Shoulder Stabilization

Shoulder stabilization procedures are performed to address shoulder instability, which can result from various factors such as ligament laxity, labral tears, bone loss, or muscle weakness. The type of stabilization procedure chosen depends on the underlying cause of instability, the direction of instability (anterior, posterior, or multidirectional), and other individual factors such as age, activity level, and anatomical considerations. Here are the main types of shoulder stabilization procedures:

Bankart Repair (Anterior Stabilization): Bankart repair is a surgical procedure used to stabilize the shoulder following anterior shoulder instability, where the shoulder frequently dislocates or subluxates forward. During this procedure, the torn labrum (a ring of cartilage) and any associated ligaments are reattached and secured to the rim of the glenoid (shoulder socket). Bankart repair can be performed arthroscopically or through an open surgical approach.

Capsular Shift (Multidirectional Stabilization): Capsular shift is a surgical technique used to tighten and reposition the shoulder capsule to address multidirectional instability, where the shoulder is unstable in multiple directions. During this procedure, Dr. Pournaras tightens and plicates (folds) the capsule, effectively reducing its volume and providing additional stability to the shoulder joint. Capsular shift can be performed arthroscopically or through an open surgical approach.

Latarjet Procedure (Anterior Stabilization with Bone Block): The Latarjet procedure is a surgical technique used to stabilize the shoulder joint following anterior shoulder instability, particularly in cases where there is significant bone loss from the glenoid socket. During this procedure, a small piece of bone and attached muscle (usually from the coracoid process of the scapula) is transferred and attached to the front of the glenoid to create a bony block. This helps to prevent further dislocations by increasing the depth of the glenoid socket and providing additional stability to the shoulder joint.

Remplissage (Engaging Hill-Sachs Lesion): Remplissage is a surgical technique used to address engaging Hill-Sachs lesions, which are defects in the humeral head that can occur due to recurrent anterior shoulder dislocations. During this procedure, Dr. Pournaras will fill the defect in the humeral head with soft tissue (usually the posterior capsule or infraspinatus tendon) to prevent engagement of the lesion against the glenoid rim during shoulder movement.

Bone Block Procedures (e.g., Eden-Hybinette Procedure): Bone block procedures involve transferring bone from another part of the body (such as the iliac crest or distal clavicle) and securing it to the deficient area of the shoulder to improve stability. These procedures are typically used in cases of significant bone loss from the glenoid or humeral head.

These are the main types of shoulder stabilization procedures commonly performed to address shoulder instability.

Symptoms of Shoulder Arthritis:

• Pain in the shoulder joint, particularly with movement or pressure
• Stiffness in the shoulder joint, especially in the morning or after periods of inactivity
• Decreased range of motion in the shoulder
• Swelling or tenderness around the shoulder joint
• Clicking or grinding sensations in the shoulder joint

Surgical options for shoulder stabilization in cases of severe instability or recurrent dislocations.

The choice of surgical procedure depends on factors such as the underlying cause of instability, the patient’s age, and activity level.

Arthroscopic Bankart Repair: This is one of the most common surgical procedures for anterior shoulder instability, where the shoulder frequently dislocates or subluxates forward. During an arthroscopic Bankart repair, Dr. Pournaras will use small incisions and a tiny camera (arthroscope) to visualize the inside of the shoulder. Specialized instruments are then used to repair and reattach the torn labrum (a ring of cartilage) to the rim of the glenoid (shoulder socket). Sutures or anchors are typically used to secure the labrum in place.

Latarjet Procedure: is a surgical technique used to treat anterior shoulder instability, particularly in cases with significant bone loss from the glenoid socket. During this procedure, a small piece of bone and attached muscle (usually from the coracoid process of the scapula) is transferred and attached to the front of the glenoid to create a bony block. This helps to prevent further dislocations by increasing the depth of the glenoid socket and providing additional stability to the shoulder.

Capsular Shift: In cases of generalized ligamentous laxity or multidirectional shoulder instability, a capsular shift procedure may be performed to tighten and reinforce the shoulder capsule. During this surgery, Dr. Pournaras will tighten and reposition the soft tissues surrounding the shoulder, effectively reducing the volume of the joint capsule. This helps to improve stability and prevent excessive shoulder movement.

Remplissage: Remplissage is a surgical technique used to address engaging Hill-Sachs lesions, which are defects in the humeral head that can occur due to recurrent anterior shoulder dislocations.

During this procedure, Dr. Pournaras will fill the defect in the humeral head with soft tissue (usually the posterior capsule or infraspinatus tendon) to prevent the lesion from engaging against the glenoid rim during shoulder movement.

Open Capsular Shift: Similar to arthroscopic capsular shift, an open capsular shift procedure involves tightening and repositioning the shoulder capsule to address multidirectional instability. With this approach, Dr. Pournaras will make a larger incision and directly visualize the shoulder to perform the capsular shift.

Bone Block Procedures (e.g., Eden-Hybinette Procedure): In cases of significant bone loss from the glenoid or humeral head, bone block procedures may be considered to reconstruct the bony anatomy of the shoulder. These procedures involve transferring bone from another part of the body (such as the iliac crest or distal clavicle) and securing it to the deficient area of the shoulder to improve stability.

Open Bankart Repair: In cases where arthroscopic Bankart repair is not feasible or effective, an open Bankart repair may be performed. This involves making a larger incision and directly accessing the shoulder joint to repair the torn labrum and capsule.

The specific surgical approach chosen will depend on the individual patient’s condition and anatomical factors.

Physical therapy is typically a crucial component of postoperative rehabilitation to optimize shoulder function and prevent complications.