Introduction

The shoulder joint is designed to give a large amount of movement. Therefore, support from the ligaments and muscles is essential. When the shoulder dislocates the ligaments can be torn or stretched and, in some cases, need to be repaired.

The Operation

The operation is done by ‘keyhole surgery’; usually through two or three 5mm puncture wounds. The operation involves repairing the over-stretched or torn ligaments deep around the shoulder joint. The repair involves stitching the torn or stretched ligaments back onto its attachment to the socket of the shoulder blade (Glenoid). This is done using tiny anchors with sutures attached to them. The repair should be protected until healing take place (for initial healing – 6 weeks).

If not suitable, the surgeon may perform open stabilisation. (Rare – less than 2%).

General Advice

You will usually be in hospital either for a day or overnight. The operation is performed under a general anaesthetic and a nerve block in your neck and will make your arm numb for 8-12 hours after surgery. This is for post-operative pain relief. After this the shoulder may well be sore and you will be given painkillers to help this. Ice packs may also help reduce pain.

You will return from theatre wearing a sling. Your arm will remain in a special sling for 4-6 weeks. This means that you will be unable to use the arm throughout this time and you will be unable to return to work.

The shoulder must remain immobilised with a sling and a body belt (underneath the clothes) for 2-3 weeks. At your follow-up appointment the body belt will be removed, and you will be allowed to wear the sling on top of your clothes.

You will be expected to remove the sling for exercises only. Your physiotherapist will advise you of these. A doctor/physiotherapist will see you prior to discharge and you will be taught exercises to do and given further advice to guide you through your recovery.

Complications

As with all surgery there is a risk of some complications. These are rare, but you should be aware of them before your operation. They include:

Complications relating to the anaesthetic.

• Infection.
• Injury to the nerves or blood vessels around the shoulder.
• Prolonged stiffness and or pain.
• Failure to achieve successful result.
• A further dislocation of the shoulder (less than 5%).
• A need to redo the surgery.

If you require further information, please discuss with the doctors either in clinic or on admission.

What to expect afterwards

Pain

A nerve block is usually used during the surgery. This means that immediately after the operation the shoulder and arm often feel completely numb. This may last for a few hours. After this the shoulder may well be sore and you will be given painkillers to help this whilst in hospital. These can be continued after you are discharged home. Ice packs may also help reduce pain. Wrap crushed ice or frozen peas in a damp, cold cloth and place on the shoulder for up to 15 minutes.

Wearing a sling

You will return from theatre wearing a sling. The surgeon/physiotherapist will advise you on how long you are to continue wearing the sling. This is usually for 4-6 weeks. You will be expected to remove the sling for exercises only. Your physiotherapist will advise you of these.

Open stabilisation

There is an incision at the front of the shoulder within the natural skin crease. The stitch can be dissolvable or may need to be removed at 2 weeks. Keep the wound dry until it is well healed.

Arthroscopic (keyhole) stabilisation

This keyhole operation is usually done through two or three 5mm puncture wounds. There may be stitches or small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 10 to 14 days.

Driving

You will not be able to drive for a minimum of 6-8 weeks. Your surgeon will confirm when you may begin.

Returning to work

This will depend on your occupation. Light activities which involve using your arm in front of your body may be resumed after about two weeks, but if your job involves heavy lifting you will be off work for up to three months. You will need to discuss this with your surgeon.

Leisure Activities

Your physiotherapist and surgeon will advise you when it is safe to resume your leisure activities. However, you will not be allowed to return to contact sports before 6 months from surgery.

Follow up Appointments

An appointment will be made for you to be reviewed at 2 weeks. You will be monitored by a physiotherapist throughout your rehabilitation with formal physiotherapy normally beginning 4-6 weeks after surgery.

Exercises

The shoulder must remain immobilised with a sling and a body belt (underneath the clothes) for 2-3 weeks. At your follow-up appointment the body belt will be removed, and you will be allowed to wear the sling on top of your clothes.

You will perform first only elbow, wrist and hand exercises.

You may well be expected to perform the following exercises when you leave hospital. Please check with your physiotherapist before commencing.

1. Keep your arm in the sling and move your hand up and down at the wrist.
2. With your arm out of the sling bend and straighten the elbow
3. With your arm in the sling and the elbow bent at your side, turn the hand to face the ceiling and then the ground.
4. With arm in the sling regularly shrug shoulders up and down and circle forwards and backwards.