Patients who suffer multiple shoulder dislocations are candidates for instability repair surgery. The essential structural injury that occurs with a shoulder dislocation is a disruption of the capsular ligaments and labrum that keep the ball and socket linked together. Instability repair involves reattaching the injured ligaments and in most cases the labrum to restore that stable linkage.
Instability repair is performed arthroscopically through small incisions with the aid of video technology. The technical aspects of instability repair involve placing small screws in the socket (glenoid) where the capsular ligaments and labrum normally attach. There are rare cases where theses screws may need to be placed in the ball (humerus) as well. The screws are called suture anchors and are made from a special form of biodegradable plastic that the body will naturally absorb over time. The suture anchors are armed with high strength sutures that are then placed through the torn capsule and labrum tissue, and through a variety of pulley-type techniques the tissue is returned back to the bone at the location of the anchor.
Patients are placed into a specialized sling which they are expected to wear for 4 to 6 weeks after surgery. The sling can be removed for bathing and changing clothes and for appropriate physical therapy, but no purposeful, active movement of the shoulder is permitted as this can compromise the healing process. Physical therapy following instability repair involves a very gradual process of stretching and progression to simple shoulder function over a period of several weeks. The goal is to slowly restore mobility to the shoulder without prematurely and excessively stretching the repair.
Pain management following instability repair involves the use appropriate pain medication and liberal use of ice. Frequent icing has been shown to have a profound effect on postoperative pain. We also utilize nerve blocks in almost all rotator cuff surgeries. The block, administered by an anesthesiologist just prior to surgery, uses a long acting numbing agent which affords the patient complete relief of shoulder pain for many hours following surgery. As the block begins to wear off patients are able to anticipate the pain that will follow and start treating it with their prescribed medication before the pain starts.