Shoulder stabilisation surgery

What is shoulder stabilisation surgery?

Shoulder stabilisation surgery is a procedure used to restore movement and strength to the shoulder joint. It’s a common treatment for recurring shoulder dislocations (when the top of the upper arm bone comes out of its socket), with about 8,000 procedures performed across the UK each year.

What is shoulder stabilisation surgery also known as?

Should stabilisation surgery may also be referred to as dislocated shoulder surgery, shoulder dislocation surgery, or shoulder instability surgery. However, all three terms refer to the same procedure.

You may also hear of it referred to as anterior shoulder stabilisation. 90% of surgeries are anterior, which means that they take place at the front of the shoulder.

What are the different types of shoulder stabilisation surgery?

There are several different types of shoulder stabilisation surgery, and which is right for you will depend on your own unique circumstances. Your consultant and medical team will be able to advise you which form of shoulder stabilisation surgery is best suited to your needs.

What are the benefits of shoulder stabilisation surgery?

It’ll probably come as no surprise that the main benefit of shoulder stabilisation surgery is that successful treatment should help to prevent further shoulder dislocations. As a result of this, you should be able to enjoy greater confidence in doing your usual daily activities, from reaching up and putting things in cupboards to taking part in sports like tennis and swimming.

You can expect to enjoy reduced pain, better strength and more range of motion in your arm and shoulder joint.

What conditions can shoulder stabilisation surgery treat?

Shoulder stabilisation surgery can be used to treat a range of conditions including:

• Recurring shoulder dislocations
• Shoulder subluxations (also known as a partial dislocation)
• Bankart lesions: This is where the labrum at the front of the shoulder socket is torn, usually as a result of forward shoulder dislocation caused by trauma.
• Hagl lesions: This is when the ligaments are ripped off of the arm bone during dislocation or trauma.
• Bone loss, which can be caused by trauma or osteoarthritis of the shoulder joint.

What is shoulder instability? 

To understand shoulder instability, you first need to understand how the shoulder socket works.

The shoulder socket, also sometimes known as the glenoid cavity or fossa, is made up of a ball-and-socket joint. The ball refers to the round bony end of the upper arm bone (humerus) while the socket is a shallow, cup-shape area at the end of the shoulder blade. The socket is ringed with cartilage called the labrum, and this helps to keep the ball more securely within it.

The shoulder joint is supported by rotator cuff muscles, which are the group of tendons/muscles that cover the joint, and ligaments with a fibrous capsule. This lubricates further stabilises it the joint.

Shoulder instability is characterised by the ball of the joint coming fully or partially out of the socket.

What causes shoulder instability?

Shoulder instability can be caused by a range of things, including but not limited to:

• Traumatic injury: these can occur in sports like cricket, tennis, padel and swimming, as well as from trips, falls and collisions.
• Repetitive strain: repeatedly doing the same overhead movements can stretch the shoulder capsule over time, and this makes dislocation more likely.
• Previous dislocation: if you’ve dislocated your shoulder previously, the ligaments within the joint may have stretched and this could make further dislocations more likely.
• Hypermobility: if you’ve been diagnosed with hypermobility, it means that you naturally have looser joints, putting you at higher risk of a dislocation.

What are the symptoms of shoulder instability?

You may have shoulder instability if you experience:

• sudden, sharp pain in your shoulder, or a deeper, persistent ache
• a feeling as though your shoulder isn’t in the socket properly
• difficulty moving your arm due to stiffness
• being concerned about doing certain movements because you feel like your shoulder joint may come loose
• clicking, popping or grinding noises from the joint
• loss of strength in your shoulder and arm
• swelling and bruising around the shoulder
• regular dislocations.

How is shoulder instability diagnosed?

Like most conditions, shoulder instability is diagnosed following a combination of physical examination, your medical history and imaging tests. These imaging tests could include x-rays or MRI scanning, as these are able to provide pictures of the structures inside your shoulder joint.

How do I know if I need shoulder stabilisation surgery?

You’ll need to attend a consultation appointment to find out if shoulder stabilisation surgery is a suitable option for you.

