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The aim of a shoulder stabilisation also known as a Bankart repair operation is to restore stability to the shoulder.
The operation is suitable for people who have detached the labrum and ligaments at the front of the shoulder as a result of an original violent dislocation. Usually, the shoulder has remained unstable and may have dislocated on a number of further occasions.
After the operation, you should not suffer further dislocations and have much reduced pain.
The operation is usually carried out keyhole (arthroscopically) through a number of small incisions around the shoulder. The aim is to restore the labrum and ligaments to their original position on the edge of the socket and they are encouraged to heal there.
The first step in the operation is to mobilise and re-position the labrum and ligaments and to create an environment in which healing can occur. Little harpoons or anchors are then inserted into the bone on the edge of the socket, which gain a good grip.
Stitches on these anchors are then used to suture the labrum and ligaments back into place. The anchors and sutures then hold everything in the right place while natural healing occurs.
The incisions are closed with stitches and waterproof dressings are applied.
Shoulder and elbow surgery can result in considerable pain and discomfort after the operation. Traditional painkillers are not always effective and have side effects. We usually offer you a local anaesthetic “block” to reduce the pain and discomfort following the procedure and also allow early more comfortable physiotherapy (if required). This consists of an injection at the side of your neck onto the nerves that supply your shoulder. The injection itself is fairly painless.
What happens?
The procedure is carried out before the start of your operation. You will have a small plastic tube placed in your arm (drip). Then you may have some sedation to make you feel relaxed. A small numbing injection in the skin is placed prior to the block needle (which is smaller than a blood-taking needle). Your arm will then start to feel very heavy and numb (a similar sensation to when you have been lying on it). This spreads down the outside of the arm (and spares the inside).
Surgery is then carried out under sedation (you are comfortable, relaxed and either awake or sleeping if you prefer) or occasionally under general anaesthesia (you are unconscious and unaware). If you are awake, you are welcome to watch the procedure on a TV screen, and we will explain to you what is happening. If you require any extra pain relief during the procedure, we can easily give you this through your drip. The block will reduce the overall amount of painkilling drugs that you will require during and after the operation.
After your operation
The numbness will usually last for between 8 and 24 hours (depending on anaesthetic mixture used). We will leave your arm in a sling; please protect your arm whilst it is numb.
You will initially experience some ‘pins and needles’ as the block wears off and then some pain. Please prepare for this by taking the painkillers that we provide. Start these before the block wears off and expect to need them regularly for around 48hrs.
Occasionally we may recommend that at the time of the block we also place a small tube (catheter) that is fixed in place and through which we can give you further local anaesthetic to prolong your numbness for a few days. We would recommend this in situations where your pain after the operation is likely to be severe.
Complications of anaesthesia
Anaesthesia is fairly safe for most people. If your health is not good the risks may be increased. Commoner complications include nausea and sore throat.
Local anaesthetic nerve blocks are generally considered to be safe. There is an approximately 5% (1 in 20) chance that they will fail or not work as well as expected. They tend to cause a small pupil and droopy eyelid temporarily and you may notice a hoarse voice or slight breathlessness.
Rare complications include reactions to the local anaesthetic solutions and nerve injury (the risk of temporary nerve symptoms e.g. tingling, numbness or weakness for a limited period is around 1 in 100 blocks and the overall risk of permanent injury approximately 1 in 5,000- 10,000 injections).
Analgesics (painkillers)
Paracetamol and an anti-inflammatory drug (if suitable for you – usually ibuprofen or diclofenac) are often used in combination. Take these regularly for the first few days.
Stronger painkillers:
Your anaesthetist will talk to you about strong painkillers, usually codeine, tramadol, oxycodone or morphine. Take these if your pain is poorly controlled (instructions will be on the packet). Some patients experience light-headedness when taking stronger painkillers; so be careful especially at first (rest up after taking them, don’t carry hot drinks or anything sharp) and take them only to counteract severe discomfort. Nausea and constipation can also occur, so drink plenty of water and increase the fibre in your diet; occasionally laxatives may be required (available from chemists).
Discharge
If you are discharged on the same day as your operation, there should be someone keeping an eye on you during the first 24 hr period. If the painkillers make you excessively drowsy, then your carer needs to rouse you and ensure you not too sensitive to them.
Emergency contact numbers will be available on your discharge information if you or your carer wishes to talk to a trained member of staff.
The operation is usually a day case and your stitches will come out at 1-2 weeks after the surgery. Your arm is placed into a special shoulder-immobilising sling and exercises and physiotherapy start on the day of surgery. Your physiotherapist will teach you all you need to know for the first couple of weeks before your discharge from hospital.
As a general guideline, your sling will be retained for a period of 4 weeks during which time you will be quite one-handed. At 4 weeks, the sling generally goes and increased exercises and movement are encouraged. Most people can return to driving a car at around 6 weeks and will have regained good ordinary use of the shoulder by 8-10 weeks.
Physiotherapy and exercises continue for 4-6 months and sports that do not impose too much stress on the shoulder, such as running, can start again at around 8-10 weeks. Activities such as golf and swimming can be resumed at around 3 months. Contact sports, including rugby and football and other high demand sports such as surfing and climbing can be reintroduced at 4-6 months.
