Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint.
Causes of Shoulder Instability
A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder. A partial dislocation is referred to as a subluxation whereas a complete separation is referred to as a dislocation.
Risk Factors of Shoulder Instability
The risk factors that increase the chances of developing shoulder instability include:
- Injury or trauma to the shoulder
- Falling on an outstretched hand
- Repetitive overhead sports such as baseball, swimming, volleyball, or weightlifting
- Loose shoulder ligaments or an enlarged capsule
Symptoms of Shoulder Instability
The common symptoms of shoulder instability include pain with certain movements of the shoulder; popping or grinding sound may be heard or felt, swelling and bruising of the shoulder may be seen immediately following subluxation or dislocation. Visible deformity and loss of function of the shoulder occurs after subluxation or sensation changes such as numbness or even partial paralysis can occur below the dislocation because of pressure on nerves and blood vessels.
Treatment Options for Shoulder Instability
Conservative Treatments for Shoulder Instability
The goal of conservative treatment for shoulder instability is to restore stability, strength, and full range of motion. Conservative treatment measures may include the following:
- Closed reduction: Following a dislocation, your surgeon can often manipulate the shoulder joint, usually under anaesthesia, realigning it into proper position. Surgery may be necessary to restore normal function depending on your situation
- Medications: Over the counter pain medications and NSAID’s can help reduce the pain and swelling. Steroidal injections may also be administered to decrease swelling
- Rest: Rest the injured shoulder and avoid activities that require overhead motion. A sling may be worn for 2 weeks to facilitate healing
- Ice: Ice packs should be applied to the affected area for 20 minutes every hour
Surgery for Shoulder Instability
When the conservative treatment options fail to relieve shoulder instability, your surgeon may recommend shoulder stabilization surgery. Shoulder stabilization surgery is done to improve stability and function to the shoulder joint and prevent recurrent dislocations. It can be performed arthroscopically, depending on your situation, with much smaller incisions. Arthroscopy is a surgical procedure in which an arthroscope, a small flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat of the condition. The benefits of arthroscopy compared to the alternative, open shoulder surgery are smaller incisions, minimal soft tissue trauma, less pain leading to faster recovery.
When the recurrent dislocations have damaged the glenoid or socket a bone graft procedure may need to be performed. This is called a Laterjet procedure. It involves moving part of the corocoid process of the scapula to the front of the glenoid or socket. The graft is attached with screws.
The replaces the lost bone and also provides a soft tissue sling at the front of the shoulder.