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If dislocation episodes occur frequently and with trivial events despite engaging in good physiotherapy, then one may have to consider surgery. However, before surgery, I would order an MRI arthrogram to understand the extent of the damage inside the shoulder joint. Once the extent of damage is understood, usually surgery is planned..
If the damage is limited to cartilage and ligament, then the repair is done by arthroscopic technique. For other circumstances especially with a bone defect, open surgery may be considered.
The aim of the operation is to reattach the cartilage element back to the rim of the socket and to create a ‘bumper’ by including part of capsule/ligament complex to re-establish the feedback loop.
The operation is usually performed as a day case procedure under general anaesthetic. One may supplement the general anaesthetic with a nerve block at neck or using local anaesthetic around the wound and inside the joint. The first step in this operation is examination of the joint under anaesthesia and if necessary to compare with the opposite side.
To perform the operation, you will be turned to your ‘good-
side’ such that the affected sided in on the top. Gentle traction will be applied to the arm to help the pass various instruments needed to perform the operation.
The shoulder joint is visualized by introducing the telescope via a small stab incision in the back of the shoulder. Sterile saline is pumped into the shoulder under pressure to distend the joint. To assess the inside of the shoulder, a further stab incision(s) may be placed in the front of the shoulder. The quality of the cartilage rim is checked from inside the joint.
Drill holes are made and an anchor with preloaded suture material is placed in the rim of the socket after creating a fresh surface. Using specialist instruments, sutures are passed around the cartilage-ligament complex and this is tied down to the socket firmly. This will secure the labrum at the right place and to some extent tighten the joint capsule. This can result in a minor loss of extremes of ranges of movement but not as much as doing this via open operation.
The wound is closed with sutures and water resistant dressing is applied. This is covered with a further layer of pressure dressing. The arm is then placed in a sling. You will be given information regarding wound care and information regarding various exercises you need to do.
Physiotherapy will be arranged if required.