Arthroscopic shoulder stabilisation

Bankart repair or Labral repair
Summary

This operation is performed for shoulder dislocation or instability caused by a history of trauma.  The aim of the operation is to repair the labrum that has been torn off by the dislocation back on to the glenoid (socket) rim.  If you consider the glenoid to be a “golf tee” the labrum is “the lip of the golf tee”.  This is done through keyhole surgery.

Factors to Consider

The shoulder has the most movement out of all the joints in the body and so consequently is prone to dislocating.  Most shoulder dislocations occur due to a traumatic event but dislocations can occur without any trauma.  When the shoulder dislocates without trauma it is usually due to the muscles around the shoulder working incorrectly.  Shoulder dislocations without trauma are best treated with physiotherapy.

Traumatic shoulder dislocations usually tear off a cartilage bolster called the labrum from the glenoid socket.  This may not heal in the correct place causing the shoulder to be more likely to dislocate again.  Younger patients have a higher risk of recurrent dislocation.  For example an 18 year old male has an 80% chance of recurrence compared to a 40% chance at the age of 30.  Women are less likely to have recurrent dislocations.  An 18 and 30 year old female risk is 45% and 20% respectively.

An arthroscopic shoulder stabilisation can reduce the risk of dislocation significantly.  It is a good operation to consider in young males who have had one dislocation or any person who has had multiple dislocations.

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is performed through 3 small (less than 1cm) cuts to your shoulder.  The surgeon is able to look at your shoulder joint to make sure nothing else is contributing to your symptoms.  The surgeon will then free the labrum where the tear has happened.  The labrum is then stitched back to the glenoid rim and secured using bone anchors.

The operation takes about 60 minutes.

Anaesthetic

The operation is performed under a general anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

It is common for you to be offered a nerve block to help with the pain.  The nerve block allows excellent pain relief immediately after the operation.  It is considered a safe method of providing pain relief with few complications (less than 1%).  You will wake up with a numb arm, similar to when you sleep on your arm awkwardly.  The block wears off within 12-24 hours and so it is important to take pain killers the night after the surgery even if you don’t have pain when you go to sleep.

The anaesthetist will talk more about the nerve block when they see you.  If you do not want a nerve block your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The risk of infection is very small and is thought to be about 0.5%.  Most infections will settle simply with antibiotics.  Damage to nerves and blood vessels around the shoulder can occur but this is rare.  Stiffness early after the surgery is common and you will need physiotherapy to help with this.  

The risk of dislocating your shoulder after surgery is about 10% with most happening in the first 2 years caused by further trauma.

 

After Surgery

Pain

Local anaesthetic or a nerve block will be used during the operation and so you will feel comfortable when you first wake up.  The nerve block can make your whole arm feel numb.  This can last up to 12 hours but the shoulder may be sore after it wears off.  You will be given a combination of pain killers to go home with.  It is important that you take regular pain relief so that you can start moving your arm early.  

You may also be given an icepack.  The nurses will show you how to place the icepack on your shoulder.  The icepack should be taken off after 15 minutes  and can be used every 2 hours.

Sling

You will wake up with your arm in a sling.  The arm should be comfortable but it is important to let the nurses know if you have pain so that further pain killers can be given.  The sling is for comfort and is normally used during the first 4 weeks.  You can take your arm out of the sling if you would like but it is best to keep your arm below shoulder height during the first month after surgery.  You should wear the sling to be for the first few weeks.

Dressings

There will be dressings applied to the wounds following your operation.  These can occasionally come off and will need to be replaced during the first 2 weeks after surgery to protect the wound.  

The dressings are splash proof but not waterproof and so you should avoid getting them wet.

The wounds are closed using non-dissolvable stitches.  The stitches will need to be removed at 10-14 days following surgery.  The nurses will arrange this to be done at your local GP practice before you are discharged.

Physiotherapy

Physiotherapy is absolutely essential in ensuring that your shoulder fully recovers.  The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you within 3 weeks of the operation.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able to swerve out of the way of something in the road.  This will vary between patients but normally takes about 3 weeks.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable.  Most people will be using their arm comfortably below shoulder height within the first 4 weeks.  Your symptoms should be improved/improving by 3 months with the majority fully recovered by 6 months.  It can, however, take up to a year for some patients to fully improve.