Shoulder Impingement

Shoulder Information

Technique of Reconstruction

It is now possible to stabilize the shoulder by arthroscopic techniques.

Traditionally however this operation was done through an incision on the front of the shoulder, but we now prefer to perform a similar operation with the aid of the arthroscope.

The surgery includes examination of the shoulder under anaesthesia to fully assess the extent and direction of the instability while the muscles surrounding the shoulder are completely relaxed. Remember that the muscles play an important role in the stability of the shoulder and it is sometimes difficult to test the ligaments alone if you are awake and reflexly tightening these muscles during the exam.

An arthroscope is used to inspect the inside of the shoulder joint in order to evaluate the joint and its cartilage. The arthroscope allows direct assessment of the condition of the labrum and rotator cuff tendons.

The operations attempt to tighten the ligaments that are loose, usually the ligaments at the front of the shoulder and repair the torn cartilage (labrum).

In this type of operation the ligaments and labrum are fixed back into their original position, and allowed to heal so that the shoulder is once again stable.

The ligaments are reattached by roughening up the edge of the bony socket and when the sutures are tied the ligaments are held in the appropriate place for healing. The sutures are often anchored to bone with a special anchors. Most, not all, of these anchors are now made of a plastic called PLA, which dissolves after they have finished performing there job, once the tissues have healed.

Open Surgery

To correct severe instability, especially when the episodes of dislocations have caused serious damage to the bones of the joint as well as cartilage and ligaments, open surgery is sometimes necessary.

In this situation an incision is made over the shoulder and the muscles are moved to gain access to the joint.

We make an incision in the lower front skin crease of the shoulder and gain access to the joint between two of its major muscles: the deltoid and the pectoralis major.

The capsule, ligaments and labrum are either repaired, reattached, or tightened depending on the tissue injury identified at surgery. The repair can be tightened done with simple sutures or with sutures attached to metal, secured to plastic, or absorbable anchors. These anchors are inserted into the bone and hold the sutures that are used to reattach or tighten the ligaments. Some of these anchors stay in the bone permanently. A bone graft is often required to replace the damaged bones.

Steps in performing

The Shoulder Reconstruction

Shoulder Instability Home Page	Shoulder Instability -diagnosis
Treatment of Initial Dislocation	When would I need an operation
Shoulder Instability Reconstruction - how it is performed	Shoulder Instability - Rehabilitation after surgery
The risks of Surgery	Shoulder Instability Links