Shoulder dislocation

Patients can dislocate their shoulder playing sports such as hockey.  Often sustained when young, the shoulder usually requires reduction at an emergency department, although it may go back in by itself.

Initial treatment involves a sling for 2 to 4 weeks, followed by intensive physiotherapy and strengthening.  Many people are then able to lead a normal life, depending on their age, and their occupation / favorite sports.

The risk of ongoing instability varies between 50% and 90%, being highest in those less than 20 years old, and those playing contact sports such as hockey or football.  Shoulder subluxation tends to be annoying, and surgery is indicated in those who experience repetitive dislocation or subluxation, or who are always worried about it occurring.

There are two types of surgery for shoulder instability.  The first is arthroscopic shoulder surgery, to repair the torn ligament (Bankart lesion) at the front of the shoulder.  This surgery is simple, and safe (1/1000 risk of infection or nerve injury), and will make the shoulder stable in 95% of cases. Patients need to be in a sling, and rehab for 6 months.

Some patients sustain bone damage in their shoulder, either after the first dislocation, or after multiple dislocations. This is often identified on MRI, and a CT as needed.  If the bone loss is very significant, open shoulder surgery (known as a Latarjet) is required to stabilize the shoulder.  In this surgery, a piece of bone (the coracoid) is moved to the front of the shoulder socket and fixed with screws.  The risk of this surgery is increased, with a 1/100 risk of infection, and increased risk of nerve and blood vessel damage. There is also a risk that the bone may not heal.

Few patients require open shoulder surgery, unless they have significant bone damage.  Dr Dwyer will carefully consider your MRI and xrays prior to deciding to perform this type of surgery.

Further information is available at Dr Dwyer’s online textbook

www.boneschool.com/shoulder-dislocation

Postoperative rehabilitation

Shoulder surgery is performed as day surgery at Women’s College Hospital. Someone must come and pick you up and take you home. It is advised to have someone around to help you for the first two days. All patients will be provided with a script for medications that should be filled at the hospital prior to going home. Medications will usually be Celebrex in the morning for 2 weeks, Aspirin at night for two weeks, and Tylenol regularly for the first week. A script for oxycodone will also be provided.

All patients will wear a sling to sleep and walk for 6 weeks after surgery. After one week, the sling can be removed when sitting in a chair, and patients are allowed to use a computer, keyboard, and mouse. Physiotherapy usually begins 6 weeks after surgery, once the shoulder is pain free, and the risk of retear is low.

If possible, patients should rent a Gameready machine, which provides ice and compression to the knee, significantly reducing postoperative pain. The information for the rental company will be provided to you. Patients are seen in clinic two weeks after surgery, for wound review. 

Patients should take a week off work after the surgery. Patients are not allowed to play sport for 6 months after surgery.

Risks of surgery

Shoulder surgery is a relatively safe operation.

An arthroscopic anterior labral repair is very safe, with a 1/1000 risk of deep infection, major stiffness, DVT/PE, and major nerve or blood vessel damage. Patients can get local areas of numbness around the incision, which typically improves over a year or two. The risk of re-dislocation after this procedure is approximately 5% – this is minimized by being in a sling for 6 weeks, and rehabilitating appropriately for 6 months.

A Latarjet procedure is major open surgery, with a 1/100 risk of deep infection, major stiffness, DVT/PE, and significant nerve or blood vessel damage. Patients can get local areas of numbness around the incision, which typically improves over a year or two. There is a risk to all the nerves around the shoulder, including the brachial plexus, the axillary nerve, the musculocutaneous nerve, and the suprascapular nerve – injury is however uncommon, usually secondary to stretch, and usually recovers over a few months. There is a risk of nonunion, malunion, and screw breakage after this procedure, which may require reoperation – this risk is approximately 1 – 2%. There is a small risk of osteoarthritis of the shoulder after this procedure, < 1%. The risk of re-dislocation after a Latarjet procedure is approximately 5% – this is minimized by being in a sling for 6 weeks, and rehabilitating appropriately for 6 months.