Mr Simon Lambert BSc FRCS FRCSEdOrth

Consultant Orthopaedic Shoulder & Elbow Surgeon

Repair of instability and rehabilitation

Repair of torn capsule and labrum tissues can be helpful in the first-time dislocation. This is almost always possible by arthroscopic techniques. When the damage is more extensive then alternative reconstruction techniques are necessary.

These may involve bone grafts and substitute ligaments, and these are more readily achieved by open operations. For either type of approach the risk of recurrence is between 5% and 15% depending on the extent of damage seen at the time of operation. If patients go back to contact sports the risk of recurrence is increased - perhaps up to 20-30% depending on the sport and the initial damage.

Whatever the operation and type of instability, a physiotherapy programme is mandatory. Before capsule tissues tear they have always been stretched first: this damages the nerve endings in the tissues and the joint loses its ability to sense what movement is happening, in which direction, and at what speed.

After repair or reconstruction of the capsule the nerve endings start to regrow and the joint regains this ability; physiotherapy helps this process to regenerate the position and motion-sensors in the shoulder, train them appropriately and then maintain them in as healthy a state as possible for the avoidance of future instability.

Without physiotherapy the operation has a lower chance of success.