In the case of an unstable shoulder that does not respond to physiotherapy treatment, there are several surgical procedures that can be used to restore stability. Each one of these is suitable for a slightly different type of dislocation. The type of procedure used by the shoulder consultant will depend upon the nature of the injury, the occupation and sporting activity of the patient, and the preference of the consultant. The more commonly used procedures are described in brief below.
The rehabilitation time before the patient can return to sport is usually about 6 months with the Bankart operation and Putti Platt operation, but less with the Bristow procedure.
In this operation the area of bone where the biceps muscle attaches at the top part of the shoulder joint is moved down about 5cm and re-attached on the front part of the shoulder blade. This is a good operation for non-sporting individuals as it provides stability and rehabilitation can be started soon after the operation. However, in the case of sportspeople, particularly throwing athletes, there is a loss of external rotation of the shoulder which is unacceptable for performance.
This operation is far more preferable for the throwing athlete, as the range of external rotation is not compromised. It is effective for damage to the labrum, as the surgeon re-attaches the labrum by drilling holes in the glenoid area of the shoulder blade. The surgeon will also cut a T-shape in the capsule and re-attach the capsule in a tighter position.
In this procedure the tendon of the subscapularis muscle is cut and then re-attached to the head of the humerus, in such away that it brings the head of the humerus tighter to the shoulder blade. Again the drawback with this procedure is that there is a loss of external rotation which makes it less than ideal for the throwing athlete.
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