How is the procedure performed?
The procedure is performed under a combination of general and regional anaesthesia. The joint is examined under anaesthesia to test stability. An arthroscope is inserted into the joint and the inside of the joint is examined. The torn labrum and ligaments may be scarred down and are mobilised to allow them to be repaired in the appropriate location. The rim of the socket is scraped to promote bleeding and facilitate healing. The labrum and capsule is then fixed back to bone with suture anchors (small devices with sutures that are embedded in bone). In some instances if there is a large defect affecting the ball of the joint (Hill-Sachs lesion), the adjacent tendon is repaired into the defect (“remplissage”).
The alternatives to surgery are to do nothing or continue with physiotherapy and exercises. There is evidence to suggest that with repeated dislocations there is progressive damage to the joint.
The main benefit of the procedure is to repair the damage, restore stability and improve the function of the joint. More than 85% of patients achieve benefit from surgery.
Pain - The shoulder may be painful for some weeks after surgery. This is usually managed by taking appropriate pain relieving medication and activity modification.
Swelling – During the procedure, the joint is distended with saline and this may lead to the shoulder remaining swollen for a day or two after surgery.
Bleeding – A small amount of bleeding from the arthroscopy portal sites is not unusual and will usually settle after a day or two.
Stiffness – Some degree of stiffness is to be expected in the first few weeks after surgery. Prevention is the key and it is essential to follow the instructions provided by the physiotherapist and perform daily stretching within the limits imposed to maintain the range of movements.
Chondrolysis – Damage to the gristle of the joint has been reported after the use of thermal shrinkage of the capsule or use of intra-articular pain catheters. We do not use thermal shrinkage or intra-articular pain catheters.
Hardware failure – Suture anchors may rarely work loose from the bone. This may require further surgery to remove the loose anchors.
Infection – Infection is a possibility but is rare after arthroscopic surgery.
Recurrence – Occasionally the labrum may fail to heal or may tear again following a further injury resulting in recurrence of symptoms. The risk of this is less than 10%. This is likely to require further surgery.
Nerve or blood vessel injury – This is possible but rare.
Open surgery – The need to convert to an operation is rare but may become necessary if technical issues are encountered during the operation.
Reoperation - If the labrum is deficient or if there is glenoid bone loss it may be necessary to undertake bone block surgery and this may be deferred to a later stage.
- Following the procedure the arthroscopy portal sites (skin incisions) will be closed with sutures and tape and covered with shower-proof dressings. These dressings should be left undisturbed as far as possible for 5-7 days. If the dressings are removed for any reason they should be replaced with similar dressings or waterproof plasters. The shoulder may also be covered with an absorbent pad (or a nappy) that will be removed the day after surgery.
- Prior to discharge from hospital a physiotherapist will provide instructions about looking after the shoulder. You will be advised to protect the shoulder by wearing a special sling for 3 weeks and intermittently performing limited movements of the shoulder. After 3 weeks you may stop wearing the sling during the day and will be allowed to move the shoulder actively through a greater range. You may resume driving at 4 weeks. Strengthening exercises are started after 6 weeks. Outpatient physiotherapy will be arranged and may need to be continued for 6-12 months.
- For detailed instructions on rehabilitation click here.
Resuming work, driving and activities
- Office duties may be resumed within 3 weeks.
- Manual tasks should be avoided for at least 4 months.
- You will be able to resume driving at 4 weeks.
An appointment will be arranged for you at 2-4 weeks after the procedure. Follow-up is required for at least 12 months after surgery or until a satisfactory recovery is achieved.