Glenohumeral Joint Reconstruction
If you are experiencing pain in your shoulder because it has become unstable, either through dislocation (the ball has come completely out of the socket) or subluxation (the ball has partially come out of the socket), you may be a candidate for joint reconstruction.
Dislocation or subluxation occurs because of damage to the shoulder ligaments. Ligaments are strong cord-like structures that connect one bone to another. These ligaments tore from a single violent injury or were stretched due to repeated strenuous use.
The indications for surgery are persistent pain and instability interfering with your activities of daily living, work and/or sports. Surgery will repair the damage to the ligaments in your shoulder that have torn and/or stretched and allowed the ball to slip out of its socket.
While surgery is the best course of action, other treatments are available, including just living with the condition, physical therapy exercises, medication or injections. Your condition will not worsen if surgery is not completed, although the frequency of the episodes may increase. Shoulder instability does not generally lead to arthritis. While no one can argue that repeated subluxations or dislocations are good for your shoulder, the major damage has already been done.
The Surgery Experience
The surgery is usually completed as an outpatient procedure using the arthroscopic technique. General anesthesia is used, along with an injection of a type of novocaine that lasts four to 24 hours to help decrease shoulder pain after surgery. You will awaken in the recovery room after your surgery with your arm in a sling and attached to an ice pack (Cryo Cuff) to help control the pain and swelling. The medication, sling and ice pack will control the pain so you will be as comfortable as possible.
Instead of making a large incision, Dr. Gartsman will make three small (about 1/2") incisions. He will insert the arthroscope through the first incision, and use the other two to insert special instruments.
If a ligament tears off from its bone attachment, Dr. Gartsman will reattach the ligament to the bone with small, metal bone screws that are permanently placed inside the bone. Attached to the bone screw are sutures that are weaved through the torn ligament.
If the ligaments have become stretched, Dr. Gartsman will cut the ligament in two and overlap it. Often, Dr. Gartsman performs both procedures, depending on the type of damage.
If there is bone damage that requires a bone graft, Dr. Gartsman cannot repair this damage with the arthroscope. He will need to make one large incision in the front of your shoulder. The care after surgery and recovery are the same as for the arthroscopic surgery.
How successful is the surgery?
This type of surgery is successful about 85-95% of the time. No shoulder operation is 100% successful in every individual but the procedures we perform are reliable and will help restore the potential function in your shoulder. A large factor influencing the success of this operation is ligament healing. While we can tighten the ligaments at surgery, they stretch over time. We know this occurs so I make the ligaments tighter then normal and expect them to stretch over the year after surgery.
What no one can control is how much the ligaments continue to stretch. Sometimes they will stretch so much that slippage will occur. That is why it is so important to continue with the strengthening exercises 3 times a week for 2 years after surgery. Because of the many variables involved, I can make no guarantees other than to assure you I will deliver the very best medical care possible.
Your first office visit is two weeks after surgery so that Dr. Gartsman can examine the surgical incision. He will give you additional instructions for exercises and discuss your allowed activity level. Six weeks after surgery, more vigorous use of the shoulder will be allowed. Office visits then occur three, six and 12 months after your surgery.
Returning to Work
For most sedentary jobs, Dr. Gartsman recommends taking a week off from work. When you return to work your arm will be in a sling (six weeks after surgery) but you should be able to manage as long as you do no lifting, pushing, pulling or carrying.
Most patients can start light duty work involving no lifting, pushing, pulling or carrying more than one to two pounds, 6-8 weeks after surgery. Work at waist level and 5-10 pounds of lifting is started 3-4 months after surgery. You will generally need 3-6 months of recovery before beginning occasional work at the shoulder level, but a return to heavy lifting or overhead use may require 6-12 months.
You may enjoy walking, Stairmaster and stationary bicycle riding within one to two weeks after surgery. Jogging, and regular bicycle riding can start two to three months from surgery, as can gentle golf strokes. Swimming, running, and tennis ground strokes start four to six months after surgery while a return to overhead throwing, tennis strokes and contact sports require at least six months of rehabilitation. A full return to competitive overhead sports requires 12 full months. Returning to weight lifting is unpredictable. You may need one full year before performing activities such as the bench press and you may never recover enough to lift heavy weights.
You will need to do your strengthening exercises three times a week for two years. This allows the ligaments to heal. Some people stop exercising too soon and then the shoulder starts to hurt.
The most common complication from this surgery involves injury to nerves around the shoulder. These usually go away in two days to six weeks. This occurs in less than 1%
Permanent injury that results in diminished use, function or feeling in the extremity can occur but is exceedingly rare. Infection can occur (less than 1% of patients), and may require antibiotic treatment with pills or by injection. Rarely, surgery is necessary.
It is extremely rare for the bone screws to cause problems, but the possibility does exist and further surgery may be required. Joint problems, including stiffness or arthritis, also could occur after surgery. Failure to achieve the desired result is not strictly a complication but it can be a source of disappointment. Additionally, this operation may result in incomplete motion, strength or function.
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Standard Bankart Repair
Acute Bankart Repair
Bankart Repair with Capsular Shift
Bankart Repair Animation
Glenohumeral Joint Reconstruction Poserior
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