Shoulder instability occurs when the structures surrounding the ball-and-socket shoulder joint do not hold the ball (humeral head) securely within its socket (glenoid). A common cause is direct trauma to the shoulder, which can potentially overstretch or tear the shoulder ligaments. As a result, the joint can loosen, allowing the humeral head to move partially or completely out of the glenoid (dislocate).
Without operative treatment, shoulder instability frequently recurs, especially in young patients. Therefore, surgical treatment is often considered, and both open and arthroscopic approaches to shoulder stabilization are routinely used.
Christopher C. Schmidt, MD, is a nationally recognized Pittsburgh shoulder surgeon who specializes in the surgical treatment of shoulder instability. To stabilize the shoulder joint, Dr. Schmidt performs both arthroscopic repairs and open surgery with bone grafting (Latarjet procedures).
Arthroscopy or Open Surgery—Which Is the Optimal Repair Method?
There is no single right answer to this complex question. Dr. Schmidt determines the best treatment approach for shoulder instability on a case-by-case basis after considering multiple factors, such as the amount of bone loss present.
In general, the arthroscopic technique offers several advantages over the open technique. Specifically, arthroscopy reduces the risk of the complications commonly associated with open surgery, such as infection, violation of the subscapularis, and arthrofibrosis, while providing a comparable repair with a faster recovery. Historically, however, some proponents of the open technique have argued that it allows a surgeon to improve anchor orientation and thereby make a more anatomic and secure repair than that which can be achieved arthroscopically.
With that said, research is ongoing and arthroscopic shoulder instability repair techniques are continually evolving in terms of both methodology and results. Recently, significant advances in the understanding of the anatomy of the shoulder joint, as well as arthroscopic techniques and technologies, have helped surgeons more closely replicate the results that can be achieved with an open surgical approach.
No matter which type of procedure—arthroscopic or open—is elected to address shoulder instability, the goals are the same: to enhance shoulder joint stability and range of motion and facilitate a return to full function. If you’re exploring your treatment options for shoulder instability, Dr. Schmidt can help you make a fully informed choice.
Your Premiere Choice for Shoulder & Elbow Surgery