Subluxation > Treatments
Open or Arthroscopic Stabilization
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.
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.
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.
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.
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.
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.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
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:
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.
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.
a soft, comfortable shirt that will not irritate your
skin when worn under a shoulder sling.
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 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.
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.
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.
also are put under general anesthesia, and may be given
a mild sedative to help you relax.
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
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
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.
incisions are closed with stitches and you are taken
to the recovery room.
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.
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
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.
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.
generally recommend that you wear the shoulder sling
day and night for about two or three days.
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.
bleeding and fluid drainage is normal for the first
two days. Call your physician if bleeding continues.
your shoulder starts to heal, your physician may recommend
that you remove the sling for short periods to perform
some light, early-motion exercises.
should move your fingers and hands in the sling as much
as possible to help circulate blood.
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.
may feel some stiffness in your shoulder. If the stiffness
does not ease after two or three days, call your physician.
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.
first phase focuses on decreasing inflammation in your
shoulder. Your therapist usually helps you move your
arm and stretch your shoulder.
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.
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.
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:
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.