open versus arthroscopic brinkart repair surgery for shoulder instability

[infosearcher]

Hi,

This is a question for JainMD, though if anyone has suggestions I'd love to hear them.

I've had recurrent anterior shoulder dislocations and have been recommended to have arthroscopic bankart repair surgery with sutures. My question is, based on the fact that open surgery seems to have a lower rate of post-operative recurrence of instability than arthroscopic surgery, what issues should I consider in deciding to go with open vs arthroscopic surgery (especially considering the fact that the reason I want to have surgery is so I can regain ability to engage in exercise/sports)??  

[Jaycielle]

Thanks, it's definitely not fun. Typically my shoulder would switch off from front  stretching and slipping out and then within two years the other side would go out. On one occasion my other shoulder slipped out from over-compensating.  

But to answer your question, yes it is possible. The past two surgeries I had, my shoulder was barely connected.  Last July, the shoulder was torn from the girdle due to a work injury.  Everything connecting was stretched or torn.  It was repaired arthroscopically. I went to physical therapy for eight months after that surgery but still had a lot of pain.  I had a cortisone shot and finally another arthroscopic to "clean it up" but when my doctor was in there, he found that my shoulder was slipping from the front, side and back.

He was able to reattach 75% of my shoulder, all directions.  Recovery hurt more than a typical surgery, and also took a bit longer to get to the stage I'm at now.  Currently I'm going into my third month of physical therapy with a new therapist.  I've been to about 6 different ones and she is by far the best.  

She told me that because I'm such a rare case she has to mark up my folder and make comments everywhere.  Unlike most patients they treat with this condition, the first step is usually mobility.  I had full range back within a week after surgery at my first post-op appt.  So it's most important to just strengthen without pain or stretching.  I go twice a week, she usually massages the muscles and then its about 20-30 minutes of working out. I do the typical boring exercises and a few new ones.  My weight only went up this week and I'm only doing 1 set of 10-15 reps (which is polar opposite to every other pt I've been to).  But this whatever she is doing is making all the difference. Because I've had so many surgeries, I feel like this is my "last chance" for a while to get things where I used to be.  So far, so good (knock on wood).  Sorry to be so long with my response. Just wanted you to know, that hope is out there and you can have it repaired. Good luck!

[codeman169]

  My heart goes out to you for all the surgeries.I as well am a special case
  i have loose ligaments that cause shoulder instability in both arms. Because
  the shoulders fall out front and back all of the surgeons say surgery is out of the
  question.They say psyical theropy but that pulls them out of place every time i
  go. My question to you is;Did your shoulder fall out both ways and is there
  a type of surgery that can be done ?

[Jaycielle]

I am a rare case and by all means do not follow typical shoulder instablity trends. I am 26 years old and have played sports my entire life. When I was 17 I hurt my shoulder doing a back handspring in gymnastics. This prompted multiple episodes of discomfort and shoulder instability. My first surgery was both open and arthroscopic. I first hurt my anterior side of my shoulder. The open incision was in the crease of my armpit and the rest were 4 arthroscopic incisions. I did find more pain where the incision was but it healed fine.  

However like I said I am not normal with my body. I was born with loose ligaments throughtout my entire body. What was called "double jointed" is really more or less loose ligaments and my everything from my shoulder, elbow, knees and other joints all stretch, pop, move and crack.  Because of this, my opposite shoulder needed surgery two years later for overcompensating for the injured arm.  Two years after that the posterier side of my shoulder was instable and needed surgery. This seemed to be my trend for 6 or 7 years until my work injury.  I had a total of 8 arthroscopic surgeries due to instability direcetly related to my ligaments and 2 of those were due to a work injury.  I highly recommend arthroscopic.  Much smaller scars, and faster healing.  Each time, the wounds closed within 2 weeks. And the scars are so small that had I not had more issues with my right shoulder, it would be very difficult to see the scars.  I have to look hard to find them on my left shoulder.

Other plus sides to arthroscopic is a typically easier time in physical therapy because there is less time wasted on wounds healing. And my favorite are the pictures.  After each of my surgeries, my doctor was able to give me photographs of inside my shoulder.  Although 8 surgeries has not been fun, it has been a very interesting time in my life learning about my body (inside and out), appropriate exercises and what causes my particular instability.  All surgeries minus the past two were relatively fast recoveries and I felt "normal" after about 6 months.  Right now I'm still recovering from my most recent arthroscopic in June.  I was hurt at work in 2010, ligaments and tendons were stretched and torn, prior sutures and anchors were torn and nerves were pulled.  Those are the ony factors that are leading to my slow recovery this time around.  

I hope I don't scare you, arthroscopic is surgery, there is obvious discomfort, but in a typical instabilty case, healing is much faster and it normally takes me 6 months to feel like myself and one full year for the inside of the shoulder to heal.

[sara_eagle]

Well, I worked for an Orthopaedic Surgeon for 5 yrs and not once did he do an open Bankhart repair.  He did them all arthroscopically and everyone did great.  Think of the amount of tissue and muscle that your surgeon will have to go through to get to the affected area!  Personally, I would never have an open if I could have arthroscopic!!  You increase your risk of infection, frozen shoulder and pain!!  Best of luck to you no matter what you decide but arthroscopic is the way to go!!