Shoulder stabilisation including Latarjet

Shoulder stabilisation can be improved to reduce pain and improve joint instability.  

Shoulder stabilisation including Latarjet

Shoulder stabilisation can be improved to reduce pain and improve joint instability. 

Shoulder stabilisation including Latarjet

What is shoulder instability?

Shoulder instability is a condition that results from stretching or tearing the lining of the shoulder joint, leading to dislocation or separation of the shoulder joint. The shoulder joint is the most mobile and flexible joint in the body which makes it prone to dislocations. The joint is normally held in place due to a combination of ligaments, tendons, and a rim of cartilage called the labrum.  Instability can be caused by trauma, which can often be traced back to shoulder injuries and dislocations which are common amongst people who play contact sports. For this reason, young sporting people aged 15 to 29 years are particularly susceptible to shoulder instability, dislocation, subluxation, and labral tears. It can also occur in people who are naturally flexible or loose and have often been described as being “double jointed” as a child. In these people the instability is due to the “stretchiness” of their tissues and sometimes they can dislocate and put back their shoulder on their own.

The most common symptom of shoulder instability is repeated dislocations of the shoulder. Often there is a history of dislocating the shoulder requiring a presentation to an emergency department for treatment.  A feeling of looseness in the shoulder and ongoing pain are also signs that a shoulder may be unstable and also a sense of uneasiness or apprehension when placing the arm in the overhead “high five” position. Some patients also experience symptoms such as numbness, discolouration, deformation, and loss of shoulder function, particularly those who have weakened the connective tissue in the shoulders by sustaining multiple injuries or who are naturally loose.

In assessing you for shoulder instability, Dr Cheriachan will take your full medical history and physical symptoms into account. Dr Cheriachan will perform several different tests on your shoulder, including full physical examinations and X-rays, to isolate points of tenderness and determine factors like range of motion and areas of apprehension. A CT Scan and MRI scan is often performed to assess for any bony or ligamentous injuries which can contribute to recurrent instability. 

Non-operative and surgical treatment options exist for patients suffering from shoulder instability. The most suitable treatment for your shoulder depends on your age, sporting activities, work and nature of the dislocation. In traumatic dislocations due to a fall or injury, the risk of recurrent instability is very high amongst younger patients less than 20 and reduces with age. Dr Cheriachan will discuss these factors with you to tailor a plan suited to you. Non-operative treatments include temporary immobilisation (through slings or braces), physiotherapy to strengthen the supporting muscles of the shoulder, and certain pain medications. If these treatments do not stop the pain or resolve the problem, surgical treatments such as arthroscopic stabilisation  may be recommended. This involves repairing the ligaments and labrum back to the socket via “key hole” surgery. In patients who have significant bone loss from the arm bone or socket  or who play impact or contact sports a Latarjet procedure may be recommended. This involves taking a bone graft with tendon from the coracoid at front of the shoulder and attaching it to the socket to provide additional stability.  

Whilst any shoulder that has been dislocated is prone to dislocation in the future, total recovery is possible with the right treatment and strengthening exercises over a period of several months. There are also several factors that influence the likelihood of a positive result post-surgery. The integrity of supportive tissues, the severity of damage, patient age, and the patient’s discipline in rehabilitative exercises. In the majority of cases patients are able to regain confidence in their shoulder and return to their sporting activities, work and hobbies without pain or apprehension.

Whilst the majority of people who undergo shoulder surgery do well and are very happy with their function and result, there are general risks of surgery as listed in the FAQ section. In addition to this there are specific risks of instability surgery which includes, recurrent instability or the surgery being unsuccessful which can occur in 5-15% of cases depending on the operation and extent of your injury. Injury to the nerves tendons or blood vessels close to the surgical field which may require further surgery, stiffness or developing a frozen shoulder, ongoing pain, over tightening of the joint causing loss of motion and abnormal pain responses such as Chronic Regional Pain Syndrome (CRPS).

Most of these risks are low and less than 5 %, but it is important to be aware of these risks before consenting to surgery. Dr Cheriachan will discuss this with you in detail during your consultation.

The rehabilitation process for shoulder procedures typically takes 6 months to fully recover. This begins the day after surgery, although depends largely on the type of surgery performed. Generally, patients will need to immobilise the shoulder in a sling for the first four to six weeks after surgery before beginning a physiotherapy program to regain range of motion and strength. It may take several weeks of rehabilitative efforts before you are ready to resume activities like driving, playing sports, and depending on your job, working, and during this time, you may need to modify your lifestyle.

Preparing for your visit

Dr Cheriachan consults from Norwest on Wednesdays and Blacktown on Mondays and Thursdays.

Your first visit will be used to carefully assess your condition as well as gathering all related health information. It is important that you bring all relevant documents including scans and x-rays. We also ask that you wear clothing that allows freedom of movement as your visit will include a physical examination.