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Open Surgery to Stabilize the Shoulder: It's Not a Closed Book

Open surgery has been the standard surgical treatment for dislocated shoulders. Open surgery for the shoulder involves a large incision through the skin and muscles in order to fix the injured shoulder.

Open surgeries take time and expertise. They can lead to complications, such as infection and damage to the rim of the socket. Sometimes a procedure like this can end up reducing the range of movement in the shoulder.

In 1993, a new technique was introduced. The procedure uses an arthroscope. This instrument works like a TV camera below the skin. It lets surgeons see inside the shoulder without having to make big incisions.

With arthroscopy, patients usually recover more quickly. They may also have less pain after surgery. But the procedure may be less effective than open surgery when it comes to keeping a dislocated shoulder in place. Research shows that nine to 20 percent of patients who have arthroscopic surgery dislocate their shoulders again. However, arthroscopic techniques have improved. Some surgeons now use special tacks that are absorbed by the body as the shoulder heals.

These authors wanted to compare the results of open and arthroscopic surgeries. One hundred-seventeen patients (119 shoulders) volunteered for the study. These patients had had at least one shoulder dislocation, followed by another full or partial dislocation. The patients were mostly men. Their average age was 27. (Ages ranged from 15 to 62.) Roughly three years had passed since their injuries.

Patients were given a choice between the two kinds of surgery. If they couldn't decide, the surgeon picked for them. In the end, 53 shoulders had the open procedure. Sixty-three shoulders had the arthroscopic procedure.

Afterwards, patients wore slings for four weeks. They started strength exercises at six weeks. Contact sports were allowed at six months if shoulders were totally stable.

The authors followed up with 108 patients two to five years after surgery. The arthroscopic group was contacted about eight months before the open group.  Significantly, the arthroscopic group had fewer dislocations before surgery (six versus 10 per patient).
 
Nine shoulders (15 percent) in the arthroscopic group had another dislocation or partial dislocation two to five years after the surgery. The same was true of five shoulders (10 percent) in the open group. The difference between groups was felt to be slight.

Movement was slightly better in the arthroscopic group. Other than that, there were no differences between groups in shoulder strength or function. There were also no differences in complications from surgery or need for more surgery.

Both procedures seemed to have good results for most patients. The authors think that looseness in the shoulder may determine how well surgery works in either case. They feel that decisions about surgery should be based on patients' preferences and doctors' experiences with both kinds of surgery. These things should come before patients' age, history, or participation in sports when deciding which type of surgery to have.

References: Jon Karlsson, MD, PhD, et al. Comparison of Open and Arthroscopic Stabilization for Recurrent Shoulder Dislocation in Patients with a Bankart Lesion. In The American Journal of Sports Medicine. September/October 2001. Vol. 29. No. 5. Pp. 538-542.

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