anaesthetic and an inter-scalene block to minimise pain afterwards (see anaesthetics in shoulder surgery).
The operation takes about 30 minutes but you will be away from your bed on the ward for maybe 2 hours to allow for the anaesthetic and recovery time.And you will get a DVD of your operation to take home!
You will have to wear a sling for 4 weeks after the surgery and this also has a strap going round your lower chest. This is a bit annoying but very important in order to get the best result. You can come out of the sling to shower and dress but you have to be careful not to let the arm swing out to the side too much.
Go to the ‘looking after your stitches’ section to learn about what to do for showers etc.
How long does it take to get over the operation?
Before you are fully fit and able to play collision sports like rugby, it will be 4 to 5 months. But once you are out of the sling you can quickly start to do more and more things and increase your activity levels.
If you do a clerical type job and you can get there, you could go straight back to work. Working on a computer is a bit tricky but if you put the keyboard on your lap then you will be able to type.
If you do a heavy physical job then it will be 3 months or so before you are back doing that.
Less physical sports, the gym and swimming can all be started after about 2 months but fairly slowly at first and then build up.
Can my shoulder dislocate again?
I’m afraid so. The operation doesn’t create a super-shoulder and if you do something as forceful as you did the first time round you could dislocate it again.
I am double-jointed and my shoulder dislocates very easily. Do I need surgery?
This is one of the problems with people who have ‘ligamentous laxity’ but just having loose joints doesn’t mean your shoulders are also unstable. However if they are subluxing or dislocating very easily on the background of loose ligaments then there is usually a different problem in the joint. The labrum (that was damaged in the traumatic dislocation) remains intact and the humeral head jumps over it and stretches out the lining and ligaments of the front of the shoulder.
Surgery is NOT the first lne of treatment for this condition - atraumatic instability. The best treatment is physiotherapy and rehabilitation working on re-educating all the muscles that hold the ball in the socket. This is quite tricky and needs a specially trained physiotherapost but the results can be very good.
If this doesn’t work then an operation is an option. I do an arthroscopic capsular shift. In this procedure I tighten up the ligaments and capsule in the front of the shoulder to recreate the correct tension and hold the ball in the socket. The rehabiltation is the same as discussed above.
What are your results with the arthroscopic Bankart procedure?
This operation has about a 10% failure rate. Failures are catagorised as re-dislocations, subluxations or continued pain. Bizarrely, if you dislocate your shoulder 5 years after surgery playing top level impact sports, that counts as a failure!
Summary.
If you are young, active and sporty and have suffered a primary, traumatic anterior dislocation then the best option is early surgery. At this time the body is doing everything it can to heal itself so if we can give it a helping hand by getting the torn labrum back exactly where it is meant to be and hold it there while the tissues reheal then you should end up with a perfect shoulder with none of the longer term consequences of repeat dislocations.
If you are as old as I am then the chances are the dislocation will be a one-off and the treatment is physiotherapy rehabilitation.
If you are young, active and sporty and have suffered a primary, traumatic anterior dislocation then the best option is early surgery. At this time the body is doing everything it can to heal itself so if we can give it a helping hand by getting the torn labrum back exactly where it is meant to be and hold it there while the tissues reheal then you should end up with a perfect shoulder with none of the longer term consequences of repeat dislocations.
If you are as old as I am then the chances are the dislocation will be a one-off and the treatment is physiotherapy rehabilitation.