You may be a good candidate for the procedure if:

• you have experienced recurring shoulder dislocations
• you’ve got confirmed damage to the cartilage or ligaments in the joint
• you’re too nervous to move your shoulder/arm extensively because you’re worried it will come out of its socket
• you’ve tried other treatments like physical therapy, without success
• you’re young and have a very active lifestyle.

Who is not suitable for shoulder stabilisation surgery?

People who aren’t good candidates for shoulder stabilisation include those with:

• hypermobility, as they generally don’t have positive outcomes from this treatment and would benefit more from physical therapy
• significant bone loss
• previously failed shoulder surgery
• an active infection.

You may also be told that you’re not suitable for surgery if you’re not prepared to commit to a lengthy recovery process, have chronic health conditions or a particularly high BMI.

What are the alternatives to shoulder stabilisation surgery?

Shoulder stabilisation surgery is usually only recommended after more conservative treatment options have been exhausted. These could include:

• non-steroidal anti-inflammatory medications
• physical therapy exercises designed to improve strength in the rotator cuff muscles which can help stabilise the joint
• avoiding repetitive movement
• injection therapies such as corticosteroids, Platelet-Rich Plasma (PRP) or Hyaluronic acid.

Your consultant will be able to advise you if there are any options that could delay or avoid your need for shoulder stabilisation surgery.

How can I prepare for shoulder stabilisation surgery?

Preparing for surgery – sometimes known as prehabilitation – is an important part of your care. Studies show that by optimising your health ahead of your procedure, you could help to reduce your risk of complications, speed up your recovery and enjoy better overall outcome from treatment.

So, what does this look like? Prehabilitation can be broken down into different areas including:

• Nutrition: eating a healthy balanced diet can ensure you’ve got all the nutrition you need before surgery.
• Minimising alcohol: while you don’t need to totally avoid alcohol in the weeks before surgery, you shouldn’t drink more than the recommended amount, and you shouldn’t drink any for at least 48 hours prior to your procedure as it could increase your risk of complications.
• Stopping smoking: smoking greatly increases your risk of experiencing surgical complications, as well as delaying your rate of healing and recovery.
• Strengthening exercises: you may be given exercises to follow that will help to strengthen the surrounding muscles before your surgery.
• Stopping medications: if you take any regular medications, you may need to temporarily stop taking some of them before your surgery. Your consultant will advise.

You’ll also need to arrange for someone to drive you to and from your appointment, and to stop eating or drinking the evening before your surgery.

It’s important that you follow all prehabilitation recommendations provided by your Nuffield Health surgical team.

Will I need an MRI scan before shoulder stabilisation surgery?

Yes, you may need to have an MRI scan before your surgery. An MRI scan can be useful both for visualising the soft tissues in your joint to see the extent of the damage, and for planning your surgery.

What happens on the day of shoulder stabilisation surgery?

On the day of your surgery, you’ll be asked to come into the hospital for a few hours ahead of your procedure. This will give you time to get checked in, have all of your pre-surgery observations (blood pressure, temperature, heart rate etc) and ask any last questions you have.

What should I expect duing shoulder stabilisation surgery?

Shoulder stabilisation surgery is normally carried out under general anaesthetic. This may be combined with a nerve block, to help keep your shoulder and arm numb and comfortable in the hours straight after your surgery.

Exactly what happens during the procedure will depend on the type of shoulder stabilisation surgery you’re having. With an open surgery, a larger incision of around five to ten centimetres will be made to access the joint, whereas with arthroscopic surgery, several much small incisions will be used. Your procedure will then be performed and the incisions closed using stitches. Then you’ll be taken to a recovery room where you’ll be monitored while you come around from the anaesthesia.

In most cases, it’s possible to go home the same day as your surgery.

Is shoulder stabilisation surgery painful?

The surgery itself is performed under anaesthetic meaning that you won’t be awake or feel any pain. However, it’s normal to experience pain in the days and weeks following your procedure, and you’ll be prescribed medication to take which should help keep you as comfortable as possible.

How long does shoulder stabilisation surgery take?

