Shoulder > Shoulder Subluxation > Treatments

    Open or Arthroscopic Stabilization

Treatment Introduction  

If your shoulder subluxation does not heal with conservative treatment of rest, anti-inflammatory medication, and physical therapy, your physician may recommend surgical stabilization of your shoulder. This procedure, which can be performed arthroscopically or through an open incision, can be successful in restoring stability and pain-free range of motion to your shoulder.

Preparing for Surgery  

The decisions you make and the actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery. Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include a shoulder sling, ice packs or coolers, or heating pads. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   If your procedure requires an open incision, try to refrain from smoking for at least a week prior to surgery. This can reduce the risk of infection.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at 919-929-7103.

Day of Surgery [top]

At most medical centers, you will go to "patient admissions" to check in for your shoulder stabilization procedure. There may be separate check-in areas for ambulatory outpatient (patients who go home the same day after surgery) and for overnight inpatient surgery, so be sure to ask your physician or an assistant about this. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your shoulder may be shaved, though this is not always necessary. You will wear a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or an assistant, and meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important things to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Because you may be unable to drive, arrange for someone to help take you out of the hospital and drive you home when you are released.

   Wear a soft, comfortable shirt that will not irritate your skin when worn under a shoulder sling.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Surgery Procedure [top]

Surgery to stabilize subluxation of the shoulder takes an hour to 1½ hours to complete and is typically done on an outpatient basis, without requiring an overnight stay.

   You usually are placed in a sitting position, with your back at a 75-degree angle (sometimes called the "beach-chair" position) and your head supported. This gives the surgeons easy access to your shoulder.

   You may be given an interscalene block, also referred to as regional anesthesia, to numb your shoulder and neck area. This is administered with an injection in the side of your neck.

   You also are put under general anesthesia, and may be given a mild sedative to help you relax.

   If your surgery is arthroscopic, a small incision is made in your shoulder and an arthroscope (a tiny camera about 3 1/2 millimeters in diameter) is inserted into your shoulder. This provides images on television monitors so the surgeon can examine your labrum – the thin lip of soft tissue that lines the edge of your shoulder socket – rotator cuff, and other structures for tears.

   Microsurgery instruments are inserted through two or three additional incisions about three to four millimeters wide. If the labrum has become detached from the rim of the shoulder socket, it is reattached using sutures or absorbable tacks.

   In an open surgery, the procedure is the same except that a larger incision is made and the surgery is performed with standard instruments instead of an arthroscope.

   Your incisions are closed with stitches and you are taken to the recovery room.

Recovery Room [top]

When you awaken in the recovery room following surgical stabilization of your shoulder, your shoulder usually is wrapped in gauze, immobilized in a sling, and covered with an ice pack. You may feel a moderate amount of pain. You usually stay in the recovery room for at least two hours while the anesthetic wears off. General anesthesia wears off in about an hour and regional anesthesia may take about two hours to wear off. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days. In addition, you will be given an appointment to return in two to three weeks and a prescription for pain medicine. You should try to move your fingers while you are in the recovery room to improve circulation. Moving your wrist may be painful and you usually should not try to move your elbow. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay - though this is rarely required. The majority of patients leave the hospital after two or three hours. As soon as you are fully awakened, you usually are allowed to go home. You will probably be unable to drive a car, so be sure to have arranged a ride home.

Home Recovery [top]

After surgical stabilization of your shoulder, you will need to take steps to reduce the pain and inflammation in your shoulder. Rest, icing, and anti-inflammatory painkillers such as ibuprofen or aspirin can ease pain and swelling. Immobilizing your shoulder in a sling for two to four weeks will help keep it stabilized. During this time, your physician or physical therapist may recommend that you perform simple elbow exercises to maintain your elbow’s range of motion. Here is what you can expect and how you can cope with a sling immobilizing your shoulder:

   The first concern is to monitor swelling for the first 48 hours while wearing your sling. Physicians generally prescribe ice packs to be applied for 15 to 20 minutes at a time, three or four times a day.

