The Procedure
Shoulder stabilisation surgery is a procedure to treat shoulder instability, where dislocations or instability episodes have occurred, either once or multiple times. The surgery repairs damaged tissue in the shoulder, including the labrum, ligaments, and tendons, that have been stretched or torn, and may include repairing the biceps tendon. The repairs are usually done with anchors or sutures, with the repairs helping to restore stability to the shoulder and prevent future dislocations.
The procedure can treat anterior, posterior and global instability, and is usually indicated after conservative treatments, such as physiotherapy, have failed. Other surgeries also treat shoulder instability, however the type of surgery that is appropriate is indicated by individual circumstances.
The surgery is typically done arthroscopically, and I usually book about two hours of theatre time.
Complications
General risks of surgery include:
- Bruising & haematoma: this will vary for each patient. Bruising is a normal side effect of surgery and usually resolves in a short time.
- Infection: infection is a possible risk and is usually treated with antibiotics.
- DVT and PE: deep vein thrombosis and pulmonary embolism are blood clots that form in either the lower limbs or lungs. If left untreated, DVT and PE can have serious effects, however if treated promptly, the risks are significantly lowered. More information can be found here.
- Anaesthetic risks: general anaesthetic (GA) carries a number of risks, which will be discussed in detail with your anaesthetist prior to surgery. Fortunately, Australia is one of the safest places to undergo a GA. In Australia, the risk of mortality from GA is around 1 in 100,000. For context, the risk of death in a car accident in Queensland is around 1 in 10,000 per year.
- Wound issues: some superficial issues can develop in surgical wounds postoperatively, however most will require a small intervention to resolve the problem.
Specific risks of stabilisation surgery include:
- Shoulder stiffness
- Numbness and tingling
- Recurrent instability or dislocation
- Hardware issues
- Frozen shoulder
Pre Op
Whilst you wait for your surgery date, there are a few things to do:
- Speak to your health fund to confirm if the hospital fee for your surgery is covered on your policy
- Speak to your anaesthetist to confirm their fees Register your details with the hospital
- Read through, complete and return your paperwork to my office
- Plan your transport to and from the hospital. You won’t be able to drive yourself home after the surgery, so make sure you have a travel plan in place
- If required, arrange any recommended pre op physio appointments
- If required, get any pre op pathology tests (e.g., blood tests)
- Use benzoyl peroxide 5% wash on your shoulder for 5 applications: twice a day for two days, and then again on the morning of the surgery. This will help reduce your risk of infection from Cutibacterium acnes.
- Pack a bag for your hospital stay including regular medications in the original packaging, a loose button-up shirt to wear after surgery, nightwear, personal items including toiletries. If you have sleep apnoea, you must bring your CPAP machine.
- If you are on any blood thinners, ring my office and confirm when to stop taking them before the operation.
- If you are on any diabetic tablet medications, ring your anaesthetist and confirm whether you need to stop taking them before the operation.
- Confirm your admission details with my office one to two business days prior to surgery.
Though this can seem overwhelming, you will be provided with detailed instructions on what needs to be done so your surgery journey can be as smooth as possible.
Day of Surgery
Your admission details will be confirmed one to two business days prior to surgery. You will need to make note of your admission time and your fasting time. Your admission time may be as early as 6am. If you aren’t local to Brisbane, it is usually recommended that you stay the night before in case your admission is early.
When you arrive at the hospital, you will go through the admissions process and then be taken through to the surgical waiting area. Your anaesthetist will have a short consultation with you before you go into theatre and under general anaesthetic. I will say hi to you before the surgery in the anaesthetic bay of the operating theatre and mark your operation site with you.
Your hospital stay will usually be one night. You will be discharged usually around 10am. I will see you before your discharge. I will provide you with a folder containing a detailed postoperative pack including a letter telling you what I found at surgery and exactly what I did in your operation along with information about your rehabilitation and postoperative care. Remember to have someone available to take you home from the hospital.
Post Op Recovery & Healing
Following stabilisation surgery, recovery involves immobilisation of the shoulder, requiring full time wear of a sling for 6 weeks, for the repaired tissues to completely heal. Posterior stabilisation surgery will require an external rotation brace. During this time, physical activities are limited, and no driving is allowed. Limited physiotherapy exercises begin around 14 days after surgery, and a full recovery can take between 6 to 9 months.
Rehabilitation
Rehabilitation and physiotherapy exercises after stabilisation surgery focus on restoring range of motion and strength, and protecting the repair until healed.
