Shoulder instability is a disorder that will lead to subluxation or dislocation of the shoulder joint (excessive mobility), and the ball may come out of the socket. There are two types of shoulder instability: traumatic instability and multidirectional instability. With the traumatic type of shoulder instability, the shoulder is forcefully dislocated during an injury, such as a fall or car accident. This results in torn tendons and/or ligaments. Multidirectional instability is when the shoulder joint becomes too lose and may dislocate or partially displace with simple movements. This type of shoulder instability is not related to injury or trauma.
When the orthopedic specialist diagnoses shoulder instability, non-surgical measures are often attempted first. However, when these treatments do not prevent further episodes of subluxation or dislocation, surgery is recommended.
Shoulder Capsule Surgery
The shoulder capsule is the compartment that surrounds the shoulder joint. This envelope contains several thick ligaments and other structures that stabilize the shoulder. Patients with multidirectional instability often have laxity of the ligaments and capsule looseness. Surgery to correct this instability is aimed at tightening the ligaments and decreasing the size of the capsule. The traditional shoulder capsule surgery involves an incision in the front aspect of the shoulder, which is called a capsular shift. The arthroscopic procedure is done by the aid of a tiny flexible tube that has a camera and is inserted into the shoulder for repairs.
Open Capsular Shift
An open capsular shift is a surgery performed to tighten the shoulder joint. With this technique, the orthopedic surgeon makes an incision at the front of the shoulder and detaches the subscapularis (area of the rotator cuff) to allow visualization inside the joint. The capsule is split, the bottom aspect pulled up, and the top pulled down to lessen volume.
The advantage of the open capsular shift is that it has been perfected and works well. A top Los Angeles sports medicine orthopedic specialist can adequately visualize and tighten the joint to significantly reduce the shoulder capsule. However, the recovery is longer than other procedures due to the detachment of the subscapularis.
Capsular plication is a procedure performed arthroscopically. The Beverly Hills orthopedic surgeon will insert a tiny camera into the shoulder joint through a small incision and use sutures to grasp the areas of the shoulder capsule that need to be tightened. Some orthopedic specialists prefer this procedure because they can visualize the structures easily on the monitor and recovery time isn’t as long as with open surgery. Both techniques will work for shoulder instability, but the choice depends on the extent of the damage, the surgeon’s preference, and the patient’s health.
One of the most common structures involved with shoulder instability is the Bankart ligament, which causes the shoulder to be prone to anterior dislocations. Bankart repair involves stapling or sewing the ligaments and the labrum, on the front aspect of the joint, back into position. The orthopedic surgeon will clear away any torn or frayed edges and then drill holes for sutures into the scapula bone. The labrum and capsular ligaments are then attached to the bone. As they heal, scar tissue will anchor the ends to the bone.
Bankart repair surgery is usually done through an incision on the front region of the shoulder, but some surgeons use an arthroscopic technique. This technique means less time to heal and less time in the hospital.
Thermal Capsular Shrinkage
A newer procedure for shoulder instability is called thermal capsular shrinkage. The Los Angeles orthopedic surgeon uses an arthroscope to slide an electrode probe inside the shoulder joint. This electrode is heated and moved over the damaged ligament. The heat cause shrinkage of the capsule, as well as tightening. This surgery is still being perfected, and one complication is restricted shoulder mobility.