Shoulder Stabilization
Background
Shoulder stabilization surgery restores support to a shoulder that repeatedly dislocates or slips partly out of place. The procedure addresses injuries to the labrum and joint capsule, which help keep the ball of the upper arm centered in the socket. In some patients, bone damage also contributes to instability and must be treated.
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Dr. Fliegel selects the procedure based on the direction of instability, the condition of the labrum, the amount of bone loss, prior dislocations or surgery, and the demands of your activities. Treatment may involve an arthroscopic repair or, when more bone support is needed, a bone block procedure.
The Surgical Procedure
During surgery, Dr. Fliegel examines the labrum, joint capsule, and bone surfaces to confirm the injuries contributing to instability. He then repairs or reconstructs the damaged structures to help keep the shoulder centered as it moves.
Arthroscopic Bankart Repair +/- Remplissage
A Bankart repair treats a tear of the labrum at the front and bottom of the socket, commonly caused by a forward shoulder dislocation. Through small incisions, Dr. Fliegel uses a camera and suture anchors to reattach the labrum. The surrounding capsule may also be tightened to restore stability.
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A dislocation can leave a dent in the back of the upper arm bone, called a Hill-Sachs lesion. If this defect is likely to catch on the socket rim, a remplissage may be added to the Bankart repair. The procedure secures tissue into the defect to reduce the risk of another dislocation. For appropriately selected patients, adding remplissage has been associated with less recurrent instability without compromising return to sport.
Posterior Labral Repair
When the shoulder slips toward the back, the labrum at the rear of the socket can tear. Dr. Fliegel repairs the posterior labrum with suture anchors and addresses any looseness in the capsule. Some patients with posterior instability experience pain during pushing or weight-bearing activities rather than a complete dislocation.
SLAP Repair
A SLAP tear involves the top of the labrum, where the biceps tendon attaches. It may occur alongside another instability injury or cause pain with overhead activity. Depending on the tear and the patient’s goals, treatment may involve labral repair or a biceps tenodesis, which moves the biceps tendon attachment away from the damaged area.
Bone-Block Stabilization
When significant bone loss from the shoulder socket makes a labral repair less reliable, Dr. Fliegel may perform an open bone block procedure to rebuild the socket and reduce the risk of another dislocation. This may also be considered after a previous stabilization procedure has failed.
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In a Latarjet procedure, a piece of bone from the shoulder-blade called the coracoid is transferred to the front of the socket and secured in place. This restores missing bone, while the attached tendon provides an additional stabilizing effect as the arm moves.
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Alternatively, Dr. Fliegel may use a donor bone graft. A distal tibial allograft uses bone and cartilage from a donor shinbone to reconstruct the socket’s shape and joint surface. There are also preshaped donor bone graft designed to fit the socket rim that can be used. Unlike the Latarjet, these grafts do not bring an attached tendon with them. The choice depends on the pattern and amount of bone loss, previous surgery, and the anatomy of your shoulder.
Choosing the Right Procedure
No single operation is best for every unstable shoulder. Dr. Fliegel uses your examination and imaging to assess labral injury, bone loss, and other factors that increase the risk of recurrence. A CT scan may be obtained when a more detailed measurement of bone loss is needed.
Recovery Timeline
Recovery protects the repair first, then gradually restores motion, strength, and shoulder control. Your exact instructions depend on the procedure performed.
Early Recovery (Weeks 1 - 6)
The shoulder needs protection while the repaired tissues begin to heal.
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Wear a sling as instructed.
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Move your hand, wrist, and elbow as permitted.
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Avoid lifting, pushing, pulling, and positions that stress the repair.
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Begin physical therapy and shoulder motion according to your procedure-specific plan.
Intermediate Recovery (Weeks 6 - 12)
Physical therapy gradually restores motion and begins strengthening. Exercises progress differently after an anterior repair, posterior repair, SLAP treatment, or bone block procedure.
Late Recovery (Months 3 - 6)
Strengthening becomes more demanding, and athletes begin controlled sport-specific exercises when ready. Many patients can resume lower-demand, noncontact activities during this period.
Return to Sport (Months 6 - 12 and Beyond)
Return to contact or overhead sports depends on shoulder stability, motion, strength, and performance during sport-specific testing. After a bone block procedure, bone healing also helps determine when activity can safely progress. The timeline is individualized rather than based on the calendar alone.
What to Expect
Pain Management
We utilize a multimodal approach including a nerve block when appropriate, oral medications, and ice therapy to minimize the postoperative pain and to limit narcotic use. Swelling and discomfort are expected early on, but most patients find their pain very manageable with this comprehensive approach.
Protecting the Repair
The shoulder may feel more secure well before the repair has fully healed. Follow your sling and activity instructions even as pain improves. Dr. Fliegel will guide your progression back to lifting, exercise, and sport at follow-up visits.
Success Rates
Most patients regain a stable shoulder and return to activity after surgery, but another episode of instability remains possible. That risk varies with the procedure, bone loss, prior dislocations, and the demands of your sport. Fliegel will discuss the expected outcome for your specific injury and use strength, shoulder control, and sport-specific testing to guide your return to play.