For most patients with recurrent dislocation or subluxation, surgery is necessary to control the symptoms. After I have taken your history, examined you and reviewed your x-rays, I will probably have a good idea as to whether your diagnosis is subluxation or dislocation. I will also generally have a reasonably good idea of the direction of the instability. Once a surgical decision is elected, I begin with an examination under anesthesia of the shoulder which will reveal more precise information as to the nature of your problem.
Following this, at arthroscopy, it is usually possible to tell whether the ligaments have been stretched, torn from the bone or both, as well as the direction of dislocation or subluxation.
For the patient with recurrent dislocation or subluxation who has torn the ligaments and cartilage (labrum) away from the bone, [this is called a Bankart lesion], the ligament and cartilage is reattached to the bone with sutures or stitches.
If the dislocation or subluxation is secondary to stretched ligaments, the ligaments are tightened, and then secured with stitches or sutures. Sometimes patients have some of both problems, that is stretched ligaments and also torn away from the bone, in which case both of the above could be carried out. Tightening the ligaments in medical terms, is called a capsulorraphy or a capsular shift. For the purposes of this discussion, capsule and ligaments mean the same thing.
For patients with MDI or multi-directional instability, a capsular shift is necessary. For patients with a pure posterior or backward dislocation/subluxation, incision on the back of the shoulder is usually carried out and the ligaments tightened from the back. In most patients with an MDI, however, the prominent instability pattern is an anterior and inferior one and what posterior instability is present can generally be corrected from the front. Most patients will go home the day of surgery and will wear a sling for comfort.