The shoulder is the most commonly dislocated joint in the body. When shoulder dislocation occurs in adolescents and children the risk of re-dislocation is up to 95%.
Although not a life threatening problem, repeated dislocation is clearly lifestyle threatening and can effectively disable an otherwise active person.
Normal shoulders have a great range of motion but this unfortunately results in reduced stability. Intact bone surfaces as well as competent soft-tissue balance and control are necessary to provide stability. The trauma of dislocation may lead to loss of bone and soft tissue restraints rendering the joint unstable. It then requires less subsequent trauma for the shoulder to re-dislocate.
Due to the high recurrent dislocation rate in the younger patient treated non-operatively a stabilisation procedure is often recommended.
Prior to surgery, imaging of the shoulder with X-Ray and often CT or MRI scan is performed to assess both the bony and soft tissue components of the joint.
In most cases, where there is only minimal damage to the bony socket of the shoulder joint, keyhole soft-tissue surgery sufficient.
When there is extensive damage to the bone of the socket, soft tissue surgery is insufficient to ensure shoulder stability. In these cases the Latarjet procedure using a bone graft to replace the deficient bone is recommended.
Surgery is performed under a general anaesthetic with a nerve-block to reduce post-operative pain. Patients usually are in hospital overnight and return home the day after surgery. A shoulder sling is used for four to six weeks and a gentle physiotherapy program is started to prevent stiffness and help regain shoulder function.
The surgical management of shoulder instability has undergone a significant evolution over time. Current techniques achieve high levels of stability with little restriction of motion with most patients returning to their pre-dislocation sport and activity.