Shoulder dislocation

The shoulder is a ball and socket joint. It has a huge arc of movement. This is because the socket is more like a plate than an egg cup. The disadvantage of this is that the shoulder can easily be dislocated with significant trauma. When the shoulder is dislocated, the soft tissue structures, which hold the ball in the socket are torn or irreversibly stretched and the shoulder then becomes too loose. Further dislocations can occur with minimal trauma. Any person who has had two dislocations has a shoulder which is permanently too loose and will only really recover with some form of surgical tightening procedure. In the past the surgical tightening was undertaken by means of an open operation through a large incision down the front of the shoulder. This operation was and is very effective. The loose structures are dissected and overlapped like converting a single-breasted into a double-breasted suit. No screws or pins are inserted, it is simply a tightening of the soft tissues. The tightening is only really tacking and the actual repair is formed by the body's own scar tissue. The patient has to remain in a sling for four weeks while this scar forms tightly. Over the last few years, surgeons have learnt to do the tightening as a keyhole procedure using keyhole stitching techniques. This treatment is very effective for the majority of cases although there will still be a few patients who are not suitable for keyhole surgery. The advantage of the keyhole surgery is that it is done through three, six millimetre keyholes and no significant incision is made. There is therefore much less pain in the immediate aftermath of the surgery. With the keyhole surgery, however, it is still necessary to be in a sling for four weeks because the repair is still that of scar rather than the stitches. All patients return to the gymnasium at six weeks for muscle strengthening and to football at twelve weeks but are not able to resume rugby, tennis or over-arm swimming until six months after the surgery.