What is the Surgery for Traumatic Shoulder Instability

Traumatic shoulder instability is a condition in which the shoulder joint moves out of place more easily than normal because of an injury (trauma). This can happen when tissues that connect the shoulder bones and surround the joint (shoulder capsule) become loose or torn. Shoulder instability may cause a tear in the rim of cartilage (labrum) around the edge of the shoulder socket (glenoid). Surgery may be done to repair or reattach torn tissue, repair a torn labrum, or both. The procedure varies depending on your condition.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Bleeding.
• Infection.
• Allergic reactions to medicines.
• Damage to other structures or organs, such as blood vessels or nerves. Nerve damage can cause tingling or numbness.
• Long-term shoulder stiffness.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Other instructions

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• Your surgeon will move your shoulder to observe how it moves out of its socket.
• An incision will be made over the front of your shoulder.
• The muscles that cover your shoulder joint will be cut and separated, and your shoulder capsule will be opened.
• A curved bone at the tip of your shoulder blade may be removed.
• If your labrum is torn, several small holes will be made on the edge of your glenoid socket, near the tear. Stitches (sutures) will be placed through the holes to reattach your labrum to your glenoid.
• Stretched bands of tissue (ligaments) in your shoulder capsule will be shortened, and any torn ligaments will be repaired.
• The incisions in your shoulder capsule and the muscles over your shoulder joint will be closed with sutures.
• Your incisions will be closed with sutures or staples and covered with a bandage (dressing).
• Your arm will be placed in a sling.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You may have some pain. Medicines will be available to help you.
• Do not drive for 24 hours if you received a sedative, or until your health care provider approves.

Surgery for Traumatic Shoulder Instability, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Tenderness.
• Stiffness.
• Bruising.
• Swelling.

Follow these instructions at home:

If you have a sling:

• Wear the sling as told by your health care provider. Remove it only as told by your health care provider.
• If your sling has a pillow, do not remove it unless told by your health care provider.
• Loosen the sling if your fingers tingle, become numb, or turn cold and blue.
• Do not let your sling get wet if it is not waterproof.
• Keep the sling clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• Keep your bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your dressing. If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

• If directed, put ice on your shoulder area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Raise (elevate) your upper body on pillows when you lie down and when you sleep.
  • Do not sleep on the front of your body (abdomen).
  • Do not sleep on the side that your surgery was performed on.

Driving

• Do not drive for 24 hours if you received a medicine to help you relax (sedative) during your procedure.
• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe for you to drive.

Activity

• Do not use your arm to support your body weight until your health care provider approves.
• Do not lift or hold anything with your arm until your health care provider approves.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You develop tingling, numbness, or coldness in your arm or hand.
• You have pain that gets worse or does not get better with medicine.

Get help right away if:

• You have severe pain.
• You lose feeling in your arm or hand.
• Your hand or fingers turn very pale or blue.