What is the recurrent anterior instability?

Glenohumeral instability is the inability to maintain the humeral head centered in the glenoid fossa (socket). Anterior refers to the direction, the front,of the shoulder. This is also called a Bankart tear. An arthroscopic Bankart repair is usually successful in stabilizing a shoulder with recurring dislocations. However, sometimes surgery can fail to stabilize the shoulder, either because the repair is not strong enough or because the socket or the ball of the shoulder is compromised.

How do you repair the instability?

After evaluating your physical exam, history of injury, previous procedures and the radiology studies, Dr. Gillespie will discuss with you what he feels the most successful surgery for you is:

Open Bankart repair: the torn tissue of the labrum is sewn back to the rim of the socket.
Glenoid Grafting: a contoured bone graft may provide the needed stability by deepening the socket. The goal of the bone graft surgery is to build up the socket so that it provides more stability for the joint. The bone graft can be harvested from the iliac crest (hip bone at the belt line) or taken from cadaver bone It is shaped, and then screwed to the front of the socket.

Hill Sachs Lesion Grafting: bone is used to fill in the divot created from the ball hitting the socket during dislocation. The bone is cut to size and secured with headless screws.
Latarjet procedure: transfer the coracoid process to the front of the glenoid and repairs the capsular labral tissues to the stump of the coracoacromial ligament.

Length of Stay

You will not stay overnight. This is same day surgery, you will need someone to drive you home the day of surgery

Anesthesia

Patients usually have two types of anesthesia for this surgery. The first is general anesthesia, which means you are asleep. The second type of anesthesia is a nerve block. Your arm will be numb and will feel very strange. The nerve block will last about 12-14 hours. The anesthesiologist will speak to you on the day of surgery. The ultimate choice of anesthesia technique is up to you and your anesthesiologist.

Incision

You will have an incision extending up from the crease of your underarm in the front of your shoulder.

Pain

You will have oral pain medication prescribed for when you are discharged home.

Sling

Your arm will be placed in a sling prior to leaving the operating room. You are to remain in your sling 24 hours a day except to bathe. This includes sleeping in your sling. For the six weeks that you are in your sling, you are not permitted to drive.

Dressings

You will go home with tape and gauze dressings. After 2 days you may remove the dressings. There will be steri strips over the incisions. The steri strips are to remain in place until they fall off on their own. You may see some blue sutures (stitches) sticking out of the incision. The sutures will be removed at your first postoperative visit 10-14 days after your surgery.

Physical Therapy

For the first six weeks of recovery you will do remain in your sling at all times. Once the sling is discontinued, you will begin a gentle home exercise program. The last three months of your recovery you will continue with daily home exercises and attend formal physical therapy three times a week.

Restrictions

Recovery from open stability surgery is 5 months. During that time you will have restrictions on the use of your operative arm.

Day of surgery to 6 weeks: remain in sling, no use of arm, out of work, no driving
Months 1.5-2.5: opposite hand work only