shoulder instability

SHOULDER TOPICS

Shoulder Anatomy

Impingement Syndrome

Rotator Cuff Tears

*These pages are for informational purposes only and are not intended as medical advice.  Please consult a physician for specific diagnosis and treatment options*

Shoulder instability typically results after an initial traumatic shoulder injury such as a shoulder dislocation.  The shoulder joint is a ball and socket joint.  The ball is the top portion of the humerus bone.  The socket portion is the shallow saucer-like plate known as the glenoid.  When the shoulder dislocates, the ball portion comes completely out of the socket.  Shoulder dislocations are painful and the shoulder looks abnormal.  People with shoulder dislocations usually go to the hospital to have the shoulder put back in proper position or "reduced".  After a shoulder dislocation, the ligaments and capsule that help give the joint stability and protection becomes loose or even torn because of the injury.  Having a loose capsule or partially torn capsule can cause the shoulder to "sublux" or have the ball partially in and partially out of the socket.  Subluxation frequently causes a quick instance of pain and may feel the shoulder "slipping" in the joint.  The person is usually hesitant to move their shoulder too much for fear that the shoulder may sublux or even dislocate again.  Shoulder dislocations frequently occur anteriorly or "out the front" of the shoulder but can also occur in other directions as well although less frequently.

DIAGNOSIS

When a person comes to the office with shoulder instability, a history and physical will be done.  As well as understanding your symptoms, your doctor will check your shoulder motion.  The doctor will stress the shoulder to check for the ligament strength to determine if shoulder instability is present.  The physician may also xray your shoulder to check for possible causes for shoulder instability or fractures.  An MRI or arthrogram (special xray in which a dye is injected into your shoulder) may be ordered to further determine any damage to the ligaments or capsule such as overstretching or even tearing the ligaments or capsule.

TREATMENT

After the shoulder has initially dislocated or subluxed it is important to rest the shoulder to prevent reaggravating the shoulder. Taking antiinflammatory medications cam help reduce the pain and swelling. Once the pain and swelling have subsided, general range of motion exercises outlined by your doctor will be started to regain your strength and range of motion. Improving the strength to the rotator cuff muscles can help prevent the shoulder from dislocating or subluxing again. These exercises may be set up with a physiotherapist.

Despite these measures, it is possible that the ligaments and capsule were overstretched beyond the point of preventing dislocations or subluxations from occurring.  At this point, surgery is usually indicated.  If the person suffered a tear in the capsule or ligaments at the time of the initial injury, it is possible that surgery may be required sooner.

Surgery to treat shoulder instability is variable.  It depends on the severity of the injury and the doctor's preference.  Some surgery is done arthroscopically (through small puncture-like incisions).  If the shoulder capsule is loose, a special heating wand may be used.  The heating wand interacts with special fibers in the shoulder (known as collagen fibers) contracting or shrinking up the tissue, thus tightening it up.  It is important to note that this technology is fairly recent (within the past few years) and long term results are not known at this time. 

Occasionally the capsule or ligaments are excessively loose or even torn.  The surgery may be done arthroscopically or through a small incision.  The repair involves suturing the loose or torn tissue and attaching it to the bone (glenoid).  This can be accomplished with suture or with special anchors (either metal or plastic) that attach to bone to hold it in place.  This will tighten up the shoulder joint giving it more stability.

Your postoperative course is dependent on the type of surgery procedure performed and your doctor's particular preference.  Physical therapy will be an important part of your recovery and eventually you will be able to return to your previous activities.  Again, the time frame of your full recovery will be dependent on your particular injury.