Surgery for shoulder instability.

The shoulder is a joint that can move in many directions. Because the shoulder joint can move so well, there is a greater risk of the joint dislocating. We call this in the medical world a shoulder luxation. When the shoulder dislocates, there is possible damage to the ligaments, tendons and capsule of the shoulder. Often this happens during a quick sudden movement but even more often after a fall. Once dislocated, we see that the shoulder dislocates more easily. The reason for this is that the ligaments and capsule can no longer provide sufficient strength when large forces are placed on the shoulder during sports or other times in everyday life. At this point, we speak of shoulder instability. When physical therapy no longer provides sufficient results, surgery may be necessary to prevent worse.

Possible causes of shoulder luxation

Young athletic people are more likely to have a shoulder luxation. This is often the result of a fall or collision. When this happens more often, the likelihood of new injury is greater. Flexibility of the ligaments and tendons can also be congenital. We then speak of hypermobility of the shoulder. Often genetically determined as well. People with hypermobility have a greater chance of shoulder dislocation. To a certain extent this can be prevented by putting a good load on the muscles and ligaments through strength training. Chronic conditions may also play a role. Ehlers Danlos syndrome increases the risk of shoulder instability because of connective tissue deterioration. Our tendons, ligaments, muscles are all different forms of connective tissue types. In Ehlers Danlos, the connective tissue in our body becomes highly elastic. So this significantly increases the risk of luxation. 

Diagnosis of shoulder instability

When the shoulder has been dislocated more than once, the likelihood of persistent shoulder instability is significantly increased. Imaging studies such as an MRI scan, X-ray or CT scan often provide a good picture about the anatomical structures in and around the shoulder.

inversion trauma
Some examples of injuries or injuries to the shoulder include:

A bankart lesion. A bankart lesion can occur in two ways: a bony Bankart lesion or a normal bankart lesion. A bankart lesion is located in the lower part of the labrum. The labrum is a cartilage-like ring that provides extra stability in the shoulder. This ring, as it were, enlarges the naturally small socket of the shoulder and sits like a suction cup around the head of the shoulder. A bankart lesion is an injury to the labrum. In a bankart lesion, the labrum is damaged or even torn away from the socket of the shoulder. When a piece of bone from the socket tears off along with it, we speak of a bony bankart lesion. 

A bankart lesion can occur in several ways. We often see excessive force on the shoulder causing damage to this part of the labrum. A bankart lesion can also be caused by repeated overuse of the shoulder. Consider overhead sports such as baseball where there is a lot of force on the shoulder over an extended period of time. The pain is usually located at the front of the shoulder and sometimes there is a recognizable click during movements of the shoulder.

Conservative vs. Surgical 

When the choice is made not to operate, physical therapy is an option. The muscle strength of the shoulder is trained to increase the stability of the shoulder. NSAIDs can also be used to relieve the pain. Should the symptoms not subside sufficiently, surgery may be considered. The damaged lower part of the labrum will be reattached. In some cases the capsule of the shoulder is also damaged. This will also be repaired during the operation. After the surgery the shoulder should not be subjected to heavy loads. In the first phase of the rehabilitation the mobility of the shoulder will be restored, before any training can take place to increase the load bearing capacity of the shoulder.

Treatment of a SLAP lesion

Non-operative

A SLAP lesion can be treated with physical therapy. This involves looking at how best to train the shoulder without causing too much discomfort. Pain medication is also often used to suppress symptoms. In some cases, a corticosteroid injection may be chosen. Treatment is mainly focused on increasing the muscle strength of the muscles around the shoulder. Upper hand activities and upper hand sports are discouraged during rehabilitation. In some cases it is again possible to function pain-free within the chosen sport. If this is not the case after 4-5 months, surgery can still be chosen.  

physio fitaal physiotherapy
Operative

When physical therapy does not produce the desired results, surgery may be necessary. Through keyhole surgery, the torn portion of the biceps attachment is sutured to the socket of the shoulder. Normally, after this surgery, the biceps tendon can resume its function normally. However, research shows that this does not always give the desired effect. A large group of people still have some degree of pain and reduced function of the shoulder even after surgery. Another option is to detach the entire biceps tendon from its place of attachment to the socket of the shoulder. We call this a biceps tendon tenotomy. This method often gives better results in terms of pain relief. 

After surgery

After surgery, a sling(sling) is fitted. This will be worn for 4-6 weeks. Shoulder rehabilitation after surgery takes on average 8 months to a year. In the first 8 weeks you will often not be able to drive a car or ride a bike. After 4-6 months one can participate again in different sports. With contact sports, this will take just a little longer.

Fysio Fitaal specializes in rehabilitation after surgery. Rehabilitation after surgery often has a big impact and can be exciting. Fysio Fitaal makes rehabilitation after surgery insightful, manageable and transparent. Independence and self-reliance are important pillars within rehabilitation. The team of Fysio Fitaal in Tilburg provides an exclusive service with a personal approach. On your own strength to a fit and pain free life. Together with you we draw up the rehabilitation plan to help you get closer to your goal.

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