Your shoulder is a ball and socket joint. I always describe it to people as being like a golf ball on a tee. With this picture in mind, if something causes the shoulder to dislocate, it can damage the lip of the golf tee. This damage can make it more likely that further dislocations will occur in the future as it reduces the stability of the shoulder.
Shoulder stabilisation surgery is carried out in order to repair this 'lip', give the shoulder more structural integrity and reduce the risk of recurrent dislocations.
There are different types of shoulder dislocation. The classic one, and the one I most often see here at Circle, is the type experienced by many a rugby player. They're involved in a tackle and the impact forces their shoulder to pop out of the socket (dislocation). Other common injuries include falling on the arm from standing or at speed (falls from bikes, horses or while skiing).
Often a quick trip to their nearest A&E will see the joint put back in the right place (reduced). The shoulder will often need to be in a sling for a period of time and physiotherapy is helpful to get the shoulder going. Once over the initial injury, it is often useful to have the full extent of the damage assessed to choose the right treatment.
Other people can experience instability due to having very mobile joints (called “hyperlaxity”) or subtle instabilities. This can often cause the feeling of the joint dropping out of position (or “subluxing”) and clicking back.
Once you've had a shoulder dislocate, the odds are high that you will have more in the future.
Most people come to see me a couple of weeks after their initial dislocation. Current national guidelines advise that all first-time shoulder dislocations should see a shoulder surgeon to assess them. The main question I'm trying to answer at this stage is whether they are likely to re-dislocate or not. To make things more challenging for me(!), most young sporting people have a very high chance of the joint popping out again, although this risk does decrease with age. However, over the age of 45, there is an increased chance of tearing some of the important muscles of the shoulder (called the rotator cuff muscles), so it is important to rule this out.
When I see you for a consultation, I'll talk with you about your previous dislocation to get a good understanding of what caused it and the type of damage you may have to the shoulder. I will also examine your shoulder, carefully moving your arm into various positions to help me assess any pain or weakness in the joint.
I may arrange for you to have additional diagnostic scans like an X-ray, CT or MRI scan if this would help to assess the best treatment options.
Once we know the extent of the damage to your shoulder, we'll be able to talk through treatment options with you. Many people can be successfully treated with physiotherapy alone and I can refer to you for therapy. If surgery would be helpful, I'll explain the procedure and give you all the information you need in order to make an informed choice about whether to have surgery or not.
If you have had a number of dislocations, suggesting an inherent weakness in the joint, surgery can be of help and can often be done arthroscopically.
Arthroscopy is a type of keyhole surgery. Using only tiny cuts into the shoulder, I'll insert a thin tube known as an arthroscope into the joint. The arthroscope has a light and a camera and gives me a really good view of the joint. Once I have assessed the joint, I will insert small surgical tools through the arthroscope in order to repair any damage and to help stabilise the joint.
For people who have severe damage in the shoulder, or have previously had a repair but have dislocated again, a normal or “open operation” may be the best option.
The most common question I'm asked by people before this stabilisation surgery is, "how soon can I play rugby again?". Rugby players are 'below shoulder' athletes, as they don't often need to move their arms above their heads. This helps with recovery from shoulder surgery, as the shoulder tends to be at more risk when the arms are raised above shoulder height.
Rugby players tend to be able to return to competitive play around 3 - 6 months after surgery, whereas 'above shoulder' athletes like swimmers and tennis players may need 6 - 9 months. Shoulder stabilisation surgery is said to have a 90% success rate. It can reduce your risk of dislocation to probably about 10% over 10 years, which is a big difference.
I decided fairly early on in my orthopaedic training that I wanted to specialise in treating shoulder and elbow problems. During my years working as a shoulder and elbow specialist, I have been privileged to see the difference good, effective treatment makes to people's lives. I have a particular interest in the effective management and treatment of sports injuries, so if you are a keen sportsperson keen to get back to playing again at the highest levels, I can help.
Your initial consultation will help us find out exactly what the problem is. We'll then be able to talk through the treatment options so that you can make an informed decision.
It's easy to schedule an appointment with me here at Circle, my private secretary will be delighted to help you book a time and day that is convenient for you.