Shoulder Instability Surgery- Reliable Results For Most Athletes

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Many young athletes with a shoulder dislocation from sports activity will choose to have shoulder stabilization surgery
  • Modern arthroscopic surgery techniques generally result in extremely stable shoulders for 90% of athletes and high satisfaction

I wrote last week about improvements in ACL surgery over the last 25 years and this week I’d like to explore improved results from another commonly performed sports medicine surgery- stabilization surgery for the dislocating shoulder. The results here mirror those of ACL surgery in many ways.

Many young athletes dislocate a shoulder from trauma, typically a dive with the arm outstretched overhead. This can happen in any sport involving that kind of motion, and any contact sport.

Most surgeries were performed through a large “open” incision 25 years ago, but nowadays can be performed arthroscopically in most cases. For uncomplicated stabilization of shoulders that have had a small number of dislocations from trauma, we should expect 90% of shoulders to remain stable and satisfaction rates upwards of 80% out to about 5 years with current methods, for recreational athletes.

Early Open Surgery Methods- Very Good At Stabilizing, Not So Good At Retaining Motion

Historically, the open surgery was for an unstable shoulder was reported in the early 1900s. A surgeon named “Bankart” first described the essential anatomy of the torn ligament and labrum stabilizing the shoulder in 1923, and for the most part we still generically refer to a shoulder stabilization as a “Bankart repair”.

Over the decades as additional knowledge was gained, modifications to the original procedures were developed. A key component surrounded understanding why surgeries on shoulders with many dislocations tended to do poorly compared to ones with only a few dislocations. While there are many factors, restoring bone loss that resulted from the dislocations was a major advancement.

As it turned out, open stabilization was extremely effective at providing excellent stabilization, with low re-dislocation rates.  But it came at a price. The rehabilitation was difficult and often resulted in permanent motion loss. Some techniques had unacceptably high rates of early arthrits. The end result was that many folks ended up with a stable shoulder but were unhappy about the result.

Arthroscopic Stabilization- Much Better At Retaining Motion With Excellent Stability

 “Arthroscopy” involves small incisions, with the surgeon visualizing and performing repairs through the small incisions. There are numerous advantages over open surgery.  Arthroscopy avoids some complications of open incisions, is generally faster, has minimal blood loss, is more comfortable after surgery, and generally leads to a faster return to sports with excllent joint motion.

And yet, in its earliest years, arthroscopic stabilization had a higher dislocation rate than open surgery. As it has been with ACL reconstruction surgery, arthroscopic shoulder stabilization has improved substantially over the years. Better surgical technique, improved surgical implants, and cutting-edge rehabilitation all play a role.

Measuring the ultimate outcome from arthroscopic shoulder stabilization surgery can involve many factors. Is there another dislocation after surgery? How is the range of motion? What’s the patient’s level of sport activity? How does the patient feel about their result?

If you’re a young athlete with an unstable shoulder, and you have a strong desire to resume a contact or collision sport you’ll likely want to consider shoulder stabilization surgery. Find an experienced shoulder surgeon and have a thorough discussion. You’ll have to work hard on your rehab and be patient but you should generally end up with an excellent result.

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Lifelong Athlete Back to Full Speed After Shoulder Surgery

Hinsdale resident John Blacketor rigorously maintained the lifestyle of an athlete after graduating from college, playing hockey, tennis, golf and football; running; lifting; skiing; and more. He wasn’t interested in slowing down.

“I played hockey throughout high school and continued in men’s leagues after college, up until I was 48,” Blacketor explained. “I was a goaltender, which is always a position that carries a high risk of injury.”

Eventually, shoulder, knee, and ongoing groin injuries—paired with late weeknight games—forced Blacketor into hockey “retirement.”

While playing baseball and softball, he developed right shoulder issues and eventually was limited to playing the infield. Determined to stay active but relieve stress on his shoulder, he focused on skiing and running. He remained active and generally pain-free.  However, shoulder pain became a serious problem after a skiing accident, which compelled him to finally seek medical advice. He underwent several months of physical therapy, which helped his mobility, but not his pain.

Finding the Right Specialist

Needing more advice, he consulted Midwest Orthopedics at Rush sports medicine specialist and surgeon, Dr. Charles Bush-Joseph, who referred him to Dr. Gregory Nicholson, a shoulder specialist at Midwest Orthopedics at Rush.

Dr. Nicholson performed a history and physical examination of the shoulder and upper extremity. He ordered an MRI for Blacketor which showed he had a torn rotator cuff, cartilage damage and bone spurs (also known as “osteophytes”). To offer some relief, Nicholson gave Blacketor a cortisone shot but shortly thereafter, the pain returned.

Dr. Nicholson discussed surgery to address the necessary shoulder repairs. Blacketor agreed. “I didn’t want to go through this pain off and on,” Blacketor explains. “So, I said, ‘why don’t we cut to the chase and get this fixed?’ and Dr. Nicholson agreed.”

Dr. Nicholson performed surgery arthroscopically to repair his torn rotator cuff, address the cartilage damage and remove the bone spurs. This is a minimally invasive procedure performed through small incisions called portals. There is less soft tissue damage, and less pain and swelling post-surgery. Blacketor experienced this first hand as his recovery progressed ahead of schedule. He needed pain medication for just a couple days and completed physical therapy in less than eight weeks. Today, he has full range of motion with no pain and is back playing golf.