   If the swelling has decreased after 72 hours, you may be able to apply heat to help reduce pain. You should not apply heat to swollen areas because heat increases blood flow to the skin, which can prolong the healing process.

   Physicians generally recommend that you wear the shoulder sling day and night for about two or three days.

   You can usually remove the gauze bandage and bathe regularly after two days. If surgeons had to make a 1½-inch "mini-incision" to suture a rotator cuff tear, you may have to keep the bandage on and sponge bathe for about seven days. You can take your sling off for brief periods while you bath, but remember to avoid moving your injured shoulder.

   Some bleeding and fluid drainage is normal for the first two days. Call your physician if bleeding continues.

   When your shoulder starts to heal, your physician may recommend that you remove the sling for short periods to perform some light, early-motion exercises.

   You should move your fingers and hands in the sling as much as possible to help circulate blood.

   If you develop a rash or irritated skin around your sling, call your physician.

    If you notice any abnormal wear or discomfort in the sling, contact your physician as early as possible. In general, do not try to "grin and bear it" if discomfort does not go away within a few days. Slings should not irritate your skin.

   You may feel some stiffness in your shoulder. If the stiffness does not ease after two or three days, call your physician.

Rehabilitation [top]

Passive motion exercises, such as "pendulum" exercises, often can begin a few days after surgical stabilization of your shoulder. However, it may take three or four weeks before you can begin to move your shoulder through a limited range of motion by yourself. Physical therapy to restore range of motion and strength to your shoulder usually progresses through four phases. The time you spend in each phase depends on the severity of your injury and your body’s ability to heal.

   The first phase focuses on decreasing inflammation in your shoulder. Your therapist usually helps you move your arm and stretch your shoulder.

   When you feel comfortable moving your arm with your own strength, you can work on restoring a full range of motion and strengthening the hands, wrist, and elbow.

   The third phase focuses on shoulder-strengthening exercises. These may begin with isometric exercises, which strengthen the muscles without motion, and progress to resistive exercises that may involve pulleys or weights.

   When the muscles in the injured shoulder are about as strong as the uninjured muscles, phase four of rehabilitation becomes more activity oriented. You usually perform sport-specific exercises and coordination drills under the supervision of a therapist or coach.

Athletes in sports that require overhand throwing may undergo a more aggressive rehabilitation program in which full range of motion in the shoulder is restored after six weeks. For most patients, light throwing can resume after four months, but full-speed throwing, heavy weightlifting, and contact sports should not be undertaken until at least six months after surgery. Here are examples of shoulder stretching and strengthening exercises:

   Shoulder stretching exercises

   Shoulder strengthening exercises

Prevention [top]

The best way to prevent recurrent shoulder subluxation is to make the shoulder stretching and strengthening exercises you learned in rehabilitation part of your everyday routine. After you suffer an initial subluxation, your shoulder may be more vulnerable to instability. The natural integrity of the socket may not be strong enough to withstand the force of contact sports or repeated overhead motion. You may have to rely much more on the muscles in the rotator cuff (supraspinatus, infraspinatus, subscapularis, and the teres minor), lower neck, and upper back to hold your shoulder in place. Sports that involve repeated overhand motion, like baseball and tennis, inevitably put stress on your shoulder. To prevent injury, you need to practice proper technique when doing these activities. You also may need to alter your work environment to avoid repeated overhead activities. In general, your shoulder can become healthy and stable after subluxation, but you may need to be cautious of activities that could result in accidental collisions or falls. Your physician may recommend that you avoid contact sports or risky, high-speed activities. You should wear shoulder pads during contact sports. Your physician can recommend the best types of protective gear for your shoulders. If you play a sport that does not require overhand motions, your physician may prescribe an abduction harness, which is worn around the chest and affected arm. The harness helps to stabilize the shoulder by preventing you from raising your arm above 90 degrees. If you feel persistent pain in your shoulder during activities, you should cut back your activity level and return to your physician for a check-up.

Physical Therapy
Open or Arthroscopic Stabilization
   Treatment Introduction
   Preparing for Surgery
   Day of Surgery
   Surgery Procedure
   Recovery Room
   Home Recovery

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