Physiotherapy Guidelines
Anterior Stabilisation Day 1 Physiotherapy Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling.
Goals:
- Protect the healing labral and capsular repair – patient educated to avoid ER/Abd/Ext (external rotation/ abduction/extension i.e. no reaching out to the side & behind) combination movements
- Assist in the management of pain and inflammation
- Maintain limited GHJ PROM (glenohumeral joint passive range of motion) to avoid excessive stiffness, maintain AROM (active range of motion) of adjacent joints
- To ensure that by week 6 that the shoulder is appropriately tight: Flexion to 90, ER (external rotation) (0) 0-10
- Maintain ROM (range of motion) in adjacent joints, ensure good scapula posturing
Sling:
- Sling is to be worn full time for 6 weeks except for showering and exercises
- Patient to come out of sling 2-3x/day to perform prescribed exercises only
- Check fit, demonstrate activities of daily living (showering, dressing etc)
Precautions:
- No active use of GHJ (glenohumeral joint)
- Avoid stressing the healing repair by avoiding Abd + ER (abduction + external rotation) or movements into elevation
Therapy:
- Ensure appropriate sling fit, pt taught to don/doff sling independently, hand to align to body midline
- Appropriate use of ice
- ADL (activities of daily living) advice – light use of hand only within sling
- Patient instructed in:
- passive ROM (range of motion) exercises for GHJ (glenohumeral joint): passive pendulum to 80 degrees flexion, stick ER (external rotation) in neutral to 0- 10 degrees
- AROM (active range of motion) for adjacent joints
- scapula awareness, ensure appropriate recruitment of upper and mid trapezius
Follow up:
- With local physio at 2 weeks to ensure pain managed, appropriate HEP (home exercise program) and precautions being followed, more formal physiotherapy to commence after week 6 visit with Dr Cutbush
Global Stabilisation Day 1 Physiotherapy Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling.
Goals:
- Protect the healing labral and capsular repair – patient educated to avoid ER/Abd/Ext (external rotation/abduction/extension i.e. no reaching out to the side & behind) combination movements as well as any cross body motion, internal rotation, flexion with internal rotation movements
- Assist in the management of pain and inflammation
- Maintain limited GHJ PROM (glenohumeral joint passive range of motion) to avoid excessive stiffness, maintain AROM (active range of motion) of adjacent joints
- To ensure that by week 6 that the shoulder is appropriately tight: Flexion to 90, ER (external rotation) (0) 0-10
- Maintain ROM (range of motion) in adjacent joints, ensure good scapula posturing
Sling:
- Sling is to be worn full time for 6 weeks except for showering and exercises
- Patient to come out of sling 2-3x/day to perform prescribed exercises only
- Check fit, demonstrate activities of daily living (showering, dressing etc)
Precautions:
- No active use of GHJ (glenohumeral joint)
- Avoid stressing the healing repair by avoiding Abd + ER (abduction + external rotation) or movements into elevation as well as any cross body motion, internal rotation, flexion with internal rotation movements
Therapy:
- Ensure appropriate sling fit, pt taught to don/doff sling independently
- Appropriate use of ice
- ADL (activities of daily living) advice – light use of hand only within sling
- Patient instructed in:
- passive ROM (range of motion) exercises for GHJ (glenohumeral joint): passive pendulum to 80 degrees flexion, stick ER (external rotation) in neutral
- AROM (active range of motion) for adjacent joints
- scapula awareness, ensure appropriate recruitment of upper and mid trapezius
Follow up:
- With local physio at 2 weeks to ensure pain managed, appropriate HEP (home exercise program) and precautions being followed, more formal physiotherapy to commence after week 6 visit with Dr Cutbush
Posterior Stabilisation Day 1 Physiotherapy Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling.
