Shoulder Stabilisation

Shoulder stabilisation surgery is used to treat shoulder instability: a shoulder that has dislocated, partly dislocated or given way, either once or repeatedly.

The operation repairs the tissue that normally holds the shoulder in its socket and that has been stretched or torn. This includes the labrum (the ring of cartilage around the rim of the socket), the ligaments and the capsule, and sometimes the biceps tendon as well.

The procedure

The damaged tissue is repaired, usually using anchors and sutures, with the aim of restoring stability to the joint and reducing the chance of further dislocations.

Stabilisation surgery is used for anterior (front), posterior (back) and global (multidirectional) instability. It is usually considered after conservative treatment, such as physiotherapy, has not worked. Several different operations are used to treat instability, and which one is appropriate depends on the individual case, in particular on the direction of the instability, how much bone has been lost from the socket, and your age and activities.

Dr Cutbush typically performs stabilisation surgery arthroscopically (through keyhole incisions) and usually books around two hours of theatre time.

Risks and complications

General surgical risks

• Bruising and haematoma. The amount of bruising varies from person to person. It is a normal part of healing and usually settles quickly.
• Infection. A possible risk, usually treated with antibiotics.
• Deep vein thrombosis (DVT) and pulmonary embolism (PE). Blood clots in the leg (DVT) or the lung (PE). Untreated they can be serious, but the risk of harm is significantly reduced when they are treated promptly.
• Anaesthetic risk. This is discussed in detail with your anaesthetist before surgery. The risk of death under a general anaesthetic in Australia is approximately 1 in 100,000.
• Wound problems. Superficial wound problems can occur. Most need only a minor intervention.

Risks specific to this procedure

• Shoulder stiffness
• Numbness and tingling
• Recurrent instability or dislocation
• Hardware problems
• Frozen shoulder

Before surgery

There are a number of things to organise while you are waiting for surgery. You will also be given detailed written instructions to make the process as smooth as possible.

1. Check with your health fund whether the hospital fee is covered by your policy.
2. Confirm your anaesthetist’s fees.
3. Register your details with the hospital.
4. Read, complete and return the paperwork to Dr Cutbush’s office.
5. Arrange your transport to and from hospital. You will not be able to drive yourself home.
6. Book any pre-operative physiotherapy that has been recommended.
7. Have any pre-operative blood tests or other pathology that is required.
8. Skin preparation. Use a benzoyl peroxide 5% wash on the shoulder five times in total: twice a day for two days, then once on the morning of surgery. This reduces the risk of infection from Cutibacterium acnes.
9. Hospital bag. Pack your medications in their original packaging, a loose button-up shirt, nightwear and toiletries. If you have sleep apnoea, bring your CPAP machine.
10. Blood thinners. Phone Dr Cutbush’s office to confirm when to stop them before surgery.
11. Diabetic tablets. Phone your anaesthetist to confirm whether to stop them.
12. Confirm your admission details with the office one to two business days before surgery.

The day of surgery

• Your admission details are confirmed one to two business days before surgery. Make a note of your admission time and your fasting time.
• Admission can be as early as 6am. If you live outside Brisbane, staying overnight beforehand is usually recommended.
• After admissions you wait in the surgical waiting area. The anaesthetist meets you briefly before you have your general anaesthetic.
• Dr Cutbush greets you in the anaesthetic bay and marks the operation site with you.
• You usually stay one night and are typically discharged around 10am. Dr Cutbush sees you before discharge.
• You are given a folder containing your post-operative pack. It includes a letter describing what was found and what was done during surgery, along with rehabilitation and post-operative care information.
• Arrange for someone to take you home.

Recovery and healing

• The shoulder is immobilised in a sling full time for six weeks, so that the repair can heal fully. If you have had a posterior stabilisation, an external rotation brace is used instead of a sling.
• Physical activity is restricted during this period, and you are not allowed to drive.
• Limited physiotherapy exercises begin about 14 days after surgery.
• Full recovery can take six to nine months.

Rehabilitation

Rehabilitation focuses on restoring movement and strength while protecting the repair until it has healed. Your exact program depends on which operation you have had. Dr Cutbush’s guidelines cover eight variants: anterior, global and posterior stabilisation, each with or without a biceps tenodesis, plus posterior stabilisation with a bony allograft. The elements below are common to all of them.

Day one

Goals

• Protect the healing labral and capsular repair by avoiding combined positions. Anterior and global repairs avoid external rotation combined with abduction or extension. Global and posterior repairs also avoid cross-body movement, internal rotation, and flexion combined with internal rotation.
• Manage pain and inflammation.
• Keep passive glenohumeral movement limited to prevent stiffness, while keeping the adjacent joints actively moving.
• By week six the shoulder should be appropriately tight. For anterior and biceps variants, the targets are flexion to 90 degrees and external rotation of 0 to 10 degrees.
• Maintain range of motion in the adjacent joints and good scapular posture.

Sling

• Worn full time for six weeks, except when showering or doing your prescribed exercises.
• Come out of the sling two to three times a day, for your prescribed exercises only.
• The fit is checked and you practise daily tasks such as showering and dressing.

Precautions

• No active use of the glenohumeral joint.
• If a biceps tenodesis was done: no active elbow flexion and no loading of the biceps tendon.
• For posterior repairs: the sling should be positioned so that there is minimal tension on the repair, in a position of slight external rotation.

Exercises

• The sling is fitted correctly and you are taught to put it on and take it off independently.
• Ice is used as needed.
• Light hand use only, within the sling, for daily activities. Posterior repairs also avoid cross-body and hand-behind-back movements.
• Passive pendulum exercises to 80 degrees of flexion. External rotation is taken to neutral, or to 0 to 10 degrees for anterior and posterior repairs. Posterior repairs avoid internal rotation. For a bony allograft, follow the operation record for external rotation limits.
• Active movement of the adjacent joints.
• Scapular awareness, with emphasis on the upper and mid trapezius.

Follow-up

You see your local physiotherapist at two weeks, to check your pain control, your home exercise program, the fit of your sling and your precautions. Formal physiotherapy starts after the week six review with Dr Cutbush.

Results after surgery

Stabilisation surgery aims to restore stability to the shoulder, reduce dislocations and instability symptoms, and improve pain and function. Published series report good to excellent results in most patients. Individual results vary.

How closely you follow the recovery plan, and whether you continue with physiotherapy, have a strong influence on the long-term outcome. Individual factors and the type of surgery performed also affect the result.

Next steps

• Shoulder instability
• Anterior shoulder instability
• Shoulder anatomy
• Surgery FAQs
• Book a consultation

This page is general information about a surgical procedure and is not a recommendation that you have it. Whether surgery is appropriate for you can only be determined after assessment. All surgery carries risk; the risks relevant to you are discussed in consultation before any decision is made.