Back to list of procedures >

Stabilisation (and SLAP repair)

What causes an unstable shoulder?

Your shoulder joint is surrounded by a capsule, which is thickened in part by very strong ligaments designed to maintain normal joint stability. It is normally very difficult to tear the capsular ligaments, or pull the shoulder out of joint. These type of injuries usually occur when a great deal of force has been applied to the shoulder or arm e.g.; or tackle in rugby. This can be described as a traumatic dislocation.

Some people naturally have loose shoulder joints, and their shoulder can slip in and out of the joint in more than one direction. This is known as “multi-directional instability”. This can often cause many problems and restrict daily living, as the patient will be afraid their shoulder will come out of the joint if they move their arm in a certain way.

With a severe dislocation the ligaments may become permanently detached from the front of the capsule. This is often described as a Bankart lesion. Your surgery may or may not involve repairing a Bankart lesion.

Damage to the “gristle” (labrum) around the socket of the shoulder joint may also be referred to as a SLAP (Superior Anterior to Posterior) lesion. This may be part of the damage caused by a dislocation but can also occur as a separate problem. It is repaired in a similar way to the ligaments.

Shoulder instability is one of the more challenging disorders that orthopaedic surgeons treat. The incredible range of movement your shoulder is capable of is achieved by a balance between the structures that allow motion, along with the structures that stabilise and move the joint i.e. the tendons, muscle groups and the capsule. Once this balance has been disrupted, it can be challenging to correct without causing excessive tightness or laxity.

How is this treated?

Shoulder instability following a traumatic dislocation can be treated with surgical procedures that are designed to repair and strengthen the ligaments that maintain normal joint stability.

Repairing the torn capsule and ligament back to the bone is called a Bankart repair, and tightening the capsule of the shoulder is called a capsular shift. Both of these procedures can be done using a keyhole technique (arthroscope) or as an open procedure.








Post operative instructions

Day 1 – 2 weeks
Day 1 commence with Polysling with body belt attached for 3 -4weeks
Finger, wrist and scapular setting exercises.
Gentle pendular exercises out of sling.
Assisted elbow flexion and extension.
Passive flexion as comfortable to 90°.
Passive external rotation to neutral.
Postural awareness.
Home when comfortable.

2 – 4 weeks
Polysling to be removed and weaned off.
Continue pendular exercises, flexion, extension and circumduction
Commence active assisted exercise as comfortable.
Active assisted abduction to 60° or more.
Active assisted external rotation comfortable to neutral.
Commence proprioceptive exercises (minimal weight bearing below 90°)

6- 12 weeks
Regain scapula and gleno humeral stability.
Gradually increase Range of movement with active exercise
Increase external rotation beyond neutral actively
Strengthen Rotator cuff
Increase proprioception through open and closed chain exercises.
Progress corestability.
Ensure and treat posterior capsular tightness if required.

No abduction exercises with external rotation until 3 months.

Milestones

Week 6 Elevation to pre-op level.
Week 12 Minimum 80% range of external rotation compared to asymptomatic side. Normal movement patterns throughout range.
Driving 8 weeks
Return to work Light duties as tolerated after 6 weeks
Heavy duties at 3 months
Swimming Breaststroke at 8 weeks
Freestyle at 3 months
Golf 3 months
Contact sports, racquet sports and rock climbing 6 months- including horse riding, football, martial arts.

Early Phase Shoulder Stabilisation Exercises (Weeks 1-2)

These exercises are designed to complement your Information Sheet.

Shoulder pendular exercises
Position: Step standing. With arm in sling lean your body forward. Support your body weight resting the un-operated arm on a table.
Action: Gently rock your weight from your front foot to your back foot, enabling the arm to move back and forth using your body weight, rather than your shoulder muscles.
Reps:  Repeat x6-10 x 3 per day

Progress to taking the arm out of the sling, as you feel comfortable.

Passive flexion < 90 (Weeks 1-2)
Position: Lying on your back.
Action: Hold your operated arm around the wrist using your unoperated arm. Raise both arms up towards your head using your unoperated arm to assist the exercise.
Reps: Repeat x6-10 reps x3 per day.
Progress to assisted weeks 2-4

Passive External rotation to neutral (1- 2 weeks).
Position: Lying on your back, hold a stick or similar.
Action: Start with your elbows tucked in at sides of body. Use un-operated arm to help move the operated arm, by pushing the stick rotating the arm away from body. Keep elbows tucked in. Move the arm no further than midline to protect the repair.
Reps: Repeat x6-10 x 3 per day.

Back to list of procedures >


 
Contact me
For further information and advice:
E:
info@shoulder-and-bone.co.uk
 

Alternatively, please call Michele Murphy:
T: 02392 352 206

 
Procedures
Click for further information
 
 
 © C J Hand, 2010
Site by Wizbit