Shoulder Stabilization

Shoulder stabilization refers to a range of surgical procedures aimed at restoring normal anatomy and, thus, stability to the shoulder joint. The goal of shoulder stabilization is to prevent recurrent dislocations, reduce pain, and improve the shoulder’s function and range of motion, thereby enhancing the quality of life and allowing individuals to return to their daily activities or sports.

Initially, shoulder instability is often managed with non-surgical treatments, especially if it’s the patient’s first dislocation. These treatments focus on strengthening the muscles around the shoulder, improving proprioception (joint position sense), and stabilizing the joint through rehabilitative exercises. Non-surgical treatments typically include:

• Anti-inflammatory medications: NSAIDs are used to reduce pain and swelling.
• Physical Therapy: Customized exercise programs are designed to strengthen the rotator cuff muscles and the other shoulder stabilizers to support the shoulder joint.
• Activity Modification: Patients are advised to avoid activities or movements that could exacerbate their condition, such as overhead sports or heavy lifting until their strength and stability improve.
• Bracing: In some cases, a shoulder brace may limit movement and provide external support to the joint during the healing process or while participating in activities that could pose a risk.

First-time shoulder dislocations are associated with a high rate of recurrent instability, especially in young athletes. Some may have recurrent instability soon after or, in others, after a period of years after their first dislocation.

Surgical intervention may be necessary when non-surgical treatments fail to provide adequate stability or in cases of significant structural damage to the joint (such as glenoid fracture or bony Bankart injury). The choice of surgery depends on the specific causes and characteristics of the instability, as well as the patient’s age, activity level, and preferences. Common surgical procedures include:

• Arthroscopic Bankart Repair or Arthroscopic Stabilization: A Bankart Lesion is a tear in the shoulder labrum or detachment of the labrum caused by a shoulder dislocation. The labrum plays an integral role in providing shoulder stability. In cases of recurrent shoulder dislocations or for highly active individuals or athletes, surgical repair may be recommended to reattach the torn labrum to the bone and restore stability to the shoulder. This procedure involves reattaching the torn labrum to the rim of the shoulder socket using suture anchors, thereby restoring stability to the joint. The surgery is often performed arthroscopically, using small incisions and specialized instruments to minimize recovery time and improve outcomes. Recovery from a Bankart repair involves a period of immobilization with a sling (typically six weeks) to allow for healing, followed by a structured physical therapy program. Rehabilitation focuses on gradually restoring the shoulder’s range of motion, strength, and stability. The duration of recovery can vary but often takes approximately six months, depending on the extent of the injury and the specific demands of the patient’s activities or sports.
• Latarjet Procedure: In cases where significant bone loss from the glenoid socket or recurrent dislocations that have not been successfully treated with other methods (such as prior arthroscopic stabilization) occur, the Latarjet procedure may be an option. It involves transferring a piece of bone, called the coracoid, from the shoulder blade with an attached tendon to the front of the glenoid, thereby increasing the socket depth and restoring shoulder stability. This procedure may be performed as open or arthroscopic surgery.

Overall, the majority of studies showed similar rates of return to play following arthroscopic Bankart repair or open Latarjet procedure. Studies indicate that the rate of repeat shoulder dislocation is lower in the Latarjet group compared to the arthroscopic Bankart repair group.