The shoulder joint is a ball-and-socket joint and the body's most mobile joint, allowing you to position your hand in space 360 degrees around your body. This mobility, however, also makes the shoulder an easy joint to dislocate.
A subluxation or partial dislocation is when the head of the humerus is partially out of the socket (glenoid). A dislocation means it is all the way out of the socket. Both cause pain and instability in the shoulder.
The joint is stabilised by the soft tissues surrounding the socket- the labrum, a cartilaginous rim of the glenoid cavity, the capsule, and a series of ligaments that enclose the joint. Injury and trauma can tear or stretch the labrum and ligaments, causing instability and dislocation of the joint. Repeated dislocations will lead to bone loss from the glenoid.
Shoulder Dislocation Surgical Options in Perth
Arthroscopic surgery in Perth for shoulder stabilisation
Arthroscopy is a minimally invasive surgery (or keyhole surgery) and is performed through tiny incisions (portals), made around the joint area. During arthroscopy, a small camera, called an arthroscope, is inserted into your shoulder joint. The camera displays pictures of your shoulder on a television monitor and lets me to see the structures of your shoulder in great detail. Small incisions are made to insert the other surgical instruments.
Tearing of the labrum due to trauma is called a Bankart tear. An arthroscopic stabilisation repairs the labrum back on to the glenoid using suture anchors. The capsule is also tightened back up.
Latarjet procedure
Dislocation of the shoulder sometimes results in the breaking of bone along with the labrum. This is referred to as a bony Bankart tear. When this is the case a bony procedure is required to restore stability.
The Latarjet procedure is an open surgical procedure performed to treat shoulder instability by relocating a piece of bone (the coracoid) with an attached tendon (the conjoint tendon) to the bony defect at the front of the glenoid.
An incision of 5-8 cm is made from at the front of your shoulder. The coracoid process is transected at its base and moved along with the conjoint tendon to the anterior glenoid. It is held in position with 2 screws. The labrum is reconstructed using coraco-acromial ligament as reinforcement.
A Latarjet procedure stops re-dislocation by three means:
- The coracoid increases the glenoid surface area so the humerus does not slip out of the joint.
- The conjoint tendon, passing through the subscapularis muscle, acts as a sling at the front of the shoulder.
- Reconstruction of the labrum adds additional stability
The Latarjet procedure has a lower rate of re-dislocation following surgery than arthroscopic stabilisation. It is therefore recommended for higher-risk individuals (e.g. younger patients and those playing contact sports).
Recovery
Perth Hospital Stay
Usually, you will stay in a Perth hospital for one night. A physiotherapist will visit you the morning after the surgery when you are in the hospital.
Arm Sling
You will need to wear a sling for 3-6 weeks after the operation. You can bring your arm out of the sling to do your exercises.
Shoulder wound
The wound should be kept dry until the 2 week mark.
What Medicine for Shoulder Pain Relief?
After surgery, you will feel pain. This is a natural part of the healing process. Take regular Paracetamol (Panadol 1g 3-4 times/day) and anti-inflammatories (Celecoxib 100mg twice daily with food). Use the stronger painkillers (Tapentadol or Oxycodone) as required in the first few days. The pain will settle down after the first few days
Post Surgery Appointment
Your follow-up appointment will be about 2 weeks after the surgery. At this visit, your wounds will be checked, and staples will be removed.
Perth Physiotherapy
Specific physiotherapy is not needed for the first 2 weeks following the surgery. The exercises that you were shown in the hospital are all that are required. After 2 weeks, it is important to see a physiotherapist. This will be required for about 3 months from the time of your minor shoulder surgery, to 6 months after total shoulder placement surgery in Perth.
Shoulder Dislocation Surgery Complications
After shoulder stabilisation, a small percentage of patients experience complications. I will discuss these with you prior to your surgery. In addition to the risks of surgery in general, such as blood loss or problems related to anaesthesia, complications of rotator cuff surgery may include:
- Infection. Patients are given antibiotics during the procedure to lessen the risk of infection.
- Stiffness. Early rehabilitation lessens the likelihood of permanent stiffness or loss of motion. Most of the time, stiffness will improve with more aggressive therapy and exercise.
- Recurrence of instability. Following the rehabilitation protocol and advice minimizes this risk. This risk is smaller following a Latarjet procedure.
- Fracture or failure of union of the coracoid.
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WA Orthopaedic Consulting Rooms
Perth
St John of God
Medical Clinic
Suite 213
25 McCourt Street,
Subiaco WA 6008
Albany
Great Southern
Specialist Centre,
55 Cockburn Rd ,
Mira Mar WA 6330
Phone: 08 9489 8733
Email: blakeney@wcortho.com.au
Fax: 08 9489 8735
Perth Orthopaedic Operating Theatres
St John of God Hospital
12 Salvado Rd, Subiaco WA 6008