Arthroscopic shoulder stabilization for dislocation and Bankart lesions
Shoulder dislocations are common injuries among athletes and some non-athletes. They can be very painful at the time of injury, and may require a trip to the emergency room to have the shoulder put back into the socket.
Reviewed February 21, 2015, by Dr. Seneviratne
Symptoms
The shoulder can dislocate for a variety of reasons, but the most common is traumatic — a fall or a contact injury. The shoulder will be painful with markedly limited range of motion, and any attempt to move it will hurt. If the shoulder does not go back into place on its own, it must be reduced within a few hours to prevent further and permanent damage.
Why it happens
Shoulder dislocations occur through trauma: sports injuries, falls, and high-energy trauma such as motor vehicle accidents. Typically the ball dislocates anteriorly, toward the front. Patients who have a seizure or are electrocuted can dislocate backward. Loose-jointed patients with ligamentous laxity can dislocate in multiple directions, and these are considerably more difficult to treat surgically.
The primary restraint preventing dislocation is the labrum and capsule. During a dislocation the labrum tears off the socket — this is called a Bankart lesion — and the capsule stretches and permanently deforms. Younger patients, roughly ages 15 to 25, have a very high likelihood of re-dislocation, so they are generally treated surgically by repairing the labrum back down to the bone and shifting the capsule to tighten the shoulder. Older patients may be able to avoid surgery and be treated with physical therapy.
How it is diagnosed
Diagnosis begins with a detailed history and a thorough physical examination. X-rays are the most important initial study, with several views taken. A CAT scan may be added if there is also a fracture. An MRI allows the soft-tissue damage to be seen directly.
Treatment
Older patients can be treated non-operatively with a sling for a few weeks followed by physical therapy. Any recurrent dislocation or ongoing instability warrants surgery.
There are several ways to treat shoulder dislocations; the technique Dr. Seneviratne uses most often is arthroscopic. Some contact athletes — football, rugby and hockey players — may warrant open shoulder stabilization instead. Bone loss on the humeral head (a Hill-Sachs lesion) may require an added Remplissage procedure, where the capsule and rotator cuff are repaired into the bone defect. Bone loss on the glenoid, the socket side, will require a Latarjet procedure, transferring the coracoid process to the area of bone loss. The operation chosen is personalised to each patient.
Recovery
Shoulder stabilization is an outpatient ambulatory procedure. Pain afterwards is not usually severe, and most patients manage with Tylenol after a few days on narcotic pain medication. A sling is worn for about three weeks and physical therapy starts one week after surgery. Early healing occurs at six weeks; full healing takes six months to a year. Most professional athletes take a year to return to their sport, while recreational athletes can return sooner, at around six months, because the demand on the shoulder is lower. Every patient is different and return to play is guided by Dr. Seneviratne.
Common questions
What is the recurrence rate after shoulder stabilization surgery?
Published literature puts recurrence after arthroscopic stabilization at about 8%, and after open stabilization at about 4%. In Dr. Seneviratne's own experience, recurrence after arthroscopic stabilization is closer to 6%. Many factors predict recurrence, and he weighs patient factors, level of sport participation, and imaging findings when choosing the right operation.
Can I get arthritis after a shoulder dislocation?
Yes — especially where there is ongoing shoulder instability.
What are the risks of shoulder stabilization surgery?
Infection, bleeding, damage to nerves and blood vessels, recurrent dislocation, and shoulder stiffness.
Will I have hardware in my shoulder?
The shoulder is stabilized with tiny suture anchors drilled into the rim of the socket. These are usually suture material, and patients do not feel them.
How soon after surgery can I drive?
Usually 6 weeks, though as early as 3 weeks in some cases.
How soon can I return to work?
About 1–2 days depending on the occupation, though a week off is recommended.
How soon can I shower?
In 48 hours.
How soon can I fly?
About 1 week. Arrange an aisle seat, have someone else handle your bags, and do ankle pumps every 15 minutes in flight, as DVT is a real concern; aspirin is also advised unless your own physician says otherwise.
Shoulder video
Open shoulder stabilization in a pro football player
Shoulder dislocations in contact athletes may need open shoulder stabilization in select cases, because of the magnitude of the injury. Open stabilization in contact athletes has been shown to have a lower rate of repeat dislocation. This patient underwent open shoulder stabilization and made an excellent recovery in six months.
Endoscopic subpectoral biceps tenodesis
The procedure Dr. Seneviratne pioneered, performed through a 7mm incision with an endoscope rather than the traditional open approach.
The Latarjet procedure for recurrent shoulder dislocations
A brief overview of the Latarjet procedure for patients with recurrent shoulder instability.
PRP preparation using the Emcyte system
How platelet rich plasma is prepared in the office before injection.
Treatment of shoulder separation (AC joint separation)
A patient who had a shoulder separation underwent AC joint reconstruction, also called CC ligament reconstruction. Three months later he has excellent function, with correction of the separated AC joint.
Stem cells and rotator cuff healing, featured on CBS News
Dr. Seneviratne featured on CBS News for his work on the use of stem cells to enhance rotator cuff healing. See how the treatment worked for a patient who underwent rotator cuff repair in both shoulders.