This procedure is done for recurrent shoulder instability where the instability is associated with bone loss at the front of the glenoid (socket). It can also be used as a salvage procedure in revision cases. The bony prominence at the front of the shoulder (coracoid) is transferred to the front of the socket.

This 3D CT scan shows the socket of the shoulder where the bone at the front has been damaged by dislocation

The operation works by deepening the socket of the shoulder and the soft tissue attachments of the coracoid process then form a protective sling to prevent dislocation when the arm is imoved into the typical at risk position of abduction external rotation.

The picture shows the deepening affect and the soft tissue attachments

Procedure

This is carried out as an In patient the shoulder is approached from the front in the interval between the deltoid and the pectoralis major muscle. The coracoid process is detached as shown below. Some of the soft tissue attachments are retained (conjoint tendon and CA ligament)

Then the shoulder is entered through a horizontal split in the subscapularis muscle, the front of the socket is prepared for the graft and it is then attached by 2 screws. The soft tissues are then used to reinforce the capsule.

The picture shows the coracoid graft being fixed with screws to the front of the socket.

Postop care

Sling will remain for 4 weeks, with pendular exercises immediately. Active assist exercises start at 4weeks. Confirmation of the bone grafting healing is required before heavy activities occur.

Andrew Brooksbank