Goals:
- Protect the healing labral and capsular repair – patient advised against any cross body motion, internal rotation, flexion with internal rotation movements
- Assist in the management of pain and inflammation
- Maintain limited GHJ PROM (glenohumeral joint passive range of motion) to avoid excessive stiffness
- To ensure that by week 6 that the shoulder is appropriately tight
- Maintain ROM (range of motion) in adjacent joints, ensure good scapula posturing
Sling:
- Sling is to be worn full time for 6 weeks except for showering and exercises
- Patient to come out of sling 2-3x/day to perform prescribed exercises only
- Check fit, demonstrate activities of daily living (showering, dressing etc)
Precautions:
- No active use of GHJ (glenohumeral joint)
- Avoid stressing the healing repair by avoiding cross body movements/ IR (internal rotation)/Flexion
Therapy:
- Ensure appropriate sling fit, sling position to place minimal tension on posterior repair in an element of ER (external rotation) (Gun slinger position). Patient taught to don/doff sling independently. Hand to align to body midline
- Appropriate use of ice
- ADLs (activities of daily living) – light function of hand within sling, no cross body motion or hand behind back motions in washing or dressing
- Patient instructed in passive ROM (range of motion) exercises for GHJ (glenohumeral joint) - passive pendulum in scapula plane to 80 degrees stick ER (external rotation) at neutral to 10 degrees; No internal rotation
- AROM (active range of motion) for adjacent joints
- Education on scapula posturing ensuring appropriate recruitment of upper and mid trapezius
Follow up:
- With local physio at 2 weeks to ensure pain managed, appropriate HEP (home exercise program), sling fit and precautions being followed. Formal physiotherapy program to begin after week 6 visit with Dr Cutbush
Anterior Stabilisation and Biceps Tenodesis Day 1 Physiotherapy Guidelines
- The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling.
Goals:
- With local physio at 2 weeks to ensure pain managed, appropriate HEP (home exercise program), sling fit and precautions being followed. Formal physiotherapy program to begin after week 6 visit with Dr Cutbush
- Protect the healing labral and capsular repair – patient educated to avoid ER/Abd/Ext (external rotation/abduction/extension i.e. no reaching out to the side & behind) combination movements
- Protect the healing biceps tenodesis, no active elbow flexion.
- Assist in the management of pain and inflammation
- Maintain limited GHJ PROM (glenohumeral joint passive range of motion) to avoid excessive stiffness, maintain AROM (active range of motion) of adjacent joints
- To ensure that by week 6 that the shoulder is appropriately tight: Flexion to 90, ER (external rotation) (0) 0-10
- Maintain ROM (range of motion) in adjacent joints, ensure good scapula posturing
Sling:
- Sling is to be worn full time for 6 weeks except for showering and exercises
- Patient to come out of sling 2-3x/day to perform prescribed exercises only
- Check fit, demonstrate activities of daily living (showering, dressing etc)
Precautions:
- No active use of GHJ (glenohumeral joint), no active elbow flexion, no loading of biceps tendon.
- Avoid stressing the healing repair by avoiding Abd + ER (abduction + external rotation) or movements into elevation
Therapy:
- Ensure appropriate sling fit, pt taught to don/doff sling independently, hand to align to body midline
- Appropriate use of ice
- ADL (activities of daily living) advice – light use of hand only within sling
- Patient instructed in:
- passive ROM (range of motion) exercises for GHJ (glenohumeral joint): passive pendulum to 80 degrees flexion, stick ER (external rotation) in neutral to 0- 10 degrees
- AROM (active range of motion) for adjacent joint
- scapula awareness, ensure appropriate recruitment of upper and mid trapezius
Follow up:
- With local physio at 2 weeks to ensure pain managed, appropriate HEP (home exercise program) and precautions being followed, more formal physiotherapy to commence after week 6 visit with Dr Cutbush
Global Stabilisation and Biceps Tenodesis Day 1 Physiotherapy Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling.
Goals:
- Protect the healing labral and capsular repair – patient educated to avoid ER/Abd/Ext (external rotation/abduction/extension i.e. no reaching out to the side & behind) combination movements as well as any cross body motion, internal rotation, flexion with internal rotation movements
- Protect the healing biceps tenodesis, no active elbow flexion.
- Assist in the management of pain and inflammation
- Maintain limited GHJ PROM (glenohumeral joint passive range of motion) to avoid excessive stiffness, maintain AROM (active range of motion) of adjacent joints
- To ensure that by week 6 that the shoulder is appropriately tight: Flexion to 90, ER (external rotation) (0) 0-10
- Maintain ROM (range of motion) in adjacent joints, ensure good scapula posturing
Sling:
- Sling is to be worn full time for 6 weeks except for showering and exercises
- Patient to come out of sling 2-3x/day to perform prescribed exercises only
- Check fit, demonstrate activities of daily living (showering, dressing etc)
Precautions:
- No active use of GHJ (glenohumeral joint), no active elbow flextion, no loading of biceps tendon
- Avoid stressing the healing repair by avoiding Abd + ER (abduction + external rotation) or movements into elevation as well as any cross body motion, internal rotation, flexion with internal rotation movements
Therapy:
- Ensure appropriate sling fit, pt taught to don/doff sling independently
- Appropriate use of ice
- ADL (activities of daily living) advice – light use of hand only within sling
- Patient instructed in:
- passive ROM (range of motion) exercises for GHJ (glenohumeral joint): passive pendulum to 80 degrees flexion, stick ER (external rotation) in neutral
- AROM (active range of motion) for adjacent joints
- scapula awareness, ensure appropriate recruitment of upper and mid trapezius
Follow up:
- With local physio at 2 weeks to ensure pain managed, appropriate HEP (home exercise program) and precautions being followed, more formal physiotherapy to commence after week 6 visit with Dr Cutbush
Posterior Stabilisation Day and Biceps Tenodesis 1 Physiotherapy Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling.
