Shoulder Instability

Going to the doctor can be a difficult and emotional experience. This is even more stressful when potential surgery is a consideration. Hopefully the information listed below can alleviate some of the stress and answer any questions that may arise.

What is wrong with my shoulder?

Your shoulder is painful because it is unstable. It may dislocate (the ball comes completely out of the socket) or subluxate (the ball comes partially out of the socket). This happens because of damage to the shoulder ligaments. Ligaments are strong cord-like structures that connect one bone to another. These ligaments tore from a single violent injury or were stretched due to repeated strenuous use.

Recommend Treatments?

Approaching this injury can depends on your description of the problem, the physical examination, and the review of the X-rays. Most often surgery is recommended. The indications for surgery are persistent pain and instability that interfere with your activities of daily living, work and/or sports.

Are there any other options available?

While I believe that surgery is the best course of action, other treatments are available. These range from no treatment (just living with the condition) to physical therapy exercises, medication or injections. While any of these treatment options may be successful in your situation, in my experience they will not work reliably. We can arrange for any or all these options if your desire.

What happens if surgery is not performed?

I do not think your condition will worsen though sometimes the frequency of instability episodes increases over time. Shoulder instability does not generally lead to arthritis, however repeated episodes of instability can cause further damage to the joint surface of the shoulder.

What is the purpose of the surgery?

The purpose of the surgery is to prevent further episodes of instability by repairing the torn or damaged ligaments. The surgery is usually done using arthroscopic technique. Instead of a large incision, I use 3 or 4 small (about 1/2″) incisions. Through 1 incision I insert the arthroscope which lets me look inside your shoulder. The other 3 incisions are used to insert special instruments which are used to repair ligaments. Occasionally, an open repair is needed due to the type of damage that has occurred in your shoulder. This requires a larger incision in the front of your shoulder. The type of damage inside your shoulder will determine which of these techniques I will use.

What kind of anesthesia is used?

You and the anesthesiologist will discuss your surgery and decide which type of anesthesia is the best choice for you. You will have the opportunity to discuss any worries or concerns with the anesthesiologist prior to your surgery.

How long will I stay in the hospital?

Patients enter the hospital in the morning, have the surgery and are sent home the same day. This is called outpatient surgery.

What about complications?

Shoulder surgery is a complex and delicate process designed to repair damaged structures deep within the human body. Complications can occur. Fortunately these are rare. The most common complication involves injury to nerves around the shoulder. Usually these occur due to pressure as we spread apart the muscles around the shoulder so that we can see the joint’s interior. These usually go away in 2 days to 6 weeks. This occurs in less than 1% of patients. Permanent injury that results in diminished use, function or feeling in the extremity can occur but is exceedingly rare. Infection can occur, less than 1%, and may require oral antibiotics, antibiotics by injection and rarely surgery. It is extremely rare for the bone screws to cause problems, but the possibility does exist and further surgery may be required.

How successful is the surgery?

This type of surgery is successful approximately 90% of the time. No operation is 100% successful in every individual but the procedures we perform are reliable and will help restore your shoulder’s function. The operation is most successful at relieving pain. What is harder to accomplish is the return to vigorous overhead use of the arm in work and/or sports. Whether you can return to your previous level is an individual matter and depends on the amount of damage to your shoulder, how well it heals, how well you rehabilitate and how strenuous your desired level of work or sports is on your shoulder. A large factor influencing the success of this operation is ligament healing. While we can tighten the ligaments at surgery, they stretch over time. We know this occurs so I make the ligaments tighter than normal and expect them to stretch over the year after surgery.
What no one can control is how much they continue to stretch. Sometimes they will stretch so much that slippage will occur. That is why it is so important to continue with the strengthening program indefinitely. Because of the many variables involved, I can make no guarantees other than to assure you I will deliver the very best medical care possible.

When can I return to routine activities?

You will be able to use your fingers, wrist and elbow immediately after surgery. You may shower with regular soap and water 48 hours after surgery as long as all of your incisions are clean and dry. You may walk outdoors, write, cook, and drive a car (automatic shift) within a few days. You may gently use your arm in front of the body as soon as possible. You must be careful not to lift more than 1-2 pounds with your operated arm.

When can I return to work?

For most sedentary jobs I recommend taking 4-7 days off from work. When you return to work your arm will be in a sling (2-6 weeks after surgery) but you should be able to manage as long as you do no lifting, pushing, pulling or carrying. Most patients can start light duty work involving no lifting, pushing, pulling or carrying more than 1-2 pounds, 6-8 weeks after surgery. Work at waist level and 5-10 pounds of lifting is started 3-4 months after surgery. You will generally need 3-6 months of recovery before beginning occasional work at shoulder level or sports. Return to heavy lifting or overhead use may require 6-12 months. There are no fixed rules for return to work. What I have described above are reasonable guidelines that I hope will help guide your return to work, school and sports.

How is the shoulder rehabilitated?

Physical therapy plays a vital role in the recovery of your shoulder. I will provide you and the therapists with specific guidelines in terms of your activity levels and restrictions. Beginning some form of aerobic exercise as soon as you are comfortable is extremely beneficial to you having a speedy recovery. You may enjoy walking, Stairmaster® and stationary bicycle riding within 1-2 weeks. Jogging, and regular bicycle riding can start 2-3 months from surgery, as can gentle golf strokes. Swimming, running, and tennis ground strokes start 4-6 months after surgery.
Return to overhead throwing, tennis strokes and contact sports require at least 6 months of rehabilitation. Full return to competitive overhead sports requires 12 full months. Return to weight lifting is unpredictable. You may need one full year before performing activities such as the bench press. You will need to do your strengthening exercises three times a week for 2 years. This allows the ligaments to heal. Some people stop exercising too soon and then the shoulder starts to hurt. The above are guidelines. I will adjust your individual rehabilitation based on the severity of the tendon tear and your progress at each office visit.

When do I return to the doctor’s office?

Your first office visit is 2-4 days following surgery. At that visit I will examine your surgical incisions and remove any sutures that were placed. I will also go over your surgical findings with you and discuss your allowed activity level. The successful outcome of your surgery is highly dependent on your compliance with the post-operative instructions. A successful result requires that patient, surgeon and therapist work together. Regular office visits are a critical part of your care. This is not the type of surgery that I can just perform and achieve a success without your help.

What about pain medication?

You will be given a prescription for pain medicine when you leave the hospital. Please take this as directed. That means that you may take the pills every 4 hours as needed. You do not have to take the pills if simple rest, arm repositioning or applying an ice pack controls the pain. If you need more medication, contact your pharmacy and they will call the office so that we may refill theprescription. We cannot do this after 4:00 PM during weekdays and we cannot refill narcotic medication on weekends.

What if I have more questions?

We encourage you to return to the office for a further discussion at any time. You can also contact us.