What Is a Putti-Platt Procedure?

Putti-Platt is one of the surgical treatment options for anterior shoulder instability.

The shoulder joint is one of the largest and most complex joints in the body. It has the greatest range of movement of any joint, but this leaves it unstable and with the highest chance of dislocation of all the body’s joints. The shoulder is a ball-and-socket type of joint that permits a wide range of movement. Its bony structures include the upper arm bone (the humerus) and the shallow cavity (the glenoid) of the shoulder blade. The shoulder joint is formed where the head of the upper arm bone fits into the shallow cavity (glenoid fossa). The joint is surrounded by numerous ligaments and muscles such as the subscapularis, which give it stability.

• Shoulder instability refers to a condition in which an injury that allows the head of the upper arm to dislocate from the shallow cavity. This type of dislocation is also called anterior (near) shoulder instability.
• In anterior shoulder instability, the subscapularis muscle plays an important role.

The subscapularis is a triangular-shaped shoulder muscle located in the shoulder bone. This muscle attaches the shoulder bone to the upper arm bone called the humerus. The function of this muscle is to stabilize and rotate the shoulder joint. It allows the shoulder to allow the arm to turn inward. When the arm is extended, it draws the humerus forward and downward. It also prevents the dislocation of the head of the humerus (upper arm bone). The subscapularis is the most used muscle in the shoulder. It is the primary muscle used in pitching, hitting, swimming, and all types of sports. As a result, injuries to the shoulder muscle are common among athletes.

People with anterior instability of the shoulder joint can sometimes feel the ball of the shoulder come out of its socket or “give way.” Often, the episodes of giving way occur with specific activities or positions of the arm, such as throwing a ball or reaching behind the body.

• Commonly associated with severe pain
• A decreased range of arm/shoulder motion
• Swelling and bruising

Putti-Platt is one of the surgical treatment options for anterior shoulder instability. In this procedure, the flexible cord (tendon) of the subscapularis muscle is cut and then reattached to the head of the upper arm bone (humerus). This procedure makes the head of the upper arm bone tighter to the shoulder blade allowing better stability of the shoulder joint. This type of procedure is rarely indicated.

Putti-Platt is a rare procedure and done only for anterior shoulder instability. Below are conditions in which the Putti-Platt procedure is not recommended:

• Any other shoulder instability (posterior or multidirectional).
• Glenohumeral arthritis (swelling of the shoulder joint).
• Restricted external rotation of the shoulder.

The Putti-Platt procedure is done under general anesthesia. Usually, the procedure is completed within 180 minutes. During this procedure:

• The surgeon monitors the patient vitals throughout the procedure after administering general anesthesia.
• The patient is positioned in a beach-chair position. The room is arranged to allow the arm to be raised (the relaxing position) fully abducted (away from the body) and externally rotated throughout the procedure.
• The skin is incised along the shoulder bone and curved at the tip of the upper arm bone.
• The flexible cord (the tendon) of the subscapularis muscle is detached from the shoulder bone and then reattached to the head of the upper arm bone (humerus).
• After the upper bone is tightened with the flexible cord, the surgical opening is sutured, and the patient is monitored in an intensive care unit

This procedure has promising initial outcomes but disappointing long-term follow-up.

• The main drawback of this procedure is the loss of external rotation of the shoulder to increase the stability of the shoulder.
• This cannot be performed on athletes because it reduces the shoulder range of motion.
• Pain and recovery periods are more in this procedure.
• Sometimes, late osteoarthritis (degeneration of the joints) is observed after this procedure.

• After surgery, the patient’s shoulder may be immobilized for three to six weeks.
• Rehabilitation with exercises is recommended for the next two months after the immobilization period.
• Usually, patients regain full motion and strength of the shoulder joint after one year of the procedure.