Invited faculty
Dr Ken Cutbush attended the Royal North Shore Shoulder Symposium as an invited faculty member. The course is a well-established Australian shoulder course, directed at teaching shoulder surgery skills to Australian orthopaedic surgeons.
The lecture
The lecture, "Shoulder Instability: How I do it", covered anterior Bankart repair, open repair for HAGL tears, arthroscopic Latarjet reconstruction and arthroscopic posterior bone block procedures.
The range reflects the fact that there is no single operation for an unstable shoulder. Which of these is appropriate depends on the direction of instability, how much bone has been lost, and which structures have failed.
How a shoulder becomes unstable
The shoulder trades stability for movement. The ball at the top of the arm bone is much larger than the socket it sits against, and it is held in place by a rim of cartilage called the labrum, by the capsule and ligaments that enclose the joint, and by the muscles around it. When the shoulder dislocates, those structures are stretched or torn. If they heal in a lengthened position, or if bone has been chipped from the rim, the joint can give way again with progressively less force, and some shoulders go on to dislocate repeatedly. Instability can also run backwards or in several directions rather than forwards, which changes what has been damaged and what needs to be addressed.
The operations covered
A Bankart repair reattaches the torn labrum and tightens the capsule at the front of the socket, usually arthroscopically through small portals. A HAGL lesion is a tear of the ligament where it attaches to the arm bone rather than to the socket, which sits in a position that generally calls for an open repair. An arthroscopic Latarjet transfers a small block of bone from the front of the shoulder blade onto the front rim of the socket to replace bone that has been lost. A posterior bone block applies the same principle at the back of the joint, for shoulders that are unstable in that direction. Each is chosen on the basis of examination and imaging rather than by preference, and each is followed by a period of protected movement and rehabilitation. Individual results vary.