You fell.. and you dislocated your shoulder.  You went to the emergency room, your shoulder was put back into place, but now your shoulder has re-dislocated a number of times.  You now have “recurrent shoulder instability”.

What’s next?

What is Shoulder Instability?

Shoulder instability is a situation where your shoulder remains unstable or continues to dislocate long after an initial injury.   The reason why your shoulder continues to dislocate is usually because you have torn a cartilage disc in the shoulder that we call the labrum.  The labrum serves as  the point of attachment for the ligaments in the shoulder.  Therefore if the labrum has torn off the bone, the ligaments are no longer functioning normally.  Please see the posts on why shoulder dislocations occur for a more in-depth discussion.

Shoulder Dislocation - Bankart Lesion - Labral Tear

Many of you have expressed an  interest in seeing what we actually do when we operate on a shoulder which continues to dislocate.  The pictures below are from a patient where the labrum and ligaments had torn off the front of the shoulder.  This is called a Bankart or a Perthes lesion.  This is the “essential” lesion that allows a shoulder to continue to dislocate… until it is repaired.  Until a few years ago, many of these procedures were accomplished open, through a painful incision on the front of the shoulder. There are still good indications for an open procedure… but that’s another discussion altogether.   Nowadays it is *standard* for many shoulder surgeons to accomplish the repair of the labrum and ligaments arthroscopically.

What Surgery is performed for a Shoulder Dislocation?

These pictures show the initial injury where the labrum has separated from the bone and is sitting behind the tip of the silver metal probe.  The second picture shows a suture anchor in place.  This is a small plastic or metal piece placed into the bone.  There is a small eyelet on the top of the anchor and that holds a suture.  The suture is then shuttled through the tissue to be repaired and the sutures are then tied.  Once the sutures are passed through the labrum and ligament they can be tied down.  After tying the sutures the labrum and ligaments are repaired to the bone, and in their normal anatomic position—third picture.    Assuming  all goes well, you, the patient,  have a 90+ percent chance of success.

Shoulder dislocation surgery, or the arthroscopic repair of the labrum should be a very straightforward procedure for an experienced shoulder physician.  As with developing competence in anything, make sure that your surgeon performs many of these.  Volume matters.  The more experienced and skilled your surgeon is, the better the chances are that you will be able to return to your prior level of function before your shoulder began dislocating.