Goals:
- Protect the healing labral and capsular repair – patient advised against any cross body motion, internal rotation, flexion with internal rotation movements.
- Protect the healing biceps tenodesis, no active elbow flexion.
- Assist in the management of pain and inflammation.
- Maintain limited GHJ PROM (glenohumeral joint passive range of motion) to avoid excessive stiffness.
- To ensure that by week 6 that the shoulder is appropriately tight.
- Maintain ROM (range of motion) in adjacent joints, ensure good scapula posturing.
Sling:
- Sling is to be worn full time for 6 weeks except for showering and exercises
- Patient to come out of sling 2-3x/day to perform prescribed exercises only
- Check fit, demonstrate activities of daily living (showering, dressing etc)
Precautions:
- No active use of GHJ (glenohumeral joint)
- Avoid stressing the healing repair by avoiding cross body movements/ IR (internal rotation)/Flexion
- No active elbow flexion
Therapy:
- Ensure appropriate sling fit, sling position to place minimal tension on posterior repair in an element of ER (external rotation) (Gun slinger position). Patient taught to don/doff sling independently. Hand to align to body midline
- Appropriate use of ice
- ADLs (activities of daily living) – light function of hand within sling, no cross body motion or hand behind back motions in washing or dressing
- Patient instructed in passive ROM (range of motion) exercises for GHJ (glenohumeral joint) - passive pendulum in scapula plane to 80 degrees stick ER (external rotation) at neutral to 10 degrees; No internal rotation
- AROM (active range of motion) for adjacent joints
- Education on scapula posturing ensuring appropriate recruitment of upper and mid trapezius
Follow up:
- With local physio at 2 weeks to ensure pain managed, appropriate HEP (home exercise program), sling fit and precautions being followed. Formal physiotherapy program to begin after week 6 visit with Dr Cutbush
Posterior Stabilisation with Bony Allograft Day 1 Physiotherapy Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling.
Goals:
- Protect the healing bone block and labral repair – patient advised against any cross body motion, internal rotation, flexion with internal rotation movements
- Assist in the management of pain and inflammation
- Maintain limited GHJ PROM (glenohumeral joint passive range of motion) to avoid excessive stiffness
- To ensure that by week 6 that the shoulder is appropriately tight
- Maintain ROM (range of motion) in adjacent joints, ensure good scapula posturing
Sling:
- Sling is to be worn full time for 6 weeks except for showering and exercises
- Patient to come out of sling 2-3x/day to perform prescribed exercises only
- Check fit, demonstrate activities of daily living (showering, dressing etc)
Precautions:
- No active use of GHJ (glenohumeral joint)
- Avoid stressing the healing repair by avoiding cross body movements/ IR (internal rotation)/ Flexion
Therapy:
- Ensure appropriate sling fit, sling position to place minimal tension on posterior repair in an element of ER (external rotation) (Gun slinger position). Patient taught to don/doff sling independently. hand to align to body midline
- Appropriate use of ice
- ADLs (activities of daily living) – light function of hand within sling, no cross body motion or hand behind back motions in washing or dressing
- Patient instructed in passive ROM (range of motion) exercises for GHJ (glenohumeral joint) - passive pendulum in scapula plane to 80 degrees, stick ER (external rotation) at neutral as per operation record; No internal rotation
- AROM (active range of motion) for adjacent joints
- Education on scapula posturing ensuring appropriate recruitment of upper and mid trapezius
Follow up:
- With local physio at 2 weeks to ensure pain managed, appropriate HEP (home exercise program), sling fit and precautions being followed. Formal physiotherapy program to begin after week 6 visit with Dr Cutbush.
Results After Surgery
Stabilisation surgery is typically a very successful procedure, restoring stability and lessening dislocations and instability symptoms, as well as improving pain and function. Adhering to recovery processes and ongoing physiotherapy can have significant impacts on long term results, however individual factors, as well as the type of surgery, can influence outcomes.