What is shoulder instability?
Shoulder instability and dislocations occur most commonly from a traumatic event or injury, often in overhead and contact sports, such as AFL. Depending on the direction of force on the shoulder joint, the ball (humeral head) may dislocate from the socket (glenoid) in either a forward or backward direction. When this occurs, the strong ligaments and fibrocartilage around the shoulder joint are stretched and torn. There may also be associated injury to surrounding tendons, nerves and fracture of the bone. Once a shoulder has dislocated, it becomes more prone to occuring again and being unstable.
Read more about the treatment options for shoulder instability here.
The symptoms of shoulder instability include:
- Repeat dislocations of the shoulder joint, which may or may not require visits to the Emergency Department to put the shoulder ‘back in joint’.
- Ongoing sensations of the shoulder sliding in and out of the socket, even if it does not fully dislocate.
- Pain or ‘lack of confidence’ in the shoulder when putting your arm above your head.
- Inability to return to sport.
What is the Latarjet and why is it a good option?
The Latarjet procedure is a technique used to reconstruct the shoulder which suffers from repeated dislocations and instability. It was developed in France and has been modified over the years to its current modern form. It is a good option in patients who are involved in high contact or overhead sports, who have sustained significant bone damage from the shoulder dislocations, or in those who are relatively young with a high chance of recurrent dislocations or instability. The operation involves shifting a small piece of bone from the shoulder blade (coracoid) with its attached tendon (conjoint tendon), and moving it to the rim of the shoulder socket where the dislocations are occuring. In this way, the shoulder socket and its ligaments can be reconstructed and the shoulder joint made even more stable than before. In fact, the tendon which has been shifted acts as a natural internal ‘sling’ for the shoulder joint. With the Latarjet procedure, a success rate of 95-98% is expected.
What’s involved in Latarjet procedure
Post operative x-ray of the Latarjet
The surgery is performed under a general anaesthetic so you are asleep for the operation. You will also have a nerve block which numbs the shoulder and arm for up to 24 hours, and gives good pain relief.
The operation takes approximately 60-90 minutes, and involves an incision at the front of the shoulder of 4-5cm in length. Through this incision, the bone graft is harvested from the shoulder blade and moved to the shoulder socket. It is placed at the front and lower aspect of the shoulder socket and fixed in placed with 2 screws. The shoulder ligaments are then tightened and repaired over the top of the bone graft.
As with any surgical procedure, there is a small risk of:
- Wound healing problems
- Blood clots
- Swelling of the operated limb – generally subsides within weeks
- Pain – discomfort is expected after an operation, however pain medications are used in a routine manner to relieve this post-operative discomfort.
Specific risks of the Latarjet shoulder reconstruction:
- Damage to nerves around the shoulder
- Stiffness or ‘frozen shoulder’
- Recurrent instability
- Fracture of the graft
- Loosening of screws
- Graft non-union
What happens after the surgery?
Postoperative instructions and follow up
After your operation you will be taken to the recovery room of the hospital, and allowed to have something to drink. When the team is happy the anaesthetic has worn off, you will be transferred to the day surgery area or to your inpatient room depending on whether you will be staying overnight. A sling / shoulder immobiliser would have been placed on your arm in the operating room, and should keep your arm comfortable and safe. If a nerve block has been performed by our anaesthetist, then your arm should feel comfortable but numb for up to 24 hours after the operation. When pins-and-needles are felt in the hand and arm then the block is starting to wear off, and your nursing staff will commence pain medication to keep you comfortable.
Discharge from hospital
On discharge from hospital you will be given:
- Physiotherapy – instructions on exercises that should commence for the shoulder, elbow and wrist. This will involve daily stretching exercises to be commenced in the first week.
- Sling – instructions on the use of your sling, including whether it is allowed to be removed.
- Dressings – please keep dressings dry and do not remove them.
- Follow up appointment time
A follow up appointment will have been made for you after the operation. This will typically be an appointment around the 2-3 weeks after the surgery. If you have any concerns before this appointment, call Dr Yu’s clinic on (08) 7099 0188 to speak with us.
My goals as a surgeon are to relieve your pain, restore your function, and return you back to doing what you love.
– Dr Raymond Yu
- Adelaide Orthopaedic Surgeon
- Adelaide Shoulder Surgeon
Dr Raymond Yu
Dr Raymond Yu is an Adelaide Orthopaedic Surgeon with post-Fellowship expertise in Shoulder and Elbow Surgery.
He specialises in orthopaedic surgery of the Shoulder and Upper Limb with a focus on modern keyhole and minimally-invasive techniques.
Dr Yu has a special passion for:
- Rotator cuff repair surgery
- Shoulder replacement surgery
- Shoulder stabilisation surgery