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The glenohumeral joint is the ball and socket joint that connects the humerus bone (upper arm bone) to the scapula (shoulder blade).
The acromioclavicular joint is the joint between the end of the clavicle (collarbone) and the scapula.
The sternoclavicular joint is the joint between the sternum (breastbone) and the clavicle.
The scapulothoracic joint is the joint between the scapula and the ribcage.
The glenohumeral joint is the most mobile joint in the body. The humeral head (ball) sits in a very shallow socket in the shoulder blade, known as the glenoid fossa, allowing large multidirectional directional movements.
Partial and complete shoulder dislocation result in extreme pain, loss of shoulder movement, feelings of instability or looseness of the shoulder and numbness, tingling or weakness of the arm. The most common cause of shoulder dislocation is trauma, such as falls or high-speed impact, usually when the shoulder is in a vulnerable position such as when your arm is stretched out to the side.
Occasionally, however, shoulder dislocation can occur due to underlying instability, which can develop as a result of previous dislocation or intensive repetitive overhead shoulder movements, such as throwing and swimming.
Shoulder dislocation is initially treated by relocating the humeral head into the glenoid socket as quickly as possible in order to reduce the amount of muscle spasm and limit the chance of nerve compression or irritation.
Shoulder dislocations are then treated conservatively once relocated, with treatments including: pain relief, ice therapy, immobilisation with a sling and progressive range of movement and strengthening shoulder exercises. Even if treated successfully shoulder dislocations can cause instability and damage within the shoulder joint which makes them much more susceptible to re-dislocation.
The most appropriate surgery in this instance is known as Latarjet shoulder stabilisation surgery, in which the coracoid process, one of the bony prominences of the scapula, is transferred to the front of the shoulder joint in order to provide more stability for the shoulder joint.
This will allow you to discuss any questions you may have and to find out more about the surgery. This will also allow us to perform a physical examination to ensure you are well enough for the surgery and anaesthetic, as well as taking measurements such as blood pressure and collecting a full past medical history of any other relevant medical conditions and medications.
Latarjet shoulder stabilisation surgery is performed under general anaesthetic as day surgery, meaning you will usually be operated on and released on the same day, but sometimes you may have to stay in overnight depending how you are doing.
Usually, a nerve block will be administered in order to reduce the feeling in your shoulder. A 5cm incision will be made at the front of your shoulder around the coracoid process and running down.
Soft tissue structures such as blood vessels and the deltoid muscles are then retracted exposing the shoulder joint. The coracoid process is then divided at the base and some muscles/tendons are released. The coracoid is then brought down to the shoulder joint at which point the humeral head is retracted and the coracoid is fixed to the front of the glenoid socket.
At the end of the surgery the structure will be preserved and closed using dissolvable sutures. After the operation you will return to the ward wearing a sling.
The risks of Latarjet shoulder stabilisation surgery will be discussed with you in detail at your pre-admission clinic appointment. Risk factors for the surgery which can affect a very small percentage of patients include:
Once the effects of the anaesthetic and nerve block have worn off pain killers will be used to control your pain. You will be required to wear a sling for up to 2-3 weeks following your surgery. Full recovery from Latarjet shoulder stabilisation surgery can take up to 3-6 months. Avoid forced gripping or heavy lifting for 2-3 weeks.
In terms of returning to work it will depend on your work environment. Returning to heavy manual labour should be prevented for approximately 8 weeks. Early return to heavy work may cause problems with your recovery. You will be given advice on your own particular situation. You will be reviewed by your consultant approximately 6-8 weeks after your surgery.
Immediately after your surgery you will be referred for outpatient physiotherapy. If you are a private patient, you will be able to back to your original physiotherapist out in the community if you wish. However, if you are an NHS patient then your physiotherapy will be set up as part of your post-operative care in house. You will follow a regimented physiotherapy programme that will allow you to start to regain movement in your shoulder and then strengthen the muscles in order to return to all of your normal activities as follows;