What is Anterior Shoulder Stabilization?
Anterior shoulder stabilization is a surgical procedure performed to treat a condition called anterior shoulder instability.
Anterior shoulder instability, also known as anterior glenohumeral instability, is a shoulder condition in which damage to the soft tissues or bone causes the head of the humerus (upper arm bone) to dislocate or sublux from the glenoid fossa, compromising the function of the shoulder. A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder. A partial dislocation is referred to as a subluxation while a complete separation is referred to as a dislocation.
Anterior shoulder instability is caused by trauma or injury to the glenohumeral joint in which the upper arm bone is dislodged from its usual position in the middle of the glenoid fossa, and there is no longer joint articulation. A tear in the labrum or rotator cuff and ligament tear in the front of the shoulder (a Bankart lesion) may lead to repeated shoulder dislocations.
Anterior shoulder stabilization surgery aims at repairing the injured labrum and tightening the surrounding ligaments in order to restore your shoulder stability and avert future dislocations. This surgery can be performed either as an open surgery that involves making a single large incision on the anterior (front) of the shoulder or as a minimally invasive arthroscopic surgery using an arthroscope that involves making 3 to 4 small keyhole incisions at the anterior of the shoulder.
Anatomy of the Shoulder
The shoulder is a ball and socket joint, formed by the bone of the upper arm (humerus), which articulates with the shoulder blade in a cavity called the glenoid fossa. The joint relies a great deal on surrounding soft-tissue structures such as tendons, ligaments, and muscles (rotator cuff muscles) to maintain smooth motion and stability. The glenoid cavity is surrounded by a raised ridge of cartilage called the labrum that deepens the cavity and a ligamentous structure called the shoulder capsule that centers the humerus in the cavity. The biceps muscle, certain back muscles, as well as a group of muscles, called the rotator cuff all work together to stabilize the shoulder.
Indications for Anterior Shoulder Stabilization Surgery
Your surgeon may recommend anterior shoulder stabilization surgery when the function of the shoulder joint is compromised with the following indications:
- Bankart lesions, an injury of the anterior glenoid labrum
- Humeral avulsion of the glenohumeral ligament (HAGL), an injury to the ligaments that join the upper arm bone to the glenoid
- Severe rotator cuff muscle injury/weakness
- Hill-Sachs defect, an injury to the cartilage and bone of the humeral head
- Failure of conservative treatment options such as medications, rest, and ice application to relieve anterior shoulder instability
Preparation for Anterior Shoulder Stabilization Surgery
Preoperative preparation for anterior shoulder stabilization surgery may involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
- You should refrain from alcohol or tobacco at least a few days prior to surgery.
- You should not consume solids or liquids at least 8 hours prior to surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Anterior Shoulder Stabilization Surgery
Anterior shoulder stabilization surgery is performed under the influence of anesthesia either arthroscopically or through open surgery, depending on the severity of your shoulder condition.
Open surgery is mostly required to correct severe instability. During this surgery, a large surgical cut is made on the shoulder and the muscles under it are moved apart to obtain access to the joint capsule, labrum, and ligaments. These soft tissue structures are then reattached, tightened, or repaired accordingly depending on the extent of tissue injury and closed with sutures.
Arthroscopic shoulder stabilization is a surgical procedure in which an arthroscope, a small flexible tube with a light and video camera at the end, is inserted into the shoulder joint to evaluate and carry out suitable repair. It is a minimally invasive surgery and is performed through a few tiny incisions (portals), about half-inch in length, made around the joint area. Through one of the incisions, an arthroscope is passed. The camera attached to the arthroscope displays the images of the inside of the joint on the television monitor, which allows your surgeon to identify the defects and carry out the required repair accordingly through tiny surgical instruments that are passed through the other incisions. The tiny incisions are then closed and covered with a bandage.
Postoperative Care Instructions and Recovery
In general, postoperative care instructions and recovery after anterior shoulder stabilization involves the following steps:
You will be transferred to the recovery area to be monitored until you are awake from the anesthesia.
- Your nurse will monitor your blood oxygen level and other vital signs as you recover.
- You may notice some pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed.
- You may also apply ice packs on the shoulder to help reduce swelling and pain.
- Antibiotics are prescribed for risk of infection associated with surgery.
- Your arm may be secured with assistive devices such as a sling for the first few weeks to facilitate healing.
- You are advised to walk as frequently as possible to prevent the risk of blood clots.
- Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking as it can negatively affect the healing process.
- Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
- Refrain from strenuous activities and lifting heavy weights for a month or two. Gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol is designed to help strengthen your shoulder muscles and optimize shoulder function.
- You will be able to resume your normal activities in a couple of months; however, return to sports may take anywhere from 4 to 6 months.
- Refrain from driving until you are fully fit and receive your doctor's consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications of Anterior Shoulder Stabilization Surgery
Anterior shoulder stabilization surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Infection
- Bleeding
- Postoperative pain
- Damage to surrounding structures
- Stiffness or restricted motion
- Thromboembolism or blood clots
- Anesthetic/allergic reactions
- Recurrence of instability
