What is a Bristow procedure?
Bristow procedure and its variants are performed to treat shoulder instability caused by shoulder blade problems (glenoid defects).
The outer end on the scapula (shoulder blade) is called the glenoid. It meets the head of the humerus (the bone of the upper arm) to form the glenohumeral cavity. This functions as a flexible ball-and-socket joint. The joint is stabilized by a ring of cartilage called the labrum.
Why is a Bristow procedure done?
Indications for open surgical intervention include recurrent anterior shoulder instability after the failure of a course of nonsurgical management. If glenoid bone loss is judged to be greater than 25-30%, restoration of bone loss must be considered as an option to prevent recurrent instability.
When is Bristow procedure avoided?
- Instability associated with weakness of the deltoid muscle, rotator cuff and/or muscles around the scapula
- Multidirectional instability associated with generalized ligament laxity
- Voluntary instability
- Uncontrolled epilepsy (seizures)
How is a Bristow procedure performed?
- The surgery is performed under general anesthesia or intravenous sedation.
- The coracoid process (an anteriorly projecting hook-like process on the outer edge of the scapula/ shoulder blades) is transferred through the subscapularis tendon.
- The subscapularis is the largest muscle in the rotator cuff of the shoulder (the group of muscles that attaches the upper arm to your shoulder). These muscles help to lift and rotate the arm.
After the surgery
- Postoperatively, pain can be managed with pain killers.
- Swelling and bruising usually resolve in about two weeks.
- The patient would be placed in a shoulder immobilizer for approximately one week, after which the patient is transferred to a standard shoulder sling for three to four weeks.
- Full extension of the elbow is not allowed, but flexion is encouraged.
- Guided exercises can begin in three to six weeks.
- After six weeks, complete range of motion of the shoulder can be initiated. Regular follow-up with the surgeon is advised.
What are the complications of a Bristow procedure?
Some complications that may be encountered are:
- Recurrent instability of the shoulder
- Loss of external rotation
- Nonunion of the coracoid transfer
- Screw-related problems
- Injury to the nerves and blood vessels
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