In most cases, shoulder stabilisation surgery takes less than two hours. However, exact times can vary.

Will I need a general anaesthetic for shoulder stabilisation surgery?

Yes, shoulder stabilisation surgery is usually carried out under general anaesthetic.

How long does it take to recover after shoulder stabilisation surgery?

Recovery from shoulder stabilisation surgery isn’t fast, with total recovery usually taking between six and twelve months. It can be broken down into different phases and is similar to the recovery from rotator cuff repair surgery.

Initial healing phase
For the first six weeks, you’ll have to wear a sling to keep your shoulder stable and immobilised. This will help start the healing process. You’ll probably need to take pain relief regularly, and you may be given some gentle physical therapy exercises to follow.

Weeks six to twelve
You’ll be able to remove your sling, but you’ll still have to avoid any significant physical activity or heavy lifting. You’ll be given more physical therapy activities to complete, to start building gradual strength and movement in your arm. You may also find that you no longer need much in the way of pain relief. If you have a sedentary job, you can probably return to work.

Months three to six
Movement should be getting easier, and your physical therapy exercises will be designed to build more strength and mobility in your shoulder. If you have a physically active job, you may be able to go back to work towards the end of this period.

Most people are able to return to their normal daily activities, including sport, by around nine months after your surgery. However, everyone is different and it’s important that you always follow the guidance of your consultant and medical team.

How soon can I drive after shoulder stabilisation surgery?

You probably won’t be able to drive for at least 6 to 8 weeks following your surgery. Your consultant will want to perform some checks on your shoulder strength and mobility to ensure that you can manoeuvre your car fully and safely. It’s important that you don’t drive before you are given permission by your consultant as this could invalidate your insurance.

How soon can I return to sport after shoulder stabilisation surgery?

Getting back to exercise after shoulder stabilisation surgery can take time, so patience is required. Generally, you should be able to take part in light, non-contact activities such as walking, swimming and stationery cycling at around 12 weeks post-surgery. However, returning to high impact exercise could take between six and 12 months. Again, always follow the guidance of your Nuffield Health surgeon.

What should I avoid after shoulder stabilisation surgery?

Your consultant will provide you with a list of activities that you should avoid in the days and weeks after your rotator cuff repair surgery. This will be quite extensive and could include:

• Performing specific arm movements, such as reaching behind your back
• Lifting or carrying anything, including light objects, for at least six weeks
• Sleeping on that should for at least six weeks
• Driving until cleared by your surgeon
• Getting the incisions wet for at least 48 hours, and not soaking them until they are fully healed
• Taking anti-inflammatory medications until otherwise advised as these could slow your rate of healing
• Smoking, as this will delay your healing and put you at more risk of post-operative complications.

Will I need physiotherapy after shoulder stabilisation surgery?

Absolutely. Commitment to a robust physical therapy programme is an essential part of your recovery and you’ll need to demonstrate your willingness to do this before being approach for the surgery.

Post-surgery physiotherapy is designed to help you regain strength, full range of movement and confidence in your ability to use your arm and shoulder. Your programme will involve both in-person appointments and exercises to complete at home.

Does shoulder stabilisation surgery leave a scar?

Yes, you will have at least one scar following your surgery. Scarring depends on whether you have open or arthroscopic surgery. Open surgery leaves one, larger scar whereas arthroscopic surgery leaves several much smaller ones. With the right care, most scars do fade over time, with arthroscopic scars often becoming almost invisible with time.

What are the risks and complications of shoulder stabilisation surgery?

All surgeries come with a risk of complications, including shoulder stabilisation.

Possible risks of shoulder stabilisation surgery

• General surgical risks such as bleeding, deep vein thrombosis, bruising and infection
• Stiffness/frozen shoulder syndrome
• Tendons and ligaments failing to heal
• Damage to nerves and blood vessels
• Persistent pain following surgery.

What is the success rate of shoulder stabilisation surgery?

Shoulder stabilisation surgery is associated with a high success rate of over 90%, with instances of any recurring instability linked to patients playing high impact sport.

How much does shoulder stabilisation surgery cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.