Instability of the Shoulder Joint
Instability of the shoulder is a condition usually seen in young patients. This can be a spectrum of complaints. At the one end we have people who dislocate their shoulder joint after an injury and then repeatedly put the shoulder joint out whenever they put the joint “at risk”. Some of these patients need to go to hospital to have the shoulder joint replaced and some learn to put the shoulder back themselves. At the other end of the spectrum there are patients that are born with flexible joints and they are able to “dislocate” the shoulder and put it back themselves. These patients often “sublux” their shoulders when they don’t actually dislocate the shoulder but “almost” dislocate the shoulder.
In the group of patients who dislocate their shoulders after an injury they usually pull off one of the ligaments. (This is called a Bankart lesion) Until such time as the ligament is re-attached they will continue to have a shoulder that is unstable. Sometimes the ligament can heal back in the right place and some people will never put their shoulder at risk so not every one needs an operation. However if the shoulder continues to come out then they will invariably need surgery to re-attach the ligament. This can be done as key-hole surgery or as a more formal open procedure. The amount of damage done at the time of the dislocation usually determines whether the operation can safely be done purely as key-hole surgery or whether it needs to be done as an open operation.
(If you would like more information on repair of the bankart lesion select Arthroscopic Bankart repair.)
In the group of patients that have hyperlax ligaments the treatment usually revolves around physiotherapy and muscle balancing. If this is not successful then the ligaments can be “shortened” by condensing the protein using a radiofrequency technique through key-hole surgery or a more formal shift of the ligaments by means of an open operation. The key-hole surgery is called capsular shrinkage and the open surgery is called a capsular shift. The capsular shrinkage operation was adopted with much enthusiasm when it first became available and unfortunately surgeons that were not shoulder specialists attempted this with disastrous results. Sadly therefore the procedure was “given a bad name”. However in the hands of shoulder specialist this procedure has produced very good results and has no greater risk of complications than other key-hole operations.
(Click here to see a video of capsular shrinkage.)
