What does surgery involve?

On the day of surgery you will be admitted to the ward or surgical admission area. You will once again meet Mr Moverley who will ensure you are still happy to proceed and that you understand the risks and benefits of the procedure. This is a good opportunity for you to ask any further questions. You will be asked to sign a consent form if you have not already done so.

You will meet your anaesthetist who will explain the type of anaesthetic you will receive. Arthroscopic shoulder surgery usually requires a general anaesthetic (you will be asleep) and a nerve block so that the arm will be numb for approximately 12 hours post operatively.

An arthroscopic stabilisation is performed as a ‘key-hole’ procedure through 3 or 4 small incisions. Mr Moverley will be able to assess the inside of your shoulder in great detail using a high resolution camera and will reattach any torn soft tissue (usually the labrum) to the glenoid (socket). This is achieved using plastic anchors, which are buried deep inside the bone. An Example of the techniques used can be seen here, in reality Mr Moverley will tailor a combination of anchors and techniques to meet the specific requirements of you shoulder.

The procedure is usually done as a day case meaning you can go home on the same day as your surgery.

The wounds are repaired with stitches and covered with a splash proof dressing. The wounds should be kept dry for 10-14 days.

What happens post operatively?

Immediately after surgery your arm will be in a sling and will usually feel heavy and numb as a result of the nerve block. You will be given painkillers if you are in any pain, and these will also be provided upon discharge.

A physiotherapist will assess you to make sure that you can remove and apply the sling safely. They will provide some early exercises to help prevent stiffness of the hand, wrist and shoulder.

How long is the rehabilitation process?

You will require extensive physiotherapy to maximise the benefit from your shoulder stabilisation. The final result from shoulder stabilisation often takes 6-12 months to be achieved.

Physiotherapy is individualised to your specific needs and will progress with the following goals:

• Early (0-6 weeks): Minimize post-operative stiffness with active finger, wrist and elbow movements. Gentle shoulder pendulum and scapula setting exercises. Protection in a sling for 3 weeks minimum. Progression to full active range of movement in a single plane only. Avoid combined abduction and external rotation (the throwing position) until week 6 to allow soft tissue healing.

• Middle (7-12 weeks): Continue to full active range of movement under supervision of physiotherapist, combined movements allowed where possible. Rotator cuff strengthening and proprioception exercises.

• Late (12 weeks and beyond): Graded return to all previous functional and recreation activities.

Approximately how long will it be before I can…?

• Drive: 3 weeks
 (minimum)
• Desk job: 2 weeks

• Manual work: 12 weeks

• Golf: 12 weeks

• Racket sport: 12 weeks


 What are the potential risks and complications?

As with any operation, a small number of people may have problems after a shoulder stabilisation. Most of these problems are quite minor and can be treated easily but occasionally further surgery is needed.

 Key risks are:

• Infection – less than 1% of cases

• Nerve injury – Extremely rare (less than 1 in 1000). One of the main nerves of the shoulder (the axillary nerve) is very close to the socket of the shoulder and a can be damaged during surgery. If permanently damaged it can lead to pain and weakness.

• Stiffness - Mild stiffness is quite common but occasionally a full frozen shoulder can develop (5% of cases) which can prolong your recovery by a few months, it usually responds well to a steroid injection.

• Failure to improve.

Is shoulder stabilisation always successful?

Approximately 85-90% of patients will make a good or excellent recovery. 10% will have some on-going discomfort and, perhaps, a sensation of instability, but will be satisfied with their outcome. Some patients will develop recurrent instability, sometimes following a new injury, and will require revision surgery.

The results of shoulder stabilisation are therefore not guaranteed which is why Mr Moverley will want to ensure that all non-operative measures have been exhausted first.