Back in Action

The park across the street from Blacketor’s house has a tennis court which frequently causes tennis balls to stray into his yard. Prior to surgery, Blacketor says “I would walk out, pick up a half dozen tennis balls, and throw them back into the courts underhanded.” Post-surgery he is tossing them back over the fence overhanded.

He recommends Dr. Nicholson to anyone with shoulder pain. What he liked best about him is his “straightforward attitude” coupled with his excellent surgical skills.


If you would like to discuss your shoulder or elbow pain with Dr. Gregory Nicholson, call to schedule an appointment at 877-MD-BONES or visit www.rushortho.com/appointments.

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3 Essential Exercises for Shoulder Stability

Brian Whittington, PT, DPT, CMTPT for Athletico Physical Therapy

The shoulder is a complex joint that consists of a “ball” on one side and a “socket” on the other. Due to this construction, the shoulder is classified as “ball-and-socket” joint. To gain a better perspective on the size of this ball-and-socket joint, think of a golf ball sitting on a tee. On one side you have a really large ball and the other a small socket. The proportions of this large ball and small socket allows for the shoulder joint to have the largest amount of motion of any joint in the body, but there is a price to pay for this amount of motion.

Because the shoulder enjoys so much freedom of motion there is a certain amount of inherent instability in it. Yet, experience tells you that your shoulders don’t fall apart whenever you try and use them. This is prevented by the surrounding shoulder musculature providing the crucial stability it needs during movement. Without this dynamic stability, your shoulders would be in big trouble.

Many of these stabilizing muscles are found on and around your shoulder blade. This means your shoulder blade has an important role in restoring or maintaining the shoulder function, and exercises focusing on this area are critical for proper shoulder stability.1 Here are three shoulder blade exercises that can help build your shoulder “core” to provide superior shoulder stability:

  • If you are currently experiencing shoulder pain, it is recommended to first have your shoulder examined before performing these exercises.

Dynamic Hug – Serratus Anterior Strengthening

Stand with one foot in front of the other and the resistance band around your back or secured behind you. Start with your elbows bent and your hands at chest height. Straighten your elbows while simultaneously reaching as far forward as you can, bringing your hands together at the end of the movement. During this exercise, your arms should be parallel or just slightly above parallel to the ground.

The key to this exercises is to make sure you are reaching as far forward as you can, performing a ”punching” motion. This exercise focuses on strengthening the serratus anterior, which is an important muscle in providing proper shoulder blade upward rotation that is needed for proper shoulder function.

Prone Y- Lower Trapezius Strengthening

Lie on your stomach with one arm off the table or bench and your hand pointed toward the ground. Raise your arm on a 45 degree angle until it is parallel to the ground. When you are performing this exercise, squeeze the lower portion of your shoulder blade toward your spine. Pause for a moment before returning to your starting position.

To advance this exercise, perform both arms simultaneously while on a stability ball. During this advanced exercise, keep your neck in good alignment by not looking forward. Instead, look at the ground a few feet in front of you.

This exercise focuses on strengthening the lower trapezius. This muscle is not only important for performing shoulder blade upward rotation, but also is involved in bringing your shoulder blade down and in toward the middle of your back.

Stability Ball High Row with External Rotation – Middle Trapezius, Infraspinatus, and Teres Minor

Sit on a stability ball (hips and knees at 90 degrees) with a resistance band secured in front of you. Start with your arms in front of you at shoulder height. Perform a row, squeezing your shoulder blades together. When your elbows are in line with your shoulders, rotate your shoulders so that your hands are now toward the ceiling. Return to the starting position by reversing the sequence.

This exercise strengthens the middle trapezius, which is important for bringing the shoulder blades together. The exercise also strengthens the infraspinatus and teres minor, which are important muscles for stabilizing the shoulder during movement.

Increasing Shoulder Stability

Adding these three exercises into your shoulder routine can assist with proper shoulder blade mechanics and help maintain proper shoulder stability. If you experience unusual aches and pains during exercise, make sure to schedule a free assessment at your nearest Athletico location.

SCHEDULE A FREE ASSESSMENT

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Discussion on Recent Injuries to Professional Athletes

Image result for trubisky shoulder injury

Dr. Brian Cole and Steve Kashul discuss recent professional sports injuries: Mitchell Trubisky’s shoulder injury, Redskins QB leg injuries and Markelle Fultz of the 76’ers who has missed the team’s last 27 games while rehabbing in California after being diagnosed with neurogenic thoracic outlet syndrome.

After a two-year stretch of confusion, frustration, internet conspiracies, andWashington v Arizona unpredictability, Markelle Fultz, the Philadelphia 76ers’ 2017 No. 1 draft pick who suddenly couldn’t shoot a basketball, was finally diagnosed with thoracic outlet syndrome (TOS).

This ailment, often untraceable even by MRI, is the cause of Fultz’s inability to shoot a basketball properly from any distance. TOS is a very real, frustrating, and difficult-to-describe ailment. That may explain why it took so long to diagnose.

Sports Medicine Weekly on 670 The Score

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