Instability of the shoulder represents a spectrum of pathology, from the subluxation or excessive movement in the very lax jointed young gymnast to the isolated traumatic sports injury with resultant dislocation.
Dislocations can be anterior (in terms of which way the ball comes out of the socket- this is the most common), posterior (rare) or multidirectional. Some patients subluxate or partially dislocate each time they perform one particular movement, others can dislocate as a party trick. Each must be treated on its merits. Generally speaking the younger you are at the time of first tramatic dislocation the higher the chance of recurrent problems.
Patients with recurrent instability and significant symptoms that have failed conservative or non surgical treatment are often investigated for the cause of the instability with a view to surgical stabilisation. This may involve clinical assessment, X-rays and possibly an MRI scan (or an MRI arthrogram where dye is injected into the joint first). Further assessment may also be required by diagnostic arthroscopy where a camera is inserted into the joint to assess the damage.
The most common cause of recurrent anterior traumatic instability is when the anterior fibro-cartilagenous lining (labrum) of the cup (glenoid) detatches inferiorly, and remains detatched. This is the so called 'BANKART' lesion. This lesion may need to be placed back onto the cup with tacks or anchors to re stabilise the shoulder. Such an operation can be done arthroscopically or open depending on the indications.
Generally speaking after such an operation the patient will wear a sling for a period of up to 6 weeks and be off contact sports for six months. Such time periods are of course variable and depend on individual pathology.
For information on post operative Physiotherapy following Stabilisation surgery, please follow this link. Anterior Stabilisation physiotherapy