Surgery for Anterior Shoulder Instability

March 9th, 2007

Following a traumatic dislocation of the shoulder, recurrent instability—either dislocation or subluxation—may occur. This happens more frequently in patients younger than 40 years of age, and less frequently in those older than 40. Physical therapy may help to improve the effectiveness of the rotator cuff in dynamically stabilizing the shoulder, but if the torn capsulolabral complex does not heal, and symptoms of instability persist, arthroscopic surgery is feasible and efficacious in the majority of patients. Further, success rates have approached those observed with traditional open approaches, making the less invasive nature of arthroscopic repair all the more attractive. In some cases open repair may be needed, however. If a fracture of the glenoid or humerus has occurred, open techniques may be need in order to provide bony reconstruction. Postoperatively, a sling is used for 4-6 weeks. Usually therapy begins at approximately 3 weeks after surgery, and it may take upwards of 3 months to regain full motion. Return to contact sports is allowed after 4 months.

The inferior glenohumeral ligament is the primary stabilizer when it comes to resisting anterior instability. When torn acutely it is called a “Bankart lesion.” When this capsulolabral complex displaces and scars to the glonoid away from the articular rim, it may be called an ALPSA lesion (anterior labral-ligamentous periosteal sleeve avulsion). Effective surgical repair requires mobilization and repair to the glenoid articular rim. Physical exam will show that the humeral head displaces anterior to the glenoid rim to some degree. If it can be displaced to the rim it is 1+; if it can be displaced over the rim, but it spontaneously comes back, it is 2+; if it stays anterior to the rim, it is 3+ (see video of physical exam).

Related Photos:

Detached capsulolabral complex

Labral complex repaired

Related Videos:

Preoperative exam shows anterior instability

1.Mobilization of labral complex

View of mobilized labral complex from the front

2. Glenoid neck burred/prepared

3. Preparation prior to suture 1st placement

4. Spectrum passed through capsule to shuttle prolene

5. Prolene placed

6.Drilling performed for anchor placement

7. Suture shuttled around labral complex

8.Suture tied

9. Completed capsulolabral repair