What are the aims of surgery?
Arthroscopic stabilisation surgery aims to restore shoulder stability, prevent dislocation and
allow a return normal sporting and recreational activity.
What needs to be done prior to surgery?
The decision to have arthroscopic stabilisation surgery should only be made after thorough
discussion with your surgeon. You should be satisfied that you have all the information you
require in order to make an informed decision and that you are aware of both the potential
risks and benefits of the planned procedure. It is important that you fully disclose any health
problems you may have had. Some may interfere with surgery, anaesthesia or aftercare.
You should inform your surgeon and anaesthetist of previous allergies or reactions to
antibiotics, anaesthetics or other medicines and in particular of any problems with prolonged
bleeding or excessive bruising. Anti-inflammatories or other drugs which increase bleeding
may need to be stopped prior to surgery. You should stop smoking at least two weeks before
surgery as smoking increases the risks of surgery and impairs healing. If you decide to have
surgery, your surgeon will ask you to sign a consent form. Read it carefully and raise any
questions. It may be necessary for additional procedures to be performed at the time of
surgery if the arthroscopic findings vary from the imaging studies. As you may need help
with you daily activities after the operation you should make the necessary arrangements
prior to surgery.
What does the operation involve?
The arthroscopic stabilisation involves making several (usually 3) small incisions less that
1cm long around the shoulder. The structures which have been damaged at the time of
shoulder dislocation are identified and repaired using keyhole techniques. This may involve
the use of sutures or small anchors. The procedure is performed using an arthroscope
which is a thin instrument attached to a video camera and light source. It allows the
operating surgeon to see inside the shoulder joint and perform the procedure while viewing a
video monitor. The arthroscope is inserted into the shoulder. Working through other small
incisions, the surgeon uses small instruments to perform the repair. Small burrs are used to
prepare the bone for repair of the damaged ligaments and capsule. The incisions are closed
with one or two stitches or small adhesive strips and dressings are applied. Local
anaesthetic will usually be injected into the wounds to help with postoperative pain control.
After surgery, you will be transferred from the operating theatre to the recovery room where
nursing staff will monitor your recovery and administer further pain relief if needed.
What happens after the operation?
Your arm may be in a sling or shoulder immobiliser. This is to protect the shoulder, relieve
pain and maintain it in the correct position. You may be able to go home on the day of
surgery but an overnight stay may be required. You will be unable to drive, so should
arrange for someone else to drive you home. You will normally have a follow-up visit with
your orthopaedic surgeon within the first couple of weeks of surgery. Stitches are usually
removed at this visit.
What rehabilitation is needed?
While the shoulder is healing some pain and discomfort should be expected. You may need
to use pain-killers during this period. It may be difficult to perform some day to-day activities
for two to three months following the procedure.
Your physiotherapist will design an exercise program for you. This is important to your
recovery and should begin shortly after surgery. It starts with gentle exercises that gradually
help you regain shoulder movement. After about six weeks, exercises are introduced in
order to help strengthen the muscles. Your surgeon will advise you about a timescale for
return to work and resumption of normal activities. Recovery takes time and depends on the
type of surgical repair. It commonly takes several months for strength, comfort and full
function of your shoulder to return to normal.
What are the likely outcomes of surgery?
In some patients, the repair can be performed successfully. The success of surgical
treatment depends on a number of factors including the quality of the tissues and the degree
of damage to the shoulder prior to the repair as well as adherence with rehabilitation
protocols. Surgery is not designed to remove pain from the shoulder but to reduce the risk
of the shoulder dislocating.
What complications are associated with the procedure?
As with all surgical procedures there are risks associated with the procedure despite the
highest standards of practice. It is possible for a shoulder to re-dislocate following
arthroscopic stabilisation surgery. The likely incidence is around 4% for this type of
procedure suing modern techniques.
Complications can occur that may have permanent effects. It is not possible to outline every
possible side effect or rare complication however, it is important that you have enough
information about the possible complications of the procedure to fully weigh up the benefits
and risks of surgery.
Possible complications of surgery include wound infection (treatment with antibiotics may be
needed, and a second or third operation may be needed to treat the infection). Pain,
discomfort or bleeding from around the incisions may occur. Most scars fade and flatten, but
some may become “keloid” and remain raised, itchy, thick and red. Further treatment may
be needed to try to improve the scar.
In unusual cases, pain may not resolve over the long term. Persistent stiffness of the
shoulder joint may require additional treatment. Injury may occur to nerves close to the