Open Shoulder Stabilization

What is Open Shoulder Stabilization?

Open shoulder stabilization is a surgical procedure performed to treat a condition called shoulder instability.

Shoulder instability is a chronic condition that causes the frequent dislocation of the shoulder joint. 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. The repeated dislocation of the humerus out of its socket is called chronic shoulder instability. 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.

Shoulder instability is commonly treated by a minimally invasive approach called arthroscopic shoulder stabilization surgery. However, too much bone loss, dislocation that cannot be reduced, severe damage to the supporting structures of the shoulder joint, chronic instability, or failure of a previous operation, may necessitate open shoulder stabilization surgery.

Anatomy

The shoulder is the most flexible joint in the body. When injury occurs, it can cause loosening and instability of the joint which can lead to partial or complete dislocation and pain. It is a ball and socket joint where the ball is formed by the head of the upper arm bone or humerus and the socket is formed by a shallow cavity in the shoulder blade called the glenoid. The glenoid is surrounded by a raised ridge of fibrous cartilage called the labrum which provides some depth to the socket increasing the stability of the joint. Stability is further enhanced by ligaments that form a capsule around the joint, as well as muscles and tendons which center the humeral head in the socket.

Indications

The main indication for open shoulder stabilization is shoulder instability which may occur as a result of injury or trauma to the shoulder, falling on an outstretched hand, repetitive overhead activities from sports or occupation, loose shoulder ligaments, or an enlarged capsule. These may cause symptoms such as pain, swelling, bruising, numbness, visible deformity, and loss of function. When conservative treatment options such as medications, rest, and ice application fail to relieve shoulder instability, your surgeon may recommend open shoulder stabilization surgery. Shoulder stabilization surgery is done to improve stability and function to the shoulder joint and prevent recurrent dislocations.

Preparation for Open Shoulder Stabilization Surgery

Preoperative preparation for open shoulder stabilization 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 Open Shoulder Stabilization Surgery

The open shoulder stabilization procedure is performed under general anesthesia with you in a semi-reclined or beach-chair position and involves the following steps:

• An incision of 10 cm is made at the front of the shoulder joint.
• Retractors are used to separate the muscles of the joint and expose the coracoid process (a small hook-like process of the shoulder bone) and its attached tendons.
• The coracoid process is freed of its attachments, and along with the conjoined tendon, is transected from its base. 
• Holes are drilled into the transected coracoid process.
• The subscapularis muscle, which passes in front of the shoulder joint, is split in line with its fibers. 
• The capsule of the shoulder joint is entered and the glenoid is exposed and prepared to receive the coracoid.
• The transected coracoid with the conjoined tendon is passed through the separated subscapularis muscle and fixed to the glenoid rim with screws through the previously drilled holes. This increases the glenoid surface and stabilizes the joint. The conjoined tendon and subscapularis muscle provide additional stability by acting as a sling.
• This procedure treats chronic shoulder instability and decreases the possibility of future dislocations.
• Upon completion, the instruments are withdrawn, the incision is closed and covered with a sterile bandage.

Postoperative Care and Recovery after Open Shoulder Stabilization Surgery

Following the surgery, your arm is placed in a sling to rest the shoulder and promote healing. You may need to remain in the hospital for 2 to 3 days before discharge to home. Pain is controlled with medication and ice packs. You will be instructed to keep the surgical wound dry and wear your sling while sleeping for a few weeks after the procedure. The sling may be removed in 3 to 6 weeks. Rehabilitation usually begins early on the first postoperative day with finger movements and passive assisted range of motion exercises. A physical therapy program is recommended for 3 months after which you can return to your regular activities. 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 Open Shoulder Stabilization Surgery

Open 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
• Fracture or failure of union of the coracoid
• Recurrence of instability