The shoulder is the most mobile joint in the human body. It is capable of amazing movements. Conversely it is therefore the most unstable joint in the human body and is vulnerable to dislocations and / or instability injuries.
Dislocation are mostly in the anterior direction but can be posterior or multidirectional. Anterior instability/dislocation or subluxation will typically produce 1 or 2 classic lesions known as the Bankart lesion and the Hill-Sachs lesion.
A Bankart lesion is an anterior labral tear (+/- some periosteal stripping) on the glenoid area of the scapula (shoulder blade). When this anterior labrum tears it effectively detentions the normal ligament and allows the shoulder to be unstable ; ie more likely to dislocate repeatedly.
The Hill Sachs lesion is like an impaction dent that occurs when the dislocated humerus bone strikes against the scapula bone. It can vary from a subtle bruise up to a deep recessed concave impression.
The treatment of instability must be tailored to the pathology identified, and to the patient who has certain goals they wish to achieve after surgery.
The procedure that shoulder specialities can offer will include
- Arthroscopic labral repairs This is the most commonly preferred technique that suits mots patients, and certainly the one that Dr Kirkham offers the most . The reasons are often that it is keyhole (less invasive). Its quicker (typically 40-60-75 mins). It’s an anatomical repair ie back to normal anatomy. Details van be elaborated as needed when you visit me.
- Latarjet procedure This is a bone transfer of the coracoid process of the scapula. It effectively deepens the socket anteriorly and creates a sling to prevent further instability. It is often the procedure of choice in NRL rugby league athletes and other contact sports.
Dr Kirkham typically uses a CT scan at 8-week post Latarjet to asses for union of the bone transfer. After that sports are resumed , being often a shorter recover time than for labral repairs
- Remplissage procedure Remplissage procedure is an imbrication of the infraspinatus tendon into the Hill Sachs defect area. Details can be provided as needed.
- Others The anaesthetist may offer you a nerve block as well as a general anaesthetic (GA). The nerve block is typically performed under ultrasound control by your specialist anaesthetist just prior to your GA. The nerve block is to reduce not only post-operative pain, but also intra-operative blood pressure changes which then means less opiates, less nausea less time to recover from the GA. Either way you are asleep and unaware of